Waikato DHB has joined forces with telecommunications firm Spark to trial a new way of helping young people with rheumatic fever to receive their vital medication called ‘Top up 4 yr top ups’.
The trial, done in partnership with the University of Waikato, Waikato Medical Research Foundation and Waikato DHB’s SmartHealth online healthcare service, aims to encourage young people to continue with their treatment by providing mobile phones and ongoing monthly top ups each time they return for their often painful monthly penicillin injections.
Waikato DHB district nurse associate charge nurse manager Maree Child, explained: “Ongoing treatment is essential for those with rheumatic fever to stop them developing rheumatic heart disease. Young people need the antibiotic injections to keep strep throat away and stop their heart valves becoming more damaged.
“The injections are administered by Waikato district nurses who do a great job. Young people usually need the injections every month for about 10 years and sometimes feel that when they start getting better they no longer need their medication, but it’s really important that they finish their course of antibiotics.”
Kiwi-owned prepay network, Activata supplied the monthly top ups for the trial. Spark worked with Samsung to provide 100 Samsung Galaxy smartphones. Altogether the suppliers have provided $62,700 to support the young people involved for 12months.
The study has also received grants from the Waikato Medical Research Foundation and the University of Waikato’s Strategic Investment Fund.
The project was developed by a group of medical students as part of the University of Auckland’s Population Health Intensive week. One of the students, now a doctor, Dr Miina Karalus has stayed on to help guide the project saying the study would look at whether using incentives in this way has any impact on helping young people stick with the treatment programme.
“Within the Waikato, there are 85 patients currently eligible for secondary prevention with the monthly injections. But almost one quarter of the 14-21 year olds on the Waikato rheumatic fever registry have fallen off the treatment plan,” Dr Karalus said.
“This is a problem because, in New Zealand, about two thirds of those with rheumatic fever who do not have monthly penicillin injections will go on to develop permanent heart valve damage requiring costly surgery.
“By incentivising, it’s not about just giving youth free technology, it’s about connecting with them in their world in a way that makes sense to them so they don’t fall off the programme. Incentives have been shown to be very effective – especially for youth.”
A Waikato DHB surgeon said that heart valve surgery is around $50,000. But after surgery there’s costs of medications, monitoring, and the cost to the patient and family.
The research trial is available to all rheumatic fever patients aged 14-21 in the Waikato.
A youth steering committee of 11 participants is meeting regularly to share their stories and help co-design how district nurses will engage with youth online, and how SmartHealth can be used as a support tool for Rheumatic Fever patients and their families. SmartHealth will also provide timely reminders for youth to have their monthly injections via their phones.
Maree Child added: “We invest so many hours into locating those that have fallen off the treatment plan, including many home visits. Being able to connect by phone will definitely help us reach this group and hopefully patients will be finding us for their monthly injection and cell phone top up, rather than us chasing to find them.”
The project is already achieving some fantastic results says Waikato DHB project coordinator and clinical nurse specialist, Michelle Morley.
“We have 78 young people on the project. Of those, 20 had not been receiving their injections regularly or on time, and are now engaging with the programme. Additionally a further five – who the district nurses had not been able to find – have been contacted and referred back into the treatment programme.
“Of that group, four are now getting their injections, and are on the research project, and the fifth person has been reviewed and is booked for their final check-up and discharge from cardiology clinic. These outcomes are fantastic and would not have occurred had this project not been in place,” Michelle says.
Spark’s Mobility Advisor Clayton Knox says: “We have a strong working relationship with the DHB’s SmartHealth team so it made sense for Spark to help with the project. It demonstrates how using digital technology can achieve better engagement with patients and further enhance traditional methods of communicating. This has to be a great outcome for the community and our young people.”
If this study is successful, it could be continued in the Waikato, used across other healthcare disciplines, and shared with other DHBs.
SmartHealth offers a free online platform and mobile app that allows people to access a range of health services via smart phone, tablet device or computer including:
- Free after hours online access to doctors by video, voice or text chat (6pm – 11pm Monday to Friday, and 8am – 8pm on weekends and public holidays)
- The ability to ask a healthcare professional a question 24/7
- Online appointments with hospital specialists without leaving your home, if appropriate for your condition
- Helpful checklists and reminders
- Good quality, doctor-approved health information on topics, conditions, treatments and research.
The project will connect with young people through their district nurse and the treatment programme, and it will also look to engage them in online communication tools, including SmartHealth, to provide a supportive network of carers including their GP, outpatient specialists and district nurses.