High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design

Abstract

BackgroundWorldwide, nearly 3 million people die of chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM in several settings, but it remains unknown which factors influence usage of eHealth and change in behavior of patients.ObjectiveOur study, e-Vita COPD, compares different levels of integration of Web-based self-management platforms in IDM in three primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-management platform for COPD patients.MethodsThe e-Vita COPD study compares three different approaches to incorporating eHealth via Web-based self-management platforms into IDM of COPD using a parallel cohort design. Three groups integrated the platforms to different levels. In groups 1 (high integration) and 2 (medium integration), randomization was performed to two levels of personal assistance for patients (high and low assistance); in group 3 there was no integration into disease management (none integration). Every visit to the e-Vita and Zorgdraad COPD Web platforms was tracked objectively by collecting log data (sessions and services). At the first log-in, patients completed a baseline questionnaire. Baseline characteristics were automatically extracted from the log files including age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ), dyspnea scale (MRC), and quality of life questionnaire (EQ5D). To predict the use of the platforms, multiple linear regression analyses for the different independent variables were performed: integration in IDM (high, medium, none), personal assistance for the participants (high vs low), educational level, and self-efficacy level (General Self-Efficacy Scale [GSES]). All analyses were adjusted for age and gender.ResultsOf the 702 invited COPD patients, 215 (30.6%) registered to a platform. Of the 82 patients in group 1 (high integration IDM), 36 were in group 1A (personal assistance) and 46 in group 1B (low assistance). Of the 96 patients in group 2 (medium integration IDM), 44 were in group 2A (telephone assistance) and 52 in group 2B (low assistance). A total of 37 patients participated in group 3 (no integration IDM). In all, 107 users (49.8%) visited the platform at least once in the 15-month period. The mean number of sessions differed between the three groups (group 1: mean 10.5, SD 1.3; group 2: mean 8.8, SD 1.4; group 3: mean 3.7, SD 1.8; P=.01). The mean number of sessions differed between the high-assistance and low-assistance groups in groups 1 and 2 (high: mean 11.8, SD 1.3; low: mean 6.7, SD 1.4; F1,80=6.55, P=.01). High-assistance participants used more services (mean 45.4, SD 6.2) than low-assistance participants (mean 21.2, SD 6.8; F1,80=6.82, P=.01). No as...

Effects of the Proactive Interdisciplinary Self-Management (PRISMA) Program on Online Care Platform Usage in Patients with Type 2 Diabetes in Primary Care: A Randomized Controlled Trial

“…In our study, 34% of the patients logged on, which was an improvement from the 11% found in the study by Roelofsen et al (2014) on the former version of e-Vita. The trainings about the functionalities of the platform seemed necessary to familiarize patients with the platform [45,47,48]. This may also have decreased the threshold for patients to visit this platform and may have helped patients and PNs to feel the gains of using it.…”

“…Other possible causes for the increase in platform usage could be the visual and technical improvements of the platform. In addition, bended care, where digital health and usual care are integrated, is likely to lead to increased use of an online program for patients with COPD [48]. Patients with diabetes log on to platforms for various reasons.…”

The Effect of Integration of Self-Management Web Platforms on Health Status in Chronic Obstructive Pulmonary Disease Management in Primary Care (e-Vita Study): Interrupted Time Series Design

“…In a patient population with more severe COPD (patient-data meta-analysis from 2016), self-management interventions improved health-related QoL at 12 months but not at 6 months [ 52 ]; this confirms our observation that long-term use of platforms is necessary for an effect on health status. In our research, the platforms are probably not sufficiently customized to the wishes or needs of COPD patients to provide sufficient motivation to use the platform on a regular basis for a longer period; in our e-Vita study, a significant number of users stopped using the platforms (attrition) [ 32 ].…”

“…Of the 702 eligible patients, 30.6% were willing to participate and provided informed consent, and 61.4% of the participants dropped out during follow-up. Even though the nonparticipants did not differ in age or gender from the participants [ 32 ], caution is required when generalizing these results to general practice.…”

“…In our e-Vita study, use of the self-management platforms was higher when the platform was an integrated part of IDM and with adequate personal assistance on how to use the platform [ 32 ]. We hypothesize that use of the platforms will improve self-management skills and thereby stabilize the health status of COPD patients, with a greater effect with higher usage.…”