Journl of Dibetes Science nd Technology Volume 4, Issue 4, July 2010 Dibetes Technology Society TECHNOLOGY REPORTS Computer-Aided Lerning in Insulin Pump Trining Sergey V., M.Sc., 1 nd Chrles J. George, M.S. 2 Abstrct This technicl report concerns novel, computer-ided lerning tool for ptients with dibetes. The gol of the tool is to mke trining in the use of n insulin pump pinless, prcticl, effective, nd eductionlly rewrding. This lerning tool (or ppliction) is unique becuse it uses virtul pump to fcilitte lerning nd llow the ptient to prctice pump opertion, presents trining tsks in stndrdized formt, nd provides corrective feedbck to help ptients better understnd nd mnge their dibetes. The ppliction s cceptbility ws surveyed by 126 helth cre professionls who re experienced in dibetes eduction nd certified in pump trining. Results suggest tht use of Insulet s OmniPod Interctive Trining is ssocited with incresed trining efficiency nd promotes positive ttitude towrd insulin pump therpy. J Dibetes Sci Technol 2010;4(4):1022-1026 Introduction Advnces in insulin infusion technology hve provided new therpeutic options for ptients with type 1 dibetes. Along with dvnces in insulin pumps come new chllenges in educting ptients bout the use of these devices for mximum benefit nd sfety. Insulin pump trining involves lerning bout specific brnd fetures to mster pump opertion nd cquiring dvnced dibetes self-mngement skills to successfully mnge dibetes with pump therpy. 1,2 Beginning insulin pump therpy requires significnt time commitment from the ptient nd medicl prctitioner for eduction nd trining ctivities. Historiclly, this process my tke from two to six months in some complicted cses. 2 Intensive trining requirements contribute to the cost of therpy nd often become brrier to the efficient introduction of new technology in dibetes cre. Trditionlly, pump mnufcturers hve been the primry sources of informtion bout their devices vi mrketing brochures nd user mnuls nd hve provided generl dibetes mngement informtion s well. However, none of these sources is bsed on principles derived from eductionl curriculum development nd lerning theories, nor do they present opportunities for interctive prctice. In this technicl report, we describe novel, interctive, computer-ided ppliction clled Insulet s OmniPod Interctive Trining (trining CD), nd we present survey study of its unique fetures nd benefits. In ddition to its unique pump simultion component, the ppliction orgnizes bsic nd dvnced self-mngement concepts, stndrdizes the delivery of trining tsks, nd provides users with corrective feedbck s they lern pump opertion. Author Affilitions: 1 dbz inc., Pittsburgh, Pennsylvni; nd 2 University of Pittsburgh Medicl Center, Pittsburgh, Pennsylvni Abbrevitions: (CAL) computer-ided lerning, (PDM) Personl Dibetes Mnger, (trining CD) OmniPod Interctive Trining ppliction Keywords: computer-ided lerning, insulin pump trining Corresponding Author: Sergey, dbz inc., 5001 Bum Boulevrd, Suite 625, Pittsburgh, PA 15213; emil ddress ssirotinin@dbz.com 1022
Methods To develop the trining CD, we relied on principles of interctive computer-ided lerning (CAL). Computer-ided lerning is estblished s cost-effective djunct to conventionl eduction; specificlly, CAL cn contribute to the efficiency of trining, reduce trining time nd ssocited costs, nd eliminte eductionl brriers. 3 5 Product Design A computer-bsed interctive trining environment ws designed to guide ptients through the key res of dibetes mngement nd the use of the OmniPod Insulin Mngement System (OmniPod System, Insulet Corportion, Bedford, MA; Figure 1). Building on Ggne s theory, the trining frmework included three essentil ingredients of teching: 6,7 1. Knowledge presenttion nd skill demonstrtion 2. Prctice opportunity with feedbck 3. User guidnce Specificlly, users were guided in their interction with the virtul OmniPod System, OmniPod System fetures were demonstrted vi simultion of insulin mngement tsks, nd corrective feedbck ws provided (if needed) t ech step in skill lerning. In ddition, the trining Figure 1. The user interfce of the OmniPod trining CD. 1023
mteril ws ppropritely structured for new nd dvnced pump users in stndrdized lerning trcks. In summry, the trining CD fetures the following unique elements: dvnced self-mngement concepts (such s bsl rtes nd progrms, bolus doses nd presets, nd insulin correction nd djustment) re presented in brief reviews longside the OmniPod fetures; multimedi tutorils provide step-by-step illustrtions on how to use the OmniPod System fetures; split-screen presenttions reinforce step-by-step instructions with guidnce on the virtul Personl Dibetes Mnger (PDM) screen; Try It Now interctive tutorils llow ptients to prctice dibetes mngement scenrios; Living Well with Dibetes section presents bsic informtion bout nutrition nd exercise, voiding low nd high blood glucose levels, nd hndling specil occsions such s illness or trvel, nd sfe environment for ptients to prctice their OmniPod skills in stndrdized formt. Survey Study Mesures After reviewing results from pilot online survey, we designed 59-item questionnire tht covered prticipnts experience in dibetes eduction nd pump trining; their fmilirity with the trining CD, Web-bsed trining, or both; stisfction with content; efficcy of the eductionl mteril; nd impct of the trining CD on the trining process. Prticipnts Instructions for the online survey were sent vi emil to 1381 helth cre professionls involved with ptients pump eduction nd registered with Insulet Corportion. Ten dys were given to respond to the survey, with no incentives nd no follow-up. From the pool of potentil prticipnts, 126 completed the survey. In ddition, 36 prticipnts who responded to fewer thn five survey questions were eliminted from the finl nlysis. Sttisticl Methods Simple frequency nlysis ws used to exmine respondents experience nd expertise in trining with vrious brnds of pumps. Group t-tests were used to compre continuous vribles. Results Chrcteristics of the 126 respondents re shown in Tble 1. Ninety-six percent re involved with trining ptients to use their pumps. In ddition, 94% re certified on the OmniPod brnd, 84% on the Medtronic MiniMed, 72% on Anims, 39% on Accu-Chek, nd 6% on Nipro. Over the three-month period, the respondents trined 1244 ptients. Both those who lredy use the trining CD nd non-users lened towrd greement (on scle of 2 = strongly disgree to +2 = strongly gree; men rtings = 0.7, stndrd devition = 1.1) tht the OmniPod System fetures led to incresed recommendtion or utiliztion of pump therpy (Tble 2). Notbly, those lredy using the trining CD more strongly greed tht ese of trining, ese of use, nd ese of lerning increse pump therpy utiliztion. Trining CD users elevted greement bout the impct of the OmniPod System design, probbility of ptient complince, nd simplifiction of insulin pump therpy did not sttisticlly differ from tht of the trining CD non-users. The trining CD users were stisfied with overll content, qulity, orgniztion, nd ese of use. Regrding ness of specific ppliction fetures, the mjority of respondents rted ech feture s or very. Overll, 80% of pump triners reported their pprovl of the teching methods used in the trining CD (Tble 3). Regrding efficiency of trining, 81% of the triners confirmed tht their pump trining is more efficient when ptient views the trining CD before beginning trining with them (dt not tbulted). Moreover, the pump triners were unnimous in recognizing the vlue nd ppropriteness of the trining CD for ptients new to insulin pump therpy. They ll greed tht the trining CD helped ptients new to insulin pump therpy gin positive ttitude towrd it. Limittions This study included response rte lower thn typicl emil-requested prticiption. 8 Respondents in this study were the pump triners, not the ptients. Although dt 1024
provided by triners reflect their experience with other devices nd trining progrms something tht is not vilble from ptient surveys future studies will need to focus on ptient perspective nd outcomes. Finlly, it is not cler how mny medicl devices would benefit from this eductionl pproch. However, the device in question ws prticulrly well suited to computer-bsed trining. Tble 1. Chrcteristics of OmniPod Triners All Triners (n = 126) Trining CD Non-users (n = 79) Users (n = 47) Amount of job involved in trining n % n % n % Rrely involved 5 4.0 4 5.1 1 2.1 Sometimes involved 24 19.0 16 20.3 8 17.0 Regulrly involved 43 34.1 32 40.5 11 23.4 One of primry responsibilities 50 39.7 26 32.9 24 51.1 Led responsibility 4 3.2 1 1.3 3 6.4 Other device certifictions (ctegories my overlp) n % n % n % Accu-Chek 49 38.9 28 35.4 21 44.7 Anims 91 72.2 57 72.2 34 72.3 Medtronic MiniMed 106 84.1 67 84.8 39 83.0 Nipro 7 5.6 3 3.8 4 8.5 OmniPod 119 94.4 72 91.1 47 100 Time needed to trin on the OmniPod System n % n % n % 1 h 11 8.7 6 7.6 5 10.6 1.5 h 29 23.0 14 17.7 15 31.9 2 h 33 26.2 24 30.4 9 19.1 2.5 h 18 14.3 8 10.1 10 21.3 3+ h 15 11.9 11 13.9 4 8.5 Stisfction with the current OmniPod trining process n % n % n % Very disstisfied 4 3.2 4 5.1 0 0.0 Disstisfied 2 1.6 1 1.3 1 2.1 Stisfied 64 50.8 40 50.6 24 51.1 Very stisfied 51 40.5 30 38.0 21 44.7 Yers of experience in dibetes eduction Hours/week providing pump or pod trining Number of ptients trined in pst three months 12.7 ± 8.0 13.1 ± 7.9 12.0 ± 8.1 4.4 ± 5.3 4.1 ± 4.6 5.1 ± 6.5 Accu-Chek 0.6 ± 3.1 0.4 ± 2.0 1.0 ± 4.5 Anims 2.1 ± 3.0 1.9 ± 2.8 2.3 ± 3.4 Medtronic MiniMed 6.0 ± 8.8 5.2 ± 8.7 7.5 ± 8.9 Nipro 0.0 ± 0.0 0.0 ± 0.0 0.0 ± 0.0 OmniPod 2.5 ± 5.0 2.3 ± 4.3 2.7 ± 6.0 p <.05 compring triners who use the trining CD versus those who do not. 1025
Tble 2. Extent of Agreement with Sttements Regrding the OmniPod System Item Ese of trining motivtes to recommend pump therpy to more ptients Ese of use motivtes to recommend pump therpy to more ptients Ese of lerning enbles more ptients to use pump therpy Wireless, tube-free design motivtes more ptients to use pump therpy Ptients re more likely to be more complint with their pump therpy The OmniPod simplifies insulin pump therpy Men (± stndrd devition) Trining CD Non-users (n = 79) Users (n = 47) 0.5 ± 1.1 1.0 ± 1.1 b 0.7 ± 1.0 1.2 ± 0.8 c 0.7 ± 0.8 1.1 ± 0.9 b 1.2 ± 0.7 1.3 ± 0.7 0.3 ± 0.8 0.7 ± 1.0 1.0 ± 0.7 1.2 ± 0.8 Rtings were on five-point scle centered on zero ( 2 = strongly disgree,, +2 = strongly gree). b p < 0.05 c p < 0.01 Tble 3. User Rtings of the Trining CD Fetures (n = 47) Trining CD fetures Overview of dvnced self-mngement concepts Step-by-step illustrtion of how to use the OmniPod System functions Guided interctions on the virtul PDM screen Virtul prctice of dibetes mngement scenrios Informtion bout bsic dibetes mngement res Sfe environment to prctice the OmniPod skills Very Helpful Rting Somewht Not 62% 26% 0% 0% 62% 23% 0% 0% 55% 28% 2% 0% 62% 19% 0% 4% 43% 40% 4% 0% 62% 19% 2% 0% Due to missing responses, percentges do not dd up to 100%. Conclusion OmniPod triners who use the trining CD ssocite it with positive ttitude towrd insulin pump therpy mong ptients s well s n increse in the efficiency of trining. The trining CD users did not report spending less time in ptient trining, but they did more strongly gree tht ese of use, trining, nd lerning contribute to incresed cceptnce of the therpy. Helth cre professionls who use the trining CD with their ptients re very stisfied with the overll trining process. Such interctive trining tools fcilitte the efficient nd cost-effective introduction of new technology for ptients with dibetes. Funding: This study ws supported by dbz inc. Acknowledgments: The uthors thnk Dr. Mri Kovcs for vluble suggestions. Disclosures: Sergey V. is full-time employee of dbz inc. nd holds shres of Insulet Corportion. Chrles J. George is full-time employee of the University of Pittsburgh Medicl Center. References: 1. Skyler JS, Ponder S, Kruger DF, Mtheson D, Prkin CG. Is there plce for insulin pump therpy in your prctice? Clin Dib. 2007;25(2):50 6. 2. Boyd LC, Boyd ST. Insulin pump therpy trining nd mngement: n opportunity for community phrmcists. J Mng Cre Phrm. 2008;14(8):790 4. 3. Lo R, Lo B, Wells E, Chrd M, Hthwy J. The development nd evlution of computer-ided dibetes eduction progrm. Aust J Adv Nurs. 1996;13(4):19 27. 4. Berridge E, Roudsri A, Tylor S, Crey S. Computer-ided lerning for the eduction of ptients nd fmily prctice professionls in the personl cre of dibetes. Comput Methods Progrms Biomed. 2000;62(3):191 204. 5. Dy JL, Rymn G, Hll L, Dvies P. Lerning dibetes: multimedi lerning pckge for ptients, crers nd professionls to improve chronic disese mngement. Med Inform (Lond). 1997;22(1):91 104. 6. Ggne RM, Driscoll MP. Essentils of lerning for instruction. 2nd ed. Englewood Cliffs: Prentice-Hll; 1988. 7. Ggne RM, Briggs LJ, Wger WW. Principles of instructionl design. 4th ed. Fort Worth: HBJ College Publishers; 1992. 8. Finchm JE. Response rtes nd responsiveness for surveys, stndrds, nd the Journl. Am J Phrm Educ. 2008;72(2):43. 1026