Stepped Care and E-Health in Behavioral Managed Care

Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives

“…These results could be attributed to the multipronged approach of the SMASH program, consisting of patient-centered, m Health resources coupled with live interactions with providers and study staff. Chronic care models have specified that the management of disease is achieved through the collaborative efforts of providers and patients to promote self-monitoring, symptom tracking, and sharing information about health status and treatment [ 53 , 54 , 55 , 56 ]. Indeed, researchers have argued that along with self-monitoring, provider feedback and communication is an essential feature for m Health-based chronic care management, as they can provide patients with motivation and encouragement [ 57 ].…”

Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine

“…The article noted that there was significant evidence that disease management improves the processes of care allowing a more functional disease control, but no important clinical evidences were found in long-term periods (perhaps for lacking follow-ups). Moreover, no conclusive results were found about cost savings ( O’Donnell, 2011 ).…”

“…According to Mercer (2011) , disease management “supports the physician or practitioner/patient relationship and plan of care; emphasizes prevention of exacerbations and complications through the use of evidence-based practice guidelines and patient empowerment strategies; and evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health” ( Mercer, 2011 , p. 152). Another interesting approach and solution is the Chronic Care Model, developed by Wagner et al (2001a , b ; Glasgow et al, 2001 ), that is based on the collaboration between a well coordinated team of clinicians-providers and an actively engaged patient, promoting self-management skills, tracking, and sharing information about patient health status and treatment programs, focusing on the family, social, and community networks ( O’Donnell, 2011 ).…”

“…Working out the previous Von Korff and Tiemans’s (2000) proposal, a strong model of stepped care based on mHealth is proposed by O’Donnell (2011 , p. 265): “the stepped care model is based on the acknowledgment that (1) different patients require different levels of care; (2) the most appropriate level of care is based on closely monitoring outcomes; and (3) moving from lower to more intensive levels of care based on patient response can increase the effectiveness of care while lowering overall costs.” Stepped care is “potentially much more consistent with the ethical imperative of choosing the least intrusive intervention for one’s patient” ( O’Donohue and Draper, 2011a , p. 3). Using this approach, many efforts in the research field have to be focused not only in the development of new clinical protocols or therapies, but in the validation of new health-care delivery model, measuring its reliability, affordability, safety, efficiency, and user satisfaction (where users are patients, professionals, stakeholders, etc.)…”

“…Each disease management program, including or not a mHealth stepped approach, has to be evaluated in relationship to cost issues, such as the measurement of return on investment (ROI; O’Donnell, 2011 ). Some evidences about pros and cons of this approach are now available in scientific literature: one of the best review ( Mattke et al, 2007 ) evaluated different types of disease management programs about quality, health outcomes and cost for various chronic conditions (three large-scale population-based studies, 10 meta-analyses, 16 systematic reviews containing 317 unique studies were considered).…”