Pilotstudie zum Einsatz eines computeranimierten Patienteninformationsprogramms für Patienten mit Typ-2-Diabetes mellitus (my-diabetes)

Abstract

This pilot study aimed to evaluate the application of a computer animated electronic patient information program (ePI) for people with type-2 diabetes mellitus. The ePI shall improve and perpetuate general and/or specific knowledge, compliance and motivation of type-2 diabetic patients as complementary to established, structured treatment and teaching programs.Patients and methods: A total of 16 patients with type-2 diabetes mellitus (50 % women, age 53.7 ± 17.0 years, diabetes duration 7.1 ± 6.5 years, weight 97.9 ± 17.8 kg, BMI 35.4 ± 4.5 kg/m2, HbA1c 7.8 ± 2.6 %, therapy: 56 % insulin therapy, 31 % oral antidiabetics, 12 % diet only) have been randomly selected at the municipal hospital Munich-Bogenhausen (Stadtisches Klinikum Munchen-Bogenhausen) and included in the study. All patients have participated in the computer animated information program, consisting of several modules covering the subjects of motivation and self-management, glucose metabolism, basics of therapy and pathophysiology of type-2 diabetes and after-diseases. All course contents are animated using audiovisual media and use interactive elements such as games, simulation and quizzes as learning control mechanisms concluding each module. To explore the increase of diabetes-related knowhow, attitude regarding the disease, program acceptance and assessment of the patients, a standardized set of questionnaires with 4 sections and a total of 40 items has been developed. Results: Upon program participation, 25 % of the patients stated to have no experience in computer usage, 13 % a little and 63 % moderate to strong. Internet experience (at least one contact) was reported by 81 % of participants. Quantitative analysis: Diabetes-related knowledge has been increased through the information program from 11.8 ± 2.2 to 17.7 ± 1.9 points (p = 0.002). Within the specific domains of knowledge, the following improvements have been observed (before vs. after): Diabetes Basics (1.4 ± 0.6 vs. 1.8 ± 0.4 points, p = 0.029), Pathophysiology (4.0 ± 1.0 vs. 5.1 ± 1.0 points, p < 0.005), Glucose Metabolism (2.4 ± 0.5 vs. 2.8 ± 0.4 points, p = 0.009), After-Diseases (1.9 ± 1.2 vs. 2.9 ± 0.3 points, p = 0.005) and Therapy (2.3 ± 0.7 vs. 2.7 ± 0.6 points, p = 0.054). Qualitative analysis: Program assessment by the patient (perceived quality, information transfer, ease of use) yielded an average of 1,4 points (“very good”) on a 6 points “Likert-Scale” (mean ± standard deviation [Median, Range]: Total course 1.4 ± 0.5 [1.0, 1.0 – 2.0], program quality 1.6 ± 0.6 [2.0, 1.0 – 3.0], ease of use and simplicity 1.2 ± 0.4 [1.0, 1.0 – 2.0], comprehensibility of information 1.3 ± 0.5 [1.0, 1.0 – 2.0], text 1.4 ± 0.5 [1.0, 1.0 – 2.0], readability 1.4 ± 0.7 [1.0, 1.0 – 3.0], voice 1.4 ± 0.5 [1.0, 1.0 – 2.0], acoustic comprehensibility 1,2 ± 0,4 [1.0, 1.0 – 2.0], seriousness and reliability 1.2 ± 0.4 [1.0, 1.0 – 2.0], quality of medical information 1.5 ± 0,.6 [1.0, 1.0 – 3.0], graphic illustrations 1,4 ± 0,5 [1.0, 1.0 – 2.0] and characters 1.4 ± 0.5 [1.0, 1.0 – 2.0]). The questionnaire to evaluate patients‘ acceptance of ePI yielded the following results: 100 % of the patients have graded the speed of information transfer and the degree of difficulty to be “appropriate”. All patients (100 %) have reported that their future enrollment in similar computer programs of this like was conceivable. 81 % have stated an increased motivation to “take better care of the diabetes”. All patients (100 %) have expressed that they wished their physician/hospital/health insurance company would provide such programs and only 25 % would not be willing to pay for such a service out of their own pocket. Discussion: Patients with type 2 diabetes mellitus highly accept the ePI. In regards of ease of use, comprehensibility and program offering, the evaluation has given very positive results. Program application leads to a significant increase in diabetes-related knowledge, compliance and motivation. Integration of the program in existing care plans appears reasonable and can improve their effectiveness and efficiency. Problem-oriented patient education can be complemented by the application of specific program modules.