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A first-of-its-kind research study by Lawson Health Research Institute is moving into the community and evaluating the use of smart technologies in the home for people with severe mental illness.  

After prototyping this approach within a hospital setting through St. Joseph’s Health Care London, the research team will be outfitting eight affordable housing units at Canadian Mental Health Association Middlesex and London and Middlesex Community Housing with smart home technology. 

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In-hospital prototype for using smart technologies in the home 

The Smart Home Community Model 

“This solution is for people who are having difficulty managing their everyday life and need a high level of care to maintain community living,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson and project lead for the Smart Home Community Model. “Technology and applications are being embedded in the lived environment and then tested to ensure they are safe, secure and appropriate for use in health care.”

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Dr. Cheryl Forchuk announcing this phase of the project, from within one of the apartment buildings. 

Study participants will select from a wide range of tools that will best meet their individual needs. Devices such as smartphones and touch-screen monitors connect with applications to provide video-conferencing, questionnaires, and prompts and reminders based on the person’s care plan. 

As an example, participants have regular access to mood scales with questions about how they are feeling. These are used extensively in mental health care settings to help address issues and start conversations with clients. The care team receives notification of the answers, giving regular insight into how the person is doing and if they need additional follow-up. 

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Depending on their needs, participants have access to automated medication dispensers and smart health monitoring devices, such as weigh scales, blood pressure monitors, glucometers, and tracking monitors for heart rate, activity and sleep. 

This patient population often faces health challenges on multiple fronts, with higher rates of diabetes and cardiac issues. They can struggle keeping balance when it comes to activity, weight and sleep. Fluctuations in any of these can be early indicators that a crisis is looming. 

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“By integrating and testing these smart tools for health care, we are not simply looking at the technology but how it can be used as a tool for communication,” says Dr. Forchuk. “We see smart technology supporting more seamless communication between health care providers and the client – all from their own homes. This helps them better manage their care and overall wellbeing, flag issues earlier on and avoid trips to the clinic when appropriate.”

Paula's Perspective 

Paula Rawlinson is chair of the family council and sits on the patient council for St. Joseph’s Parkwood Institute Mental Health Care. She personally has lived experience with mental health and as also acted as a caregiver for a family member. 

“Both myself and my family member could have benefitted from these tools, very much so,” says Paula. “When I was really suffering, I isolated myself from people a lot. Even when I lived in a group home because I needed a higher level of care. Having some sort of helpful device right there, encouraging me to keep up with things and connecting me to someone I trusted, would have made a huge difference. Especially after the first discharge.”

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She adds that for someone who is really struggling, this could be a life-saving strategy that makes a vital difference. 

For her family member, Paula sees many uses for these tools and knows that they would actually use them. “I’ve been able to see the tools and they are even simpler than using email. It makes them accessible to a lot of people in the community who would make good use of them to improve their situation.” 

Results and Impact

Some of the tools as part of this project have previously been tested formally as part of a research study and shown positive results. 

The health team has access to the data to more easily stay in touch with the person. They can work together to track trends and pinpoint triggers, creating more personalized and effective strategies. With less focus on the daily aspects of care, providers reported that in-person meetings offered more meaningful and important discussions. 

“All of the data is also viewable by the client who continues to work with a health care provider,” explains Dr. Forchuk. Clients can reach out sooner and get support more quickly. Potential issues and crisis are addressed earlier on, and in previous studies they reduced psychiatric readmissions, emergency room visits and arrests. Clients reported more satisfaction with their care and feeling better overall. 

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“When we have more people successfully achieving community living and managing their care with fewer outpatient visits and other service utilization, we can open up capacity in the system and deliver quality care at a lower cost.” 

The team anticipates that participants will experience greater levels of independence and autonomy in maintaining housing and self-care for mental health and chronic illnesses. 

Paul points out that one of the key outcomes is to avoid re-admission. “One of the main, recurring struggles is loneliness. With tools to keep people in more regular contact with their care team and assistance with their everyday life, they can shift more to having a fun life. You can build up those crucial relationships with family and friends – and those people feel less burnout as caregivers. It adds a lot of support and resiliency.” 

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Dr. Forchuk adds that “our approach is to care for the whole person – mind, body and soul. It goes beyond managing the mental illness and is about supporting people in managing their life.” 

The team already has four people enrolled in the study. In addition to people living alone, they will have participants with roommates and families to test the strategy under various real-life situations. The initial study will take place over one year. 
 

This phase of project has received generous funding from the Canada Mortgage and Housing Corporation. The Canadian Institutes for Health Research contributed to the initial pilot phase.

One in three Canadians is living with diabetes or prediabetes. When they experience complications like severe hyperglycemia (high blood sugar), they require emergency care. For many, one emergency department (ED) visit leads to multiple others. 

“There’s an increasing prevalence of diabetes in our population. It’s imperative that we support patients in managing the disease to prevent adverse outcomes and optimize health,” says Dr. Justin Yan, Associate Scientist at Lawson Health Research Institute and Emergency Department Physician at London Health Sciences Centre (LHSC). “In our research, we wanted to see whether specialized diabetes care was associated with a reduction in recurrent ED visits and hospitalizations.”

Dr. Yan and his colleagues studied de-identified data from patients who presented with hyperglycemia to the EDs at LHSC’s Victoria and University Hospitals over a one-year period. They compared those patients who had been followed by specialized diabetes care at St. Joseph’s Health Care London (250 patients) to those who had not (206 patients).

At St. Joseph’s Centre for Diabetes, Endocrinology and Metabolism, patients with diabetes are supported by a dedicated team of endocrinologists, family physician diabetologists, certified diabetes educators (registered nurses and dietitians), nurse practitioners, pharmacists, social workers and social service workers. The multidisciplinary team provides specialized care and comprehensive teaching which includes diet and lifestyle management advice, exercise programs, help with medications and more. 

“Our team provides patient-centered multidisciplinary support to patients with diabetes” says Dr. Selina Liu, Associate Scientist at Lawson, Endocrinologist at St. Joseph’s and co-investigator on the study. “We work with patients to empower them to manage their diabetes with a goal of preventing serious complications, both acute and chronic, including those that can lead to ambulance calls, ED visits and hospitalizations.”

The research team found that patients who had received specialized diabetes care were less likely to revisit the ED due to hyperglycemia (9.6 per cent versus 32.5 per cent) and to be hospitalized due to hyperglycemia (5.2 per cent versus 14.1 per cent) within 30 days of their initial ED visit. 

“While further research is needed, our findings are important for a number of reasons,” notes Dr. Yan. “They suggest that follow-up with specialized diabetes care may prevent recurrent ED visits and hospitalizations. In addition to improving patient outcomes, this could equate to significant cost savings for the health care system.”

The team hopes this knowledge can be used to develop targeted interventions for patients who are at higher risk of returning to hospital for hyperglycemia. They are planning future studies to look at what factors contribute to a patient being at higher risk of adverse outcomes and what interventions are most effective in preventing them. 

The study, “Do adult patients with type 1 or 2 diabetes who present to the emergency department with hyperglycemia have improved outcomes if they have access to specialized diabetes care?,” is published in the Canadian Journal of Diabetes. It was funded by Lawson Health Research Institute’s Internal Research Fund.