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A visit to UC Irvine: eHealth research and diabetes education in the United States

NathanDavies7 June 2016

In this post Shoba Poduval from the e-Health Unit talks about her exciting visit to California as part of the Ubihealth exchange Programme.

In March, thanks to the UbiHealth Exchange Programme, I visited the Informatics department at University of California in Irvine (UCI) supervised by Gillian Hayes and Yunan Chen. Ubihealth is a global consortium of research institutions with expertise in technology and healthcare, and the exchange programme allows researchers from member institutions to share knowledge and apply it to their own fields of work.

During my visit I met with researchers and clinicians involved in eHealth and patient self-management support. Josh Tannenbaum is an Associate Professor whose research looks at the use of digital games as an educational tool in interactive storytelling and identity transformation, with the purpose of challenging people’s assumptions about others. Professor Tannenbaum suggests that interactive digital games could be developed which allow people to experience life with diabetes, acquire greater empathy, and interact with people with diabetes in a way that is more supportive of positive lifestyle changes.

I met with Terrye Peterson, a nurse and certified diabetes educator at UCI Medical Centre. Terrye delivers diabetes education by visiting patients on the wards to discuss their management and deliver the education. Most people with type 2 diabetes in the US do not receive any structured self-management education, and barriers include limitations to access due to socioeconomic and cultural factors, health insurance shortfalls, or lack of encouragement from healthcare providers to seek diabetes education. In England, referral to diabetes self-management education has become a national Quality and Outcomes Framework (pay for performance) item for GPs, incentivising them to refer patients to a programme. In the US healthcare is funded by government programs like Medicaid, private insurance plans and out-of-pocket payments, and there is no national standardised reward and incentive scheme for referring. Other issues for diabetes management in the US include unaffordable co-payments (top-up payments) for essential treatments and lack of integration between outpatient and hospital care.

I also visited the UCI Centre on Stress & Health which, together with the Children’s Hospital of Orange County, develops interventions to relieve the pain, anxiety and stress of disease and the healthcare environment for children. I met with Drs Michelle Fortier and Zeev Kain to learn more about their work on a web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS). The programme consists of an interactive website which teaches children what to expect from surgery, and skills for coping with anxiety prior to the surgery. There are games which allow children to place equipment on animated animals and deep breathing exercises to encourage calm. The team have published findings from their randomized controlled trial of the program with children age 2 to 7 years old undergoing outpatient elective surgery. They found that children and their families found the programme helpful, easy to use and it led to a reduction in preoperative anxiety.

Finally, I met with PhD student Kate Ringland who is studying an online community for children with autism built around the game Minecraft. Minecraft is a creative game which allows players to dig (mine) and build (craft) with 3D blocks whilst exploring a variety of terrains and landscapes. Kate’s research looks at how online communities can help support social interaction for people who find face-to-face communication challenging, such as children with autism. Her results suggest that people with autism are finding new ways to express themselves and connect with others in order to form communities.

Working at the eHealth unit has taught me about the potential for technology to change the way we interact with patients and deliver healthcare. UK eHealth research addresses some similar themes as that of our US colleagues, including patient education and social interaction, but there are also differences in our health systems which mean that interventions need to be implemented in different ways. We can learn from both our similarities and differences, and international exchange and collaboration is vital for sustaining this learning.

Acknowledgements: With thanks to UbiHealth, Nadia Bertzhouse, Elizabeth Murray, Nikki Newhouse, Aisling O’Kane, Louise Gaynor, UCI Informatics, Gillian Hayes, Yunan Chen, Josh Tannenbaum, Terrye Peterson, Michelle Fortier, Zeev Kain and Kate Ringland.