Evaluation of Heart Health Online

Heart Health Online
beyondblue

Evaluation of Heart Health Online is a program to assist GPs to manage depression and related illnesses in patients with coronary heart disease.

This project builds on a previous project involving the development of an internet-based intervention (called Heart Health Online) to assist general practitioners to manage depression, and related illnesses, in people with established coronary heart disease.

The predecessors of this project are:

About the project

Aims and hypotheses

The specific aim of this project is to evaluate the effectiveness of an internet-based intervention (Heart Health Online) delivered by general practitioners (GPs) to manage depression and related illnesses, in people with coronary heart disease (CHD). The effectiveness of Heart Health Online plus usual care, delivered by GPs,  is to be compared to usual GP care alone, for improving psychological, behavioural and physiological risk factors in patients with CHD and co-morbid depression.

The broader aims of the study are to answer the following questions:

  1. What are the effects of GPs using electronic health resources to assist in their management of depression in patients with CHD, on clinical outcomes and cardiac risk?
  2. What impact does the use of these electronic resources, during the GP consultation, have on the doctor-patient relationship?

Background

There is growing demand for consumer health information across all medical disciplines, and an increasing reliance on the internet as a source of this information. It is argued that increasing depression literacy among GPs and among older people (who are also more likely to suffer CHD) will increase  the probability that depressed older people will be treated for depression. Research shows that internet-based psycho-education and self-help therapy can effectively reduce depressive symptoms. However, little has been done to accommodate individual differences and preferences in consumer health information  services.

Our research team have developed an internet-based program (Heart Health Online) for the provision of 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. In the first 6 months of the proposed study we will modify and improve Heart Health Online. We will subsequently make it available to GPs and their patients with established CHD and examine the effectiveness of this program for managing depression, and related  illnesses, in people with established CHD. It is expected the program will improve mental health, psychosocial wellbeing and health behaviours. Although there is less evidence to suggest this program will directly improve cardiovascular health, several physiological endpoints will be measured. Heart Health Online is also expected to assist patients to make informed choices about their subsequent pathways to care. It is expected to increase uptake of cardiac rehabilitation and/or mental health services in this population, which is known for its low use of such services.

Content

Heart Health Online comprises a range of health resources, consistent with the diverse information needs of CHD patients, with and without depression. The majority of resources provide psycho-education and cognitive behavioural strategies for managing depression. Resources for managing related  psychosocial concerns, such as anxiety, poor social support and anger are also included, as are relaxation strategies. In addition to these topics, many patients desired educational information to assist them to manage the physiological effects and symptoms of their heart condition, such as general information  about CHD and exercise education. Patients reported that such information would alleviate their feelings of hopelessness and anxiety. Therefore, resources pertaining to risk factors, diagnosis and symptomatology of CHD, disease progression, treatments and lifestyle management related to CHD are included.  Externally available online resources are included, as well as components from the existing Monash University suite of internet mental health interventions. These include the Pace Heart Lifeskills program that provides psychoeducation and cognitive behavioural strategies to improve depression and social support.

Research Design

This projectinvolves a randomised controlled trial, clustered by general practice (to avoid contamination between participating GPs in a practice) of the effectiveness of Heart Health Online for managing depression in patients with established CHD. A stepped intervention design will be adopted whereby GPs and patients in the control group (usual care alone) will be offered participation in the experimental condition after completing participation as controls  to the follow-up stage.

Research funding

Beyond Blue Victorian Centre of Excellence research grant: $150,000 over two years

Status

To be completed February 2010.

The research team

The research team comprises investigators from the disciplines of psychology, medicine, cardiology and information technology. Each member has a strong record of capacity building within their own discipline and has collaborated with one or more members of the research team.

Chief Investigator:

Dr. Ciaran Pier
Department of Psychology, Deakin University
Phone: +61 3 92446217
Email: ciaran.pier@deakin.edu.au

Dr Pier is a Lecturer in Psychology at Deakin University, Honorary Research Fellow in the Department of General Practice, Monash University and registered probationary psychologist. She is also an associate member of the Australian Psychological Society and member of the Australian Association of Cognitive Behavioural Therapy and the Monash University E-therapy Unit.

Co-Investigators:

Professor Leon Piterman
School of Primary Health Care, Department of General practice, Monash University
Phone: +61 3 9905 4315
Email: leon.piterman@med.monash.edu.au

Professor Piterman is an internationally recognised primary care researcher with expertise in cardiovascular research. Professor Piterman liaises with individual GP practices. He provides advice on recruitment and retention of GPs and patients, the conduct of the research and generation of research outcomes. He also provides intellectual input into the study and, with his extensive experience in general practice service provision and research; provides advice regarding the translation of this research into practice.

Professor Frada Burstein
Centre for Organisational and Social Informatics, Faculty of Information Technology, Monash University
Phone: +61 3 9903 2011
Email: Frada.Burstein@monash.edu

Associate Professor Julie Fisher
Centre for Organisational and Social Informatics, Faculty of Information Technology, Monash University
Phone: +61 3 9903 2621
Email: Julie.Fisher@monash.edu

Professor Andrew Tonkin
Faculty of Medicine, Nursing and Health Sciences, Department of Epidemiology and Preventative Medicine, Monash University
Phone: +61 3 9903 0044
Email: andrew.tonkin@med.monash.edu.au

Dr Britt Klein
School of Primary Health Care, Department of General practice, Monash University
Phone: +61 3 8575 2249
Email: britta.klein@med.monash.edu.au

Professor Andrew Murphy
School of Primary Health Care, Department of General practice, Monash University
Phone: 00353 91 493524
Email: andrew.murphy@nuigalway.ie

Former Partner Investigator:

Professor Jeff Richards (PhD, M. Psychol, BA  (Hons), FAPS)
School of Primary Health Care, Department of General practice, Monash University

Jeff had a background in clinical and health psychology. His areas of research specialty were primary health care, behavioural medicine, anxiety and mood disorders, cardiovascular health, and use of information technology in health and mental health. Jeff had a strong track record in Primary Care research along with numerous publications in leading international and national journals. He received international recognition for his development of an internet based treatment program (PANIC ONLINE) for panic disorder, which was the first of its kind in Australia. The development and pilot evaluation of that program were supported by the Australian Rotary Health Research Fund and engendered considerable national and international interest.

Project progress

  • The portal prototype has been developed
  • Usability tests have been completed
  • The project team is working on conducting clinical trials
  • Expected project completion is February 2010

Publications

PIER, C., SHANDLEY, K., FISHER, J., BURSTEIN, F., PITERMAN, L. & NELSON, M. (2008) Identifying the Health and Mental Health Information Needs of People with Coronary Heart Disease, with and without Depression. Medical Journal of Australia.

Contact us

If you have any questions, comments or feedback about the Evaluation of Heart Health Online project, please contact Frada Burstein.

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