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Background Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients. Objective This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation. Methods The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach. Results A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. Conclusions Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients’ free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.

Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.

Background and objective: Due to unrecognized and unaddressed geriatric care needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to timely identify geriatric needs. Holistic and coordinated therapeutic approaches maintain the independence of elderly patients and avoid adverse effects of several uncoordinated treatments. General practitioners’ practices are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the Northeast of Germany and to identify regional disparities. Methods: Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic or specialized geriatric care were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas. A Moran’s I analysis was carried out to identify clusters of low or high utilization rates. Results: Of all patients who were eligible for outpatient geriatric care in 2017, 58.3% (n=129,283/221,654) received at least one basic outpatient geriatric service. 77.2% (n=73,442/95,171) of the patients who were also eligible for specialized services, received any geriatric service (basic or specialized). 0.4% (n=414/95,171) of this group, actually received specialized outpatient geriatric care. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4% to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified. Conclusions: Considering the entire federal state, about half of the eligible population received basic geriatric care. Of the subgroup eligible for specialized geriatric care, only 0.4% received specialized services. The wide range of regional variations in the utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). Considering specialized outpatient care, utilization is limited to a few regions. Innovative solutions to improve access to both basic and specialized geriatric outpatient care are necessary.

BACKGROUND Geriatric patients are often treated by several healthcare providers at the same time. The spatial, informational, and organizational separation of these healthcare providers can hinder an effective treatment of geriatric patients. OBJECTIVE The aim of this study was to develop a regional Digital Health Record (abbreviated in German as ReDiFa) in order to improve health information exchange in geriatric treatment. This study also evaluated the usability of ReDiFa and seeks to identify barriers and facilitators for its implementation. METHODS The development of ReDiFa followed the Community-Based Participatory Research Approach (CBPR) and involved various geriatric healthcare professionals in all stages of development: identification of suitable regions for later implementation, identification of regional stakeholders, identifying specific, regional needs, development of a content concept, programming and testing of ReDiFa. Primary outcomes were usability of ReDiFa, expected implementation barriers and facilitators and the quality of the developmental process. Data were collected and analyzed by using a mixed-method approach. RESULTS 3 focus regions were identified, 22 geriatric healthcare providers participated in the development of ReDiFa and 11 workshops were conducted between October 2019 and September 2020. 12 participants responded to a questionnaire. Main results were, that ReDiFa should support the exchange of assessments, diagnoses, medication, assistive device supply and social information. The ReDiFa was expected to be able to improve the quality and continuity of care. Main barriers expected for implementation were: lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. CONCLUSIONS Participating healthcare professionals share similar motivations for developing ReDiFa including improved quality of care, reduction of unnecessary examinations, and more effective healthcare provision. An overly complicated registration process for healthcare professionals and the patients' free choice of their healthcare providers hinder the effectiveness of ReDiFa and result in incomplete patient health information. However, the web-based design of ReDiFa bridges interoperability problems which exists due to different technical and organizational structures of the involved healthcare facilities. ReDiFa is better accepted by healthcare professionals which are already engaged in an inter-disciplinary, geriatric-focused network. This might indicate that pre-existing cross-organisational structures and processes are prerequisites for using health information exchange systems. The participatory design supports the development of technologies adaptable to regional needs. Healthcare providers are interested in participating in the development of a health information exchange system, but they often lack the required time, knowledge and resources.