title: An evaluation of the telehealth facilitation of diabetes and cardiovascular care in remote Australian Indigenous communities: - protocol for the telehealth eye and associated medical services network [TEAMSnet] project, a pre-post study design.
abstract: Despite substantial investment in detection, early intervention and evidence-based treatments, current management strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time and face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore, we aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk vulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia.
  
  
  
  Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from three primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will be four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and telehealth screening strategy]. 2. A lifestyle survey tool administered at ≈ 6-months. 3. At ≈ 6- and 18-months, an electronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard Treatment Manual of the Central Australian Rural Practitioner's Association to generate clinical recommendations. 4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will include: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and survey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence to clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed.
  
  
  
  Remoteness is a major barrier to provision and uptake of best-practice chronic disease management. Telehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and cardiovascular disease in Indigenous Australians and serve as a model for other conditions.
  
  
  
  Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404 was retrospectively registered on 22/03/2016.
authors.affiliation: Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia. laimab@unimelb.edu.au.|Sansom Institute, University of South Australia, Adelaide, SA, Australia. laimab@unimelb.edu.au.|Department of Nutrition and Dietetics, La Trobe University, Melbourne, VIC, Australia. laimab@unimelb.edu.au.
authors.forename: Laima
authors.identifier: 0000-0002-5740-9662
authors.initials: L
authors.lastname: Brazionis
authors.affiliation: Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.|NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Alicia
authors.initials: A
authors.lastname: Jenkins
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Keech
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Ryan
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Bursell
mesh_terms: D001315:Australia / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000628:therapy*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D009520:New Zealand; D015876:Northern Territory; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D015397:Program Evaluation; D012107:Research Design; D012423:Rural Health; D012648:Self Care / Q000379:methods; D012944:Social Support; D017216:Telemedicine / Q000458:organization & administration / Q000592:standards*; D049269:Videoconferencing / Q000458:organization & administration / Q000592:standards; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Cardiovascular disease; Diabetes education; Electronic decision support; Indigenous; Mobile tablet; Nephropathy; Retinal imaging; Retinopathy; Telehealth; Type 2 diabetes