Dr Ciaran Pier (1)
Prof. Leon Piterman (1)
Assoc/Prof Frada Burstein (1)
Assoc/Prof Julie Fisher (1)
Prof. Andrew Tonkin (1)
Assoc/Prof Britt Klein (2)
Prof. Andrew Murphy (3)
Ms Lucy Jackson (4)
(1) Monash University)
(2) Swinburne University)
(3) National University of Ireland
(4) Deakin University
beyondblue Victorian Centre of Excellence
Project completion year
Heart disease remains one of the leading causes of death in older Australians. Whilst on its own heart disease can result in significant illness and impairment, when combined with depression, patients face an increased risk of death and a poorer overall prognosis (Bunker et al., 2003). Recent estimates suggest that rates of depression in cardiac patients are up to four times higher than in the general community. Cardiac patients with major depression are often not assessed or diagnosed with depression and many of those diagnosed do not receive treatment.
Patients’ self-management of their health, including depressive symptoms, may significantly improve their quality of life. Research suggests education and information about how to manage one’s health (health literacy) can improve wellbeing (Stewart et al., 2004). Although it cannot replace psychological interventions, mental health literacy is important for CHD patients who present with depression and other psychological illnesses. It refers to the patient’s ability to recognise mental disorders, identify their risk factors and causes, as well as the knowledge of how and where to seek support (Dunn, Goldney, Dal Grande & Taylor, 2009; Pier et al., 2008). Increasing mental health literacy amongst GPs and older people (who are more likely to suffer from CHD) may increase the likelihood that depressed older people will be treated for depression (Bird & Parslow, 2002). Psycho-education and self-help strategies can reduce depressive symptoms (Christensen, Griffiths & Jorm, 2004), with some of the more promising results identified within populations of older patients (Howell et al., 2008).
General Practitioners (GPs) are well placed to implement interventions targeting the psychological wellbeing of this group (Peters-Klimm et al., 2010), including improving health literacy. However, the provision of health literacy tailored to each patient’s needs is very time consuming. We therefore developed Heart Health Online, a computerised program for GPs to use with patients with CHD. In a previous study we identified the types of health resources sought by people with CHD (Pier, et al., 2008). Based on this information we developed Heart Health Online; a web-based program designed to provide educational and treatment information resources, for managing depression and related illnesses, in people with CHD. These resources were tailored to consumers’ needs and health risk profiles and subjected to a quality analysis.
Heart Health Online consists of resources relating to heart disease plus psycho-education and strategies for dealing with psychological symptoms (e.g. depression, anxiety and stress) often associated with coronary diseases. There are three different methods by which users can search for relevant information, including personalized search (users respond to a series of categories to generate information tailored to their needs), topic search (user is prompted with a list with a series of topics to search) and simple search (user enters a search term to retrieve all related resources).
The project comprised three small studies related to Heart Health Online:
- Usability Test (Note: this was completed with the additional funding from Monash University Faculty of Information Technology): In November 2008, a series of interviews and surveys were conducted with a group of GPs and people with heart disease, to evaluate the usability of the Heart Health Online portal.
- Pilot Study: A pilot study was conducted between March 2009 and October 2010, with the aim of assessing the value and practicality of the Heart Health Online portal when used in general practice settings with patients with heart disease and depression.
- Information Needs Questionnaire: Between August and November 2010, people with heart disease were surveyed to examine the nature of their health and mental health information needs, to what degree these needs were met following their diagnosis and in cardiac rehabilitation and what effect this has on levels of self-efficacy (or belief in one’s capabilities) and depressive symptoms.
- Patients with CHD found Heart Health Online was easy to use and provided useful information for managing their illness.
- After using Heart Health Online with their GP a small sample demonstrated significant improvement in stress scores and a trend toward improved depression severity.
- The majority of patients and GPs found the use of Heart Health Online had either a positive impact or no impact on the GP-patient relationship and most cited the use of computers as a barrier to using the program.
- A small sample of CHD patients attending cardiac rehabilitation reported their health information needs to be mostly met but indicated an interest in further information regarding stress, diet, medication and exercise.
- Among a small sample of CHD patients attending cardiac rehabilitation higher depression scores were associated with a reduced belief in one’s ability to control and manage chronic disease
Key findings arising from the project and implications
These findings have a number of clear implications for those involved in the primary health care of people with heart disease……..
- The provision of tailored health information by GPs may help improve levels of stress among people with heart disease.
- Computerized programs can be used during GP consultations with little impact on the GP-patient relationship. For some patients the use of a computerized program during consultations may be positive.
- It may be useful to target people with heart disease and co-morbid depression for additional care to improve self-management of their illness.
Dissemination of the study’s findings is intended at academic conferences. As noted, the results will also be published in peer reviewed journals.
The findings will be communicated to the general public and health professionals. This may be done via website and newsletters of various health and mental health organisations.
It is hoped that following the experimental trial, the Heart Health Online website or similar sources of health information (preferably in an alternative format), can be made more widely accessible to other GPs and patients for the provision of health information (note: Heart Health Online requires regular updates and maintenance to maintain its currency).
Future research should examine how health information can be tailored to individual patient needs, and delivered by GPs in an efficient manner, whilst being delivered in a format acceptable to people with heart disease. Further improvements in depression and related conditions may be found with the use of such programs within a larger population. Additionally, the current study suggests that some people with depression and heart disease require assistance in addition to attending cardiac rehabilitation groups, in order to improve confidence in one’s ability to manage health.
Pier, C., Shandley, K.A., Fisher, J.L., Burstein, F., Nelson, M.R. and Piterman, L. (2008). Indentifying the Health and Mental Health Information Needs of People with Coronary Heart Disease, with and without Depression. Medical Journal of Australia, 188: S142-S144.