An International Comparison of Prevalence and Clinical Efficacy of Using Telehealth to Support Diabetic Self-Management by Patients with Both Cardiac Disease and Diabetes

Purpose: To evaluate a cardiac-diabetes self-management program with telephone and text-message follow-up (T-CDSMP) in patients admitted with cardiac disease and comorbid diabetes across Australia and Taiwan.  

Background:  As cardiac disease and type 2 diabetes are global health problems of increasing incidence it is expected that management of patients with both of these chronic conditions will have a significant impact on global healthcare systems.  There is evidence of comparable prevalence of cardiovascular disease combined with diabetes between Australia and Taiwan with these at-risk patients having higher readmission rates compared to those cardiac patients without diabetes.  Many studies have aimed at improving patient self management of their conditions, but have not been tested across different cultural backgrounds. Our previous studies within one population have shown effectiveness in using telephone and text-messaging to assist patients with better self-management of their dual conditions to improve outcomes of self-management behaviour, self-efficacy, condition knowledge and health-related quality of life. However, this strategy has not been tested and compared across different cultures.

Methods: An international collaborative project using a randomised block design was used to address the heterogeneity of patients from two different cultural contexts. For 90% power to detect the main effects of intervention, and with location (country) being the block variable, 90 patients (a total sample of 180 patients) were required from each country. 

Results: Preliminary results showed patients with dual diagnoses of cardiac disease and type 2 diabetes in Taiwan have approximately a 21% readmission rate, compared to 22.6% in Australia (within 28 days). Initial analysis also suggests patients in the intervention group have significantly improved self-efficacy level.

Conclusion: Whilst we demonstrated similar readmission rates in patients with dual diagnoses of cardiac disease and diabetes in two high-income countries, further studies will determine whether T-CDSMP can be culturally adapted to allow similar treatment effects.