eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project

Abstract

a b s t r a c tIntroduction: Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. Methods: Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as 'high potential' for their innovative approach and studied in depth through site visits. Results: Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients' data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. Conclusion: Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

“…On the other hand, the abovementioned discrepancy might depend on the fact that, in great part of European countries, eHealth tools have been generally adopted by health systems but rarely included in integrated care programs/practices for people with MM, as those mapped during our project [65]. Conversely, both our study and previous research findings [43,78] put in evidence the relatively large number of health programs using ICT tools and identified in Spain that is a Southern European country.…”

“…In seven countries (e.g., Portugal, Slovenia, and Latvia), only one program using at least one eHealth tool was found. A more detailed description of general findings is reported in other publications [29,65]. Table 1, adoption of at least one eHealth tool in the programs, by health system characteristics, such as the national health model, strength of PC, and (de)centralization level of health system, showed on the whole a greater implementation (of programs) in decentralized countries (60%), in countries with a NHS model (68%), and also in countries with a strong/medium PC (67%: 42% strong and 25% medium).…”

“…Below, information on materials and methods is reported. A more detailed description of these aspects is provided elsewhere [52,65,66]. They were asked to identify existing integrated care initiatives at a national/regional/local level focusing on MM and to report the related information by filling in an online questionnaire for each eligible program, also with the collaboration of their expert network and program managers/leaders.…”

“…Our study then identified four categories of eHealth applications according to their main functions and adopted a classification by adapting key elements of the conceptual framework from the Chronic Care Model (CCM) and the eHealth Enhanced Chronic Care Model (eCCM) [29,65,67]. The four types of eHealth we identified are ICT tools for (i) Remote Consultation, Monitoring, and Care: regarding remote/at distance interaction between patients and health professionals, e.g., consultations/visits Moreover, opinions (agreement vs. disagreement) on potential benefits (improving quality of care, quality of life of patients enrolled, integration/management of care, and cost efficiency) and barriers (inadequate legislative framework, funding, ICT infrastructures, and technical-ICT support; lack of skills and cultural resistance among care providers and patients; uncertainty about cost efficiency; compatibility/interoperability between different eHealth tools; and privacy/security issues) were addressed, as they were perceived by expert organizations/program managers.…”

“…Further qualitative information (e.g., aim, main activities, and eHealth aspects) obtained from the site visits of HPPs in Denmark, Finland, and Spain, is reported in a separate publication [65] and also briefly in text boxes which are included in Text S1 in the Supplementary Materials.…”