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

Introduction eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

[1]  D. Berbiche,et al.  Measuring multimorbidity in older adults: comparing different data sources , 2019, BMC Geriatrics.

[2]  R. Fensli,et al.  The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review , 2019, Journal of medical Internet research.

[3]  A. Grudniewicz,et al.  Coordinating primary care services: A case of policy layering. , 2019, Health policy.

[4]  G. Agarwal,et al.  Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth , 2019, BMJ Open.

[5]  Maurice Mars,et al.  Here We Go Again - 'Digital Health' , 2019, Journal of the International Society for Telemedicine and eHealth.

[6]  P. Lehoux,et al.  What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review , 2018, International journal of health policy and management.

[7]  H. Eiríksdóttir,et al.  Health at a Glance: Europe 2018 , 2018, Health at a Glance: Europe.

[8]  M. Melchiorre,et al.  eHealth for people with multimorbidity: Results from the ICARE4EU project and insights from the “10 e’s” by Gunther Eysenbach , 2018, PloS one.

[9]  Elias Mossialos,et al.  How primary health care can make universal health coverage a reality, ensure healthy lives, and promote wellbeing for all , 2018, The Lancet.

[10]  Yakov Flaumenhaft,et al.  Personal health records, global policy and regulation review. , 2018, Health policy.

[11]  E. Savage,et al.  Frameworks for self-management support for chronic disease: a cross-country comparative document analysis , 2018, BMC Health Services Research.

[12]  J. Cumming,et al.  Keeping the faith in integration and primary care , 2018, Journal of Integrated Care.

[13]  J. Barnsley,et al.  Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies , 2018, Implementation Science.

[14]  S. Buttigieg,et al.  Technology implementation in delivery of healthcare to older people: how can the least voiced in society be heard? , 2018, Journal of Enabling Technologies.

[15]  S. Ziebland,et al.  The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study , 2018, Health Services and Delivery Research.

[16]  Robin Miller,et al.  Transforming primary care: scoping review of research and practice , 2018, Journal of integrated care.

[17]  Cristiano Codagnone,et al.  Electronic Health Use in the European Union and the Effect of Multimorbidity: Cross-Sectional Survey , 2018, Journal of medical Internet research.

[18]  L. D. de Witte,et al.  UvA-DARE ( Digital Academic Repository ) Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health , 2018 .

[19]  T. Laatikainen,et al.  Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). , 2018, Health policy.

[20]  I. Svab,et al.  Strength of primary care service delivery: a comparative study of European countries, Australia, New Zealand, and Canada , 2018, Primary Health Care Research & Development.

[21]  J. Stoffers.  The promise of eHealth for primary care: opportunities for service delivery, patient–doctor communication, self-management, shared decision making and research , 2018, The European journal of general practice.

[22]  H. Vrijhoef.  Make care coordination a high priority , 2017, International Journal of Care Coordination.

[23]  C. de Pietro,et al.  E-health in Switzerland: The laborious adoption of the federal law on electronic health records (EHR) and health information exchange (HIE) networks. , 2017, Health policy.

[24]  S. Liaw,et al.  Patient access to electronic health records : Differences across ten countries , 2017 .

[25]  Alice Delerue Matos,et al.  E-inclusion: Beyond individual socio-demographic characteristics , 2017, PloS one.

[26]  Markus Perola,et al.  Chronic disease research in Europe and the need for integrated population cohorts , 2017, European Journal of Epidemiology.

[27]  E. Wagner,et al.  Registered Nurses in Primary Care , 2017, The Journal of ambulatory care management.

[28]  Olga Kostopoulou,et al.  The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients , 2017, BMC Medical Informatics and Decision Making.

[29]  P. Hussey,et al.  Enhancing the provision of health and social care in Europe through eHealth , 2017, International nursing review.

[30]  Alison M. Devlin,et al.  Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom , 2017, Journal of medical Internet research.

[31]  Karen Andersen-Ranberg,et al.  Disparities in multimorbidity across Europe – Findings from the SHARE Survey , 2017 .

[32]  J. De Maeseneer,et al.  Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need , 2017, PloS one.

[33]  W. Schäfer.  Primary care in 34 countries : perspectives of general practitioners and their patients , 2016 .

[34]  R. Lau,et al.  Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) , 2016, Implementation Science.

[35]  Joan Torrent-Sellens,et al.  Modelling and Predicting eHealth Usage in Europe: A Multidimensional Approach From an Online Survey of 13,000 European Union Internet Users , 2016, Journal of medical Internet research.

[36]  J. Sloand,et al.  Remote Monitoring of Chronic Diseases: A Landscape Assessment of Policies in Four European Countries , 2016, PloS one.

[37]  G. Onder,et al.  Multimorbidity: Epidemiology and Models of Care , 2016, BioMed Research International.

[38]  R. Batenburg.  Health workforce planning in Europe: Creating learning country clusters. , 2015, Health policy.

[39]  Annette McElligott,et al.  National health models and the adoption of eHealth and ePrescribing in primary care – new evidence from Europe , 2015, BMJ Health & Care Informatics.

[40]  Who Europe.  Building Primary Care in a Changing Europe , 2015 .

[41]  Dionne S Kringos,et al.  Living In A Country With A Strong Primary Care System Is Beneficial To People With Chronic Conditions. , 2015, Health affairs.

[42]  B. Dimitrov,et al.  Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys , 2015, BMC Public Health.

[43]  Cristina Masella,et al.  Empowering patients through eHealth: a case report of a pan-European project , 2015, BMC Health Services Research.

[44]  Giancarlo Mauri,et al.  New Technologies for the Management and Rehabilitation of Chronic Diseases and Conditions , 2015, BioMed research international.

[45]  Sil Aarts,et al.  Older Adults' Reasons for Using Technology while Aging in Place , 2015, Gerontology.

[46]  S. Carretero.  Technology-enabled services for older people living at home independently: lessons for public long-term care authorities in the EU Member States , 2015 .

[47]  Deborah A. Greenwood,et al.  The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach , 2015, Journal of medical Internet research.

[48]  G. Onder,et al.  Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). , 2015, European journal of internal medicine.

[49]  J. D. Maeseneer.  European Expert Panel on effective ways of investing in health: opinion on primary care. , 2015 .

[50]  O. Ben-Assuli,et al.  Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. , 2015, Health policy.

[51]  J. Smolowitz,et al.  Role of the registered nurse in primary health care: meeting health care needs in the 21st century. , 2015, Nursing outlook.

[52]  Donna M. Zulman,et al.  How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions , 2015, Journal of General Internal Medicine.

[53]  P. Groenewegen,et al.  Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey , 2015, Bulletin of the World Health Organization.

[54]  George Demiris,et al.  A systematic review of telehealth tools and interventions to support family caregivers , 2015, Journal of telemedicine and telecare.

[55]  Vishnu Mohan,et al.  Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education , 2014, Advances in medical education and practice.

[56]  A. Kennedy,et al.  Addressing the evidence to practice gap for complex interventions in primary care: a systematic review of reviews protocol , 2014, BMJ Open.

[57]  D. Brooks,et al.  Home telemonitoring effectiveness in COPD: a systematic review , 2014, International journal of clinical practice.

[58]  A. Lang.  Government capacities and stakeholders: what facilitates ehealth legislation? , 2014, Globalization and Health.

[59]  Trisha Greenhalgh,et al.  Technology as system innovation: a key informant interview study of the application of the diffusion of innovation model to telecare , 2014, Disability and rehabilitation. Assistive technology.

[60]  P. Groenewegen,et al.  Political, cultural and economic foundations of primary care in Europe. , 2013, Social science & medicine.

[61]  Ioannis Maghiros,et al.  European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013) – Synthesis of outcomes , 2013 .

[62]  Dionne Sofia Kringos,et al.  The importance of measuring and improving the strength of primary care in Europe: results of an international comparative study , 2013 .

[63]  P. Groenewegen,et al.  The strength of primary care in Europe: an international comparative study. , 2013, The British journal of general practice : the journal of the Royal College of General Practitioners.

[64]  Pim P Valentijn,et al.  Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care , 2013, International journal of integrated care.

[65]  Peter Trkman,et al.  Older adults' perceptions of home telehealth services. , 2013, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[66]  Giel Nijpels,et al.  Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review. , 2012, Health policy.

[67]  C. Wendt,et al.  Conceptual frameworks for comparing healthcare politics and policy. , 2012, Health policy.

[68]  M. Johansen,et al.  An Exploratory Study of Patient Attitudes towards Symptom Reporting in a Primary Care Setting , 2010, Methods of Information in Medicine.

[69]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.

[70]  David M Cutler,et al.  Thinking outside the pillbox--medication adherence as a priority for health care reform. , 2010, The New England journal of medicine.

[71]  N. Reibling.  Healthcare systems in Europe: towards an incorporation of patient access , 2010 .

[72]  D. Protti.  Integrated care needs integrated information management and technology. , 2009, Healthcare quarterly.

[73]  Daniel Castro,et al.  Explaining International IT Application Leadership: Health IT , 2009 .

[74]  Johnny Saldaña,et al.  The Coding Manual for Qualitative Researchers , 2009 .

[75]  H. Ono,et al.  Digital inequality: A five country comparison using microdata ☆ , 2007 .

[76]  J. Barlow,et al.  A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions , 2007, Journal of telemedicine and telecare.

[77]  Jorgen P. Bansler,et al.  GUEST EDITORIAL Special Issue: Drought in South African savannas , 2020 .

[78]  Jeremy Freese,et al.  When do older adults turn to the internet for health information? Findings from the wisconsin longitudinal study , 2006, Journal of General Internal Medicine.

[79]  J. Cosby,et al.  Resilience Engineering: Concepts and Precepts , 2006, Quality and Safety in Health Care.

[80]  M. Formosa,et al.  Supporting Family Carers of Older People in Europe - The National Background Report for Malta , 2005 .

[81]  Hsiu-Fang Hsieh,et al.  Three Approaches to Qualitative Content Analysis , 2005, Qualitative health research.

[82]  S. Bhattacharjee.  New health policy. , 2001, Journal of the Indian Medical Association.

[83]  J. Huisman.  The Netherlands , 1996, The Lancet.

[84]  N. Rogers.  The new health. , 1972, Bulletin of the New York Academy of Medicine.

[85]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[86]  E. van Ginneken,et al.  Managing multimorbidity: Profiles of integrated care approaches targeting people with multiple chronic conditions in Europe. , 2018, Health policy.

[87]  Francesco Barbabella,et al.  eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project. , 2018, Health policy.

[88]  F. Lupiáñez-Villanueva,et al.  Benchmarking Deployment of Ehealth Among General Practitioners: Final Report , 2018 .

[89]  F. Schellevis,et al.  Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. , 2018, Health policy.

[90]  Union Européenne,et al.  Health at a Glance: Europe 2016 , 2016 .

[91]  F. Schellevis,et al.  Innovating care for people with multiple chronic conditions in Europe: An overview , 2015 .

[92]  G. Cochrane,et al.  Insights on earlier adoption of medical innovations: An international review of emerging and effective practice in improving access to medicines and medical technologies , 2015 .

[93]  W. Brouwer,et al.  Report on Definition of a frame of reference in relation to primary care with a special emphasis on financing systems and referral systems - ECPH (EXpert Panel on effective ways of investing in Health) , 2014 .

[94]  Geoff M. Anderson,et al.  Providing integrated care for older people with complex needs Lessons from seven international case studies , 2014 .

[95]  M. Salive,et al.  Multimorbidity in older adults. , 2013, Epidemiologic reviews.

[96]  José Manuel Ortega Egea,et al.  Profiling European physicians' usage of eHealth services , 2011, Inf. Res..

[97]  P. Groenewegen,et al.  Co-ordination and management of chronic conditions in Europe: the role of primary care – position paper of the European Forum for Primary Care , 2018 .

[98]  M. Robinson.  Does Decentralisation Improve Equity and Efficiency in Public Service Delivery Provision , 2007 .

[99]  Harry W. Blair,et al.  Participation and Accountability at the Periphery: Democratic Local Governance in Six Countries , 2000 .

[100]  A. Mills,et al.  Health system decentralization:concepts,issues,and country experience , 1990 .