None listed
Conditions
Brief summary
The TEAMSnet study is a research project which aims to improve diabetes and cardiovascular healthcare in Aboriginal and Torres Strait Islander communities. The project is developing and testing the use of internet and mobile technologies to provide diabetic retinopathy screening and coordinated diabetes and CVD care in three Aboriginal communities in remote and very remote parts of the Northern Territory. The primary hypothesis is that participation in a culturally appropriate retinal imaging programme that includes education, care coordination and management will improve clinical outcomes, adherence to eye care and clinical visits, reduce hospitalizations and patient stress in dealing with self-management and that additional analyses of the retinal images will add value in indicating potential care plans that may impact on decreasing the risk for diabetic retinopathy progression. Thus, in collaboration with Northern Territory Indigenous communities and their health care providers, we propose the overall goal of implementing and evaluating a telemedicine-supported diabetes and CVD assessment and care program to facilitate optimal healthcare delivery for Indigenous Australians. The project plans to implement an established primary care-based teleretinal eye assessment programme that acquires digital images of the retina, assesses visual acuity, and transmits, via secure telecommunication links, the data to a grading centre (at the Centre for Eye Research Australia [CERA]) for assessment of clinical retinopathy. The project will also implement a telecommunications infrastructure that supports health information exchange between participating sites, CERA retinal grading centre and investigators. This includes a web-based telehealth Chronic Disease Management Program (CDMP), a clinical data repository that incorporates eye diagnoses and management recommendations, and a telehealth program for diabetes and CVD prevention and management. The potential benefits include increased rates of timely eye screening for diabetic eye disease, the development an eye screening software technology that integrates within the primary care environment through integration with software based electronic decision support for facilitating optimal diabetes, cardiovascular disease and lifestyle management with the ultimate improvement in clinical outcomes such as blood glucose control (Haemoglobin A1c), lipid levels and blood pressure.
Interventions
Telehealth technology is implemented in a primary care environment to facilitate delivery of eye care and diabetes and cardiovascular health services. Three separate technologies will be used as follows:
1. Use of non-mydriatic retinal fundus cameras to acquire retinal images in the primary care environment. The retinal images are transmitted to a central site (Centre for Eye Research Australia) for retinopathy assessment. The resultant retinopathy reports are transmitted back to the originating
Telehealth technology is implemented in a primary care environment to facilitate delivery of eye care and diabetes and cardiovascular health services. Three separate technologies will be used as follows: 1. Use of non-mydriatic retinal fundus cameras to acquire retinal images in the primary care environment. The retinal images are transmitted to a central site (Centre for Eye Research Australia) for retinopathy assessment. The resultant retinopathy reports are transmitted back to the originating site for subsequent eye care management. Patients are encouraged to view their own retinal images and discuss diabetes and eye care with the on-site retinal imager. 2. We will develop a software application, interfaced to Communicare, the Electronic Health Record (EHR) system, to provide cardiovascular risk assessment, and diabetes and cardiovascular electronic decision support based on current laboratory values, medications and conditions. The medical data required to generate the risk calculation and electronic decision support (EDS) is electronically pulled from the Communicare EHR system. The results of the EDS is a series of recommendations based on the Central Australian Rural Practitioners Association (CARPA) clinical guidelines. 3. We will develop a mobile tablet application, primarily for use by Aboriginal Health Workers to support lifestyle decision support and self-management coaching in diabetes and heart disease. The retinal imaging will be performed annually as required by usual care. The software EDS module will be used by the GP as part of their regularly scheduled clinic visit with the patient. The mobile tablet application is primarily envisioned to be used by the nurse or Aboriginal Health Worker in the clinic waiting room while the patient is waiting to see their doctor. The retinal imaging will be performed by trained retinal imagers under the supervision of the clinic GPs and will be an adjunct to the regular visiting optometry programme. The GP will use the Electronic Decision Support software application. The clinic, nurse, diabetes educator or Aboriginal Health Worker will use the mobile tablet application under the supervision of the GP. The mobile tablet application has the capability of archiving educational material. The educational material is the standard educational material used by the clinic for their patients but converted to electronic files so that they can be delivered using the mobile tablet application. All the clinical decision support and lifestyle support are derived from the Central Australia Rural Practitioners Association (CARPA) Standard Treatment Manual (Version 6) which has a specific focus on the unique requirements of Indigenous health service provision.
Sponsors
University of Sydney, NHMRC Clinical Trials Centre
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Over the age of 18 years Confirmed clinical diagnosis of type 1 or type 2 diabetes mellitus at least 6 months prior to consent Willingness to sit through a retinal imaging session
Exclusion criteria
Under the age of 18 History of laser photocoagulation Current vitreous bleeding or haemorrhage Inability to obtain adequate retinal images (as assessed by the study retinal imager due to media opacity (cataract) or if the patient is unable to have the imaging assessments performed or is unable to engage in the proposed follow up schedule
Outcome results
None listed