Professor Alison Jones. Photo courtesy of Western Sydney Local Health District Corporate Communications.
Three IHMRI researchers have been awarded Translational Research Grants from the NSW Department of Health for projects on deliberate self harm, opioid dependence and type 2 diabetes.
Using SMS text messages to prevent self-harm
Professor Alison Jones, Pro ViceChancellor (Health Strategy) and Executive Dean of the Faculty of ScienceMedicine and Health at the University of Wollongong (UOW) and Clinical Toxicologist at Blacktown Hospital, will lead a project team of clinicians and researchers across three hospitals and three universities.
Deliberate self-harm (DSH) injury is a national health priority, accounting for $4 billion in health care expenditure each year. Repeated DSH is also a major issue for public hospitals, with approximately 15% of those presenting with self-harm making a further presentation within the next 12 months.
There is emerging evidence that DSH re-presentations can be reduced when patients feel connected and cared for in the months following their hospital contact. SMS messaging has also been used successfully in other health intervention settings and found to be beneficial in changing health behaviours.
“Our previous research showed that a series of supportive mail-out lsquo;postcards’ did significantly reduce re-presentations to hospital and associated hospital costs. SMS text messaging is well placed to now replace postcards—providing more immediate communication and a more effective intervention,” explains Professor Jones.
The TRG Scheme funding will be invested in a study conducted across Blacktown/Mount Druitt, Westmead and the Nepean/ Blue Mountains Hospitals during 2016-17.
The study will examine the number and timing of DSH re-presentations among individuals receiving standard hospital followup care, compared to those receiving standard follow-up plus supportive SMS messages every 1-2 months for 12 months following their initial hospital presentation.
“Should an SMS follow-up intervention prove to be effective in reducing DSH re-presentations, it would allow for a significantly more flexible, low-cost and deliverable medical follow-up system,” states Professor Jones.
Reducing dependence on opioids
Clinical Associate Professor Geoffrey Murray from the Illawarra Shoalhaven Local Health District has received funding to study two methods of reducing or ceasing high dose opioid use in patients with non-cancer pain.
Patients with non-cancer pain are increasingly prescribed high dose opioid medications. This has raised concerns about the efficacy of such treatment and the long-term risks to patients.
There is evidence that these medications do not provide effective pain relief in the long-term or improve quality of life, and may cause a decline in physical, social and emotional functioning.
“Many patients want to reduce their dependence on opioids but feel constrained by fear of more pain and experiencing withdrawal symptoms when the dose is reduced. Currently there are few guidelines on reducing or ceasing high dose opioids,” explains Clinical Associate Professor Murray.
Clinical Associate Professor Murray will compare the effectiveness of two methods of achieving abstinence from prescribed opioids, or maintenance at a moderate dose, six months after completion of treatment.
The first method will involve infusions of low doses of ketamine (an anaesthetic drug) under the skin over five days in hospital while the patients’ opioid medications are stopped. The second method will involve slowly tapering high dose opioids in outpatient clinics, and using other medications to help manage pain and withdrawal symptoms.
The project will also examine the relative costs of each approach. Participants in the study will be recruited from patients referred from pain clinics at Port Kembla and Shoalhaven District Hospitals, and Aboriginal Health Centres. The TRG Scheme funding will assist with data collection, entry, analysis and ethics.
Can text message intervention help manage diabetes?
Dr Susan Furber from the Health Promotion Service, Illawarra Shoalhaven Local Health District, has received funding to study the effectiveness of a text message intervention (DTEXT) for improving the health of people with type 2 diabetes living in the Illawarra and Shoalhaven.
In the next 20 years, the number of people in Australia with type 2 diabetes is estimated to increase from 870,000 to over 2.5 million, due to factors such as high rates of overweight, obesity and poor lifestyle behaviours. Research shows that lifestyle modification, such as physical activity and healthy eating and self management can improve glycaemic control and reduce complications in people with type 2 diabetes.
As the Chief Investigator of this collaborative study, Dr Furber will analyse whether people who receive mobile phone text messages for six months with information about physical activity, nutrition, weight, smoking cessation and diabetes management have improved their health.
She will also explore the integration of DTEXT for type 2 diabetes into the NSW Get Healthy Information and Coaching Service.
“There are many potential benefits of DTEXT intervention, including a reduction in lifestyle risk behaviours and the ease of reaching large numbers of people for minimal cost. By reducing type 2 diabetes related complications, there would be a significant reduction in hospitalisations and the associated economic burden on the health care system,” states Dr Furber.