Evaluation of an eHealth Intervention in Chronic Care for Frail Older People: Why Adherence is the First Target

Abstract

BackgroundOlder people suffering from frailty often receive fragmented chronic care from multiple professionals. According to the literature, there is an urgent need for coordination of care.ObjectiveThe objective of this study was to investigate the effectiveness of an online health community (OHC) intervention for older people with frailty aimed at facilitating multidisciplinary communication.MethodsThe design was a controlled before-after study with 12 months follow-up in 11 family practices in the eastern part of the Netherlands. Participants consisted of frail older people living in the community requiring multidisciplinary (long-term) care. The intervention used was the health and welfare portal (ZWIP): an OHC for frail elderly patients, their informal caregivers and professionals. ZWIP contains a secure messaging system supplemented by a shared electronic health record. Primary outcomes were scores on the Instrumental Activities of Daily Living scale (IADL), mental health, and social activity limitations.ResultsThere were 290 patients in the intervention group and 392 in the control group. Of these, 76/290 (26.2%) in the intervention group actively used ZWIP. After 12 months follow-up, we observed no significant improvement on primary patient outcomes. ADL improved in the intervention group with a standardized score of 0.21 (P=.27); IADL improved with 0.50 points, P=.64.ConclusionsOnly a small percentage of frail elderly people in the study intensively used ZWIP, our newly developed and innovative eHealth tool. The use of this OHC did not significantly improve patient outcomes. This was most likely due to the limited use of the OHC, and a relatively short follow-up time. Increasing actual use of eHealth intervention seems a precondition for large-scale evaluation, and earlier adoption before frailty develops may improve later use and effectiveness of ZWIP.

Mobile health solutions for the aging population: A systematic narrative analysis

“…59 Communication is identified as a common theme in six articles. 28,30,37,40,45,54 Diffusion also deals with social change, and mHealth applications involve social change and the acceptance of this modality of delivery of care to a specific elderly population. 58 Acceptance is mentioned three times as a facilitator 23,25,52 and three times as a barrier (misunderstood, rejected).…”

“…Effective, outcomes, and communicative were mentioned in 6/60 occurrences (10%). 27,28,30,[37][38][39][40]45,46,48,53,[54][55][56]58 mHealth can change behaviour through feedback. It can mentally stimulate patients to delay the advance of dementia, improve triage decisions and arrangement of transportation through communication channels, increase self-efficacy augmenting existing interventions and thereby outcomes.…”

“…27,39,45,46,56,58 Mobile technology can also serve as a tool of communication to augment existing modalities to provide real-time data and increase the level of communication between patient and provider. 28,30,37,40,45,54 Quality of life was mentioned in 5/60 occurrences (8%), and it encompassed observations that mobile technology can make life easier, convenient and more comfortable for the user. 23,30,31,38 One study showed a positive impact on lifestyle indicators.…”

“…23,25,52 The improvement of access included technology to enhance coordination of care without the limitations of proximity or mobility. 40,46,55 The theme of convenient was only mentioned once (2%). The authors pointed out that elderly with dementia are willing to wear mobile technology, they willingly accept it, and they feel that it is convenient to use for multiple purposes.…”

Implementation strategy for the school-based sex education program Long Live Love

“…The website is developed applying Intervention Mapping (IM), a protocol to systematically develop interventions using theory and empirical evidence (Bartholemew et al, 2011). IM has proven to be an effective protocol in the development of various online health promotion interventions (Makai et al, 2014;van Bruinessen et al, 2014;Voogt, Poelen, Kleinjan, Lemmers, & Engels, 2014).…”