The role of nurse-led telephone triage in supporting people with multimorbidity to engage in digital self-management

This study investigates the role of telephone triage nurses (TTNs) in engaging people with multimorbidity (PwMs) in sustained use of digital technologies to self-manage health and wellbeing.

The increase in global life expectancy over the past 50 years, while undoubtedly one of the greatest achievements of the modern age does not mean however that people are necessarily living well for longer, as evidenced by the fact that global healthy life expectancy in 2016 was estimated to be just 63.3 years. Chronic health conditions such as cancer, cardiovascular disease, chronic obstructive pulmonary disease, dementia and diabetes are increasing in prevalence as a result of an ageing population. Multimorbidity – the presence of two or more chronic conditions – places a considerable burden not just on health services, but also on the PwM, physically, mentally, socially and financially. PwMs are at risk of functional decline and disability, in addition to having to take multiple medications (polypharmacy) and requiring frequent health care utilisation which leads to poor quality of life. Health care may be disjointed as PwMs are required to make multiple, often badly co-ordinated visits to several health care providers.

Self-management of conditions necessitates the PwM to set daily priorities and make frequent decisions. PwMs are required to learn effective techniques to manage their illness, and how to cope over time, through trial and error. Keeping PwMs engaged in the self-management process is essential in achieving better health outcomes and quality of life for them. One answer to the above issues may lie in providing PwMs with digital health care interventions such as apps, monitoring devices for blood pressure or blood glucose levels, weighing scales etc., in tandem with a nurse-led telephone triage system to provide a monitoring service of PwMs’ health readings.

The first exploratory phase of this qualitative study comprised a focus group interview with three TTNs and 10 one-to-one semi-structured telephone interviews with PwMs. These interviews examined PwMs’ self-management of their conditions using technology, and the role that TTNs play in supporting them in this process. An initial analysis of the data revealed that the relationship between the TTNS and the PwMs was key to imbuing PwMs with the confidence and motivation to use DHIs. Both the TTNs and the PwMs mentioned trust as an intrinsic characteristic of the relationship between them, and it was this two-way relationship which was fundamental to PwMs successful self-management. The feelings of being supported and encouraged, and ‘having someone looking out for them’ was important to the PwMs, with one PwM remarking about it: ‘that is the diamond’. It also became evident that without the support of the TTNS, the PwMs were unlikely to remain effectively engaged with their self-management.

Resulting from the findings of phase one, the second qualitative phase of the study will build on investigating how PwMs engage with DHI, in addition to identifying how the TTNS can support that engagement.

Supervisors

Primary

Dr. Julie Doyle, Director, NetwellCASALA, DkIT

Secondary

Dr John Dinsmore, Health Innovation Lead/Deputy Director of the Trinity Centre for Practice and Healthcare Innovation (TCPHI), TCD

Expected completion date of study

September 2022

Publications to date

Journal Articles

Sheridan, P., Carragher, L., Carragher, N. and Treacy, J. (2019). Development and validation of instrument to measure stress among older adult nursing students: the Student Nurse Stressor-15 Scale (SNS-15). Journal of Clinical Nursing, 28(7-8), pp. 1336-1345. DOI: 10.1111/jocn.14723

Doyle, J., Murphy, E., Gavin, S., Pascale, A., Deparis S., Tommasi, P., Smith, S., Hannigan, C., Sillevis Smitt, M., van Leeuwen, C., Lastra, J., Galvin, M., McAleer, P., Tompkins, L., Jacobs, A., Marques, M.M., Medina, J., Boyle, G. and Dinsmore, J. (2020). ProACT - A digital platform to support self-management of multiple chronic conditions: findings in relation to engagement during a one-year proof-of-concept trial. Journal of Medical Internet Research. DOI: 10.2196/22672.

Dinsmore, J., Hannigan, C., Smith, S., Murphy, E., Kuiper, J., O’Byrne, E., Galvin, M., Jacobs, A., Sillevis Smitt, M., van Leeuwen, C., McAleer, P., Tompkins, L., Brady, A-M., McCarron, M. and Doyle, J. (2020). Digital health platform for integrated and ProACTive patient centred care (ProACT): protocol for an action-research proof of concept trial. JMIR Research Protocols. DOI: 10.2196/22125.

Conference Presentations

Sheridan, P., Carragher, L., Carragher, N. and Treacy, J. (2020). Development and validation of an instrument to measure stress among older adult nursing students: the student nurse stressor 15 (SNS-15) scale. Oral presentation at TheConf 2020, TCD, Dublin, March 2020.

Smith, S., Doyle, J., Sheridan, P., Tompkins, L., Sheerin, J., Galvin, M., Murphy, E., Sillevis Smitt, M., van Leeuwen, C., Jacobs, A. and Dinsmore, J. (2020). Digital technology adoption by healthcare professionals: learnings from a 12-month trial in two countries. Oral presentation at TheConf 2020, TCD, Dublin, March 2020.

Tompkins, L., Doyle, J., Murphy, E., Galvin, M., Sheerin, J., Jacobs, A., Sillevis Smitt, M., van Leeuwen, C., Smith, S., Sheridan, P. and Dinsmore, J. (2020). Informal carers’ experience of using a digital application to support older adults with multimorbidity. Oral presentation at TheConf 2020, TCD, Dublin, March 2020.

Sheridan, P., Doyle, J., Smith, S., van Leeuwen, Sillevis Smitt, M., Jacobs, A. and Dinsmore, J. (2020). The role of telephone triage nurses in supporting older adults with multimorbidities in Ireland and Belgium to self-manage using digital technology. Poster presentation at DigiFest 2020, Scotland, UK, December 2020.

Smith, S., Dinsmore, J., Sheridan, P., Jacobs, A. and Doyle, J. (2020). Adoption of digital technology by healthcare professionals: trial learnings from two countries. Poster presentation at DigiFest 2020, Scotland, UK, December 2020.

Sheridan, P., Doyle, J., Smith, S., Tompkins, Sheerin, J., Galvin, M., Murphy, E. Sillevis Smitt, M., van Leeuwen, C., Jacobs, A. and Dinsmore, J. (2020).The role of telephone triage nurses in supporting older adults with Multimorbidities to self-manage using digital technology. Poster presentation at TheConf 2020, TCD, Dublin, March 2020.