mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience

Abstract

BackgroundGiven the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions.ObjectiveThe objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts.MethodsWe conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method.ResultsIn this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting.ConclusionsThis study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.

Health information technology to improve care for people with multiple chronic conditions

“…The review identified 16 studies including seven RCTs that studied self‐management support, quality of life, and health service utilization (Table 1). 70–86 These health IT interventions were delivered via patient portal, remote patient monitoring technology, patient‐reported outcome collection applications, and telemedicine virtual coaching 72,73,78,79,81,82,87 …”

Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development

“…Studies conducted in other countries have shown that digital interventions can help in managing multimorbidity among NCD patients. 67–69 However, most of the studies in this review had participants with diabetes, among which the burden of multiple morbidities was not evaluated explicitly. Only one study has reported an intervention for addressing psychological stress among diabetic patients.…”

A mHealth-Intervention to Support the Self-Management of Multimorbid Patients in General Practices in Germany (Telepracman) – Study Protocol of a Randomized Pilot Study

“…In the research literature, we identi ed only one study on a mHealth-intervention that explicitly addressed multimorbid patients in the primary care setting [13][14][15][16][17][18]. This study showed that multimorbid patients accept and use mHealth-interventions.…”