ProACT - A Digital Platform to Support Self-Management of Multiple Chronic Conditions: Findings in Relation to Engagement during a one-year Proof-of-Concept Trial (Preprint)

BACKGROUND Self-management, a core activity for older adults living with multiple chronic conditions (multimorbidity), is challenging, requiring the person to engage in multiple tasks such as symptom monitoring, recognition of exacerbations, medication adherence and inter-stakeholder communication. A digital, integrated care approach is a critical part of the solution, however, there is a dearth of literature on this topic. Furthermore, there is little research on older adults’ acceptability, usage and experiences of engaging with digital health technologies, particularly over long periods of time. OBJECTIVE The objectives were to (1) co-design and develop a digital health platform, called ProACT, to facilitate older adults self-managing multimorbidity, with support from their care network (CN); (2) evaluate end user engagement and experiences with the platform through a 12-month trial. METHODS The ProACT digital health platfrom is presented. The platform was evaluated in a year-long proof-of-concept (PoC) action research trial with 120 older persons with multimorbidity (PwMs) in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts, and a technical helpdesk. Interactions with the platform during the PoC trial were logged to determine engagement, semi-structured interviews were conducted with participants and analysed using inductive thematic analysis methods, while usability and user burden were examined using validated questionnaires. RESULTS This article presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who took part, 24 withdrew before the end of the study while three passed away. The remaining 93 participants actively used the platform until the end of the trial, on average taking two or three health readings daily over the course of the trial, in Ireland and Belgium respectively. Participants reported ProACT to be usable and of low burden. Findings from interviews outline that participants experienced multiple benefits as a result of using ProACT, including improved self-management, improved health and wellbeing and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology didn’t work as expected. CONCLUSIONS This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multiple chronic conditions. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for this include a strong focus on user-centred design and engagement throughout the project lifecycle, resulting in a platform that met user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.22125

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GPS' PERCEPTION OF THE PATIENT ORIENTED INTERVENTIONS AS KEY ELEMENTS OF PATIENT CENTRED CARE FOR PEOPLE WITH MULTIMORBIDITY.pdf

Knowledge International Journal ◽

10.35120/kij2802561a ◽

2018 ◽

Vol 28 (2) ◽

pp. 561-565

Author(s):

Radost Assenova ◽

Levena Kireva ◽

Gergana Foreva

Keyword(s):

Chronic Conditions ◽

Patient Centered Care ◽

Self Management ◽

Multiple Chronic Conditions ◽

Positive Health ◽

Patient Centered ◽

Effective Response ◽

Patient Centred Care ◽

Centered Care ◽

Health Related

Background: Patients with multimorbidity represent a significant portion of the primary healthcare population. For healthcare providers, managing patients with multiple chronic conditions represents a challenge given the complexity and the intensity of interventions. Integrated and patient-centered care is considered an effective response to the needs of people who suffer from multiple chronic conditions. According to the literature providing patient-centered care is one of the most important interventions in terms of positive health-related outcomes for patients with multimorbidity.Aim: The aim of the study is to evaluate the GPs’ perception of patient oriented interventions as key elements of patient centred care for patients with multimorbidity.Material and methods: A cross-sectional pilot study was conducted among randomly selected 73 GPs. A direct individual anonymous survey was performed to explore the opinion of respondents about the importance of two patient-oriented interventions, each one including specific elements of patient-centered care for patients with multimorbidity. The tool was developed as a result of the scoping review performed by Smith et al. (2012;2016). A 5-point Likert scale (0-not at all, 1-little, 2-rather, 3-much, 4-very strong) was used. The data were analysed using descriptive statistics. In processing the data, the software product for statistical analyses - SPSS version 17 was performed for Windows XP.Results: Our results show that both categories - providing patient-oriented approach and self-management support interventions were highly accessed by the respondents. The most frequent categories of interventions identified in our study were Creating individualized and adapted interventions, Performing regular contacts and Reinforcing adherence. Less frequently reported elements such as Considering relatives’ needs and Developing self-management plan are still underestimated by the Bulgarian GPs.Conclusions: The acceptance and understanding of innovative patient-centered interventions adapted to patients with multimorbidity could be accepted as a good indicator for improving health-related outcomes and care for patients with multiple chronic conditions.

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A self‐management support program for older Australians with multiple chronic conditions: a randomised controlled trial

The Medical Journal of Australia ◽

10.5694/mja17.00127 ◽

2018 ◽

Vol 208 (2) ◽

pp. 69-74 ◽

Cited By ~ 5

Author(s):

Richard L Reed ◽

Leigh Roeger ◽

Sara Howard ◽

Jodie M Oliver‐Baxter ◽

Malcolm W Battersby ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Chronic Conditions ◽

Controlled Trial ◽

Support Program ◽

Self Management ◽

Multiple Chronic Conditions ◽

Management Support ◽

Randomised Controlled

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One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity

Journal of Multimorbidity and Comorbidity ◽

10.1177/26335565211039780 ◽

2021 ◽

Vol 11 ◽

pp. 263355652110397

Author(s):

Martin Fortin ◽

Moira Stewart ◽

José Almirall ◽

Djamal Berbiche ◽

Mathieu Bélanger ◽

...

Keyword(s):

Health Status ◽

Healthy Eating ◽

Chronic Conditions ◽

Health Behaviours ◽

Lower Number ◽

Self Management ◽

Patient Centered ◽

Younger Patients ◽

Subgroup Analyses ◽

One Year

Context Interventions for people with multimorbidity have obtained mixed results. We aimed to document the long-term effect of an intervention for people with multimorbidity. Methods 284 patients (18–80 years) presenting three or more chronic conditions were recruited from seven family medicine groups in the Saguenay-Lac St-Jean region, Quebec, Canada. The patient-centered intervention was based on motivational approach and self-management support. Outcomes were evaluated in a one-year pre-post study design with questionnaires that included the Health Education Questionnaire (heiQ), the Self-Efficacy for Managing Chronic Diseases, the Veteran RAND-12 Health Survey (VR-12), the EuroQoL 5-Domains questionnaire, the Kessler six item Psychological Stress Scale, and measures of smoking habit, physical activity, healthy eating and alcohol consumption. Subgroup analyses by age, number of conditions, sex, and income were also conducted. Results The heiQ domain of emotional wellbeing improved significantly. Improvement was also observed for the VR-12 and the K6. Among the health behaviours, only healthy eating was improved. Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. Conclusion One year after the intervention, participants significantly improved a variety of outcomes. Subgroup analyses suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. This suggests that future interventions should be tailored to patients’ characteristics including age, sex, income and number of conditions.

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“I had to change so much in my life to live with my new limitations”: Multimorbid patients’ descriptions of their most bothersome chronic conditions

Chronic Illness ◽

10.1177/1742395317699448 ◽

2017 ◽

Vol 14 (1) ◽

pp. 13-24 ◽

Cited By ~ 9

Author(s):

Cindie A Slightam ◽

Kirsten Brandt ◽

Emily C Jenchura ◽

Eleanor T Lewis ◽

Steven M Asch ◽

...

Keyword(s):

Chronic Conditions ◽

Self Management ◽

Multiple Chronic Conditions ◽

Post Traumatic Stress ◽

Academic Center ◽

Health Related ◽

Post Traumatic ◽

Multimorbid Patients ◽

Different Characteristics

Objective To characterize diseases that are described as most bothersome by individuals with multiple chronic conditions and to identify themes that characterize their experiences with their most bothersome condition. Methods In a survey of patients at an academic center and a Veterans Affairs hospital, we asked individuals with multiple chronic conditions to identify their most bothersome chronic condition and describe why it is challenging. Standard content analysis methods were used to code responses and identify themes reflecting characteristics of most bothersome conditions. Results The most commonly cited bothersome conditions were chronic pain (52%), diabetes (43%), post-traumatic stress disorder (25%), heart failure (24%), and lung problems (20%). Conditions were described as most bothersome due to: (a) impact on function and quality of life (e.g. active symptoms, activity limitations), (b) health consequences or sequelae (e.g. risk of complications), and (c) challenges associated with treatment or self-management. Patterns of theme dominance varied for conditions with different characteristics. Discussion The conditions that patients with multiple chronic conditions identify as most bothersome vary depending on individuals’ diseases and their health-related preferences and priorities. Ascertaining patients’ most bothersome conditions and associated challenges, stress, and frustrations may help ensure that management decisions are aligned with patient preferences and priorities.

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Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2017.04.007 ◽

2017 ◽

Vol 97 ◽

pp. 131-135 ◽

Cited By ~ 7

Author(s):

Katja Brenk-Franz ◽

Bernhard Strauß ◽

Fabian Tiesler ◽

Christian Fleischhauer ◽

Nico Schneider ◽

...

Keyword(s):

Primary Care ◽

Adult Attachment ◽

Chronic Conditions ◽

Self Management ◽

Multiple Chronic Conditions ◽

Primary Care Patients

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Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

10.21203/rs.2.15520/v2 ◽

2019 ◽

Author(s):

Kah Mun Foo ◽

Meena Sundram ◽

Helena Legido-Quigley

Keyword(s):

Qualitative Study ◽

Waiting Time ◽

Chronic Conditions ◽

Resource Constraints ◽

Healthcare Providers ◽

Policy Formulation ◽

Care Quality ◽

Self Management ◽

Multiple Chronic Conditions ◽

Facilitators And Barriers

Abstract Background About one-third of all adults worldwide were diagnosed with multiple chronic conditions (MCCs). Literature had found several challenges of providers and patients coping with managing MCCs in the community, and yet limited research studies that consider their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods This involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provides subsidised primary care services. Topic guides were developed with reference from literature review, Chronic Care Model (CCM) and Framework for patient-centred access to healthcare. Results Despite perceived affordable charges and availability of support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of the healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those that did not turn up might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges of delivering safe and quality care with limited consultation duration due to the need to manage waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle related guidelines, patients’ actions are influenced by multiple factors including work nature, beliefs and environment. Conclusions There were barriers on care access, delivery and self-management as reported. It is crucial to adopt whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCCs management. This study has also highlighted the importance to consider different viewpoints of healthcare providers and users in policy formulation and community care planning.

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Helping persons with multiple chronic conditions overcome barriers to self-management

The Nurse Practitioner ◽

10.1097/01.npr.0000733676.28520.db ◽

2021 ◽

Vol 46 (3) ◽

pp. 20-28

Author(s):

Yuanyuan Jin ◽

Lisa Bratzke ◽

Linda C. Baumann

Keyword(s):

Chronic Conditions ◽

Self Management ◽

Multiple Chronic Conditions

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Predictors and patterns of portal use in patients with multiple chronic conditions

Chronic Illness ◽

10.1177/1742395318803663 ◽

2018 ◽

Vol 16 (4) ◽

pp. 275-283 ◽

Cited By ~ 2

Author(s):

Kimberly R Powell ◽

Chelsea Deroche

Keyword(s):

Chronic Conditions ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Demographic Characteristics ◽

Self Management ◽

Multiple Chronic Conditions ◽

Negative Binomial Regression Model ◽

Secure Messaging ◽

Practice Size ◽

Or Practice

Objective To explore predictors of portal use by patients (registered portal users) with multiple chronic conditions according to demographic characteristics and use of specific features hypothesized to support self-management. Methods Two data sources were used in this analysis: electronic health records and 12 months of data from web server log files. Patients ( n = 500) included in the analysis were 45 years or older, registered portal users, and diagnosed with at least two chronic conditions. We fit a negative binomial regression model to predict portal use (number of logins) based on practice size and location, demographic characteristics, and use of specific portal features (secure messaging and patient-entered data). Results Among patients with one or more logins, age, distance separating the patient from his or her primary care provider, and having a diagnosis of heart failure were significant predictors of portal use ( p < .05). No significant differences in portal use were found according to gender, ethnicity, or practice size and location. Conclusion Considering the extraordinary investment on implementation and meaningful use of portal technology, low overall use and the large number of registered non-users is especially troubling. Regardless, our results demonstrate potential opportunities to leverage portal technology especially for patients living in rural and underserved areas to improve self-management of chronic illness.

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Federal Initiatives in Self-Management for Patients With Multiple Chronic Conditions: Implications for the Doctor of Nursing Practice

Clinical Scholars Review ◽

10.1891/1939-2095.8.1.139 ◽

2015 ◽

Vol 8 (1) ◽

pp. 139-144

Author(s):

Kim Kuebler

Keyword(s):

Affordable Care Act ◽

Chronic Conditions ◽

Management Practices ◽

Nursing Practice ◽

Self Management ◽

Multiple Chronic Conditions ◽

Use Of Self ◽

Readmission Rates ◽

Doctor Of Nursing Practice ◽

Federal Initiatives

The ratio of people aged 65 years and older compared to people aged 20–64 years are expected to rise by 80% over the next decade. Currently, 70% of the American population is living with a chronic disease, and 2 out of 3 have multiple chronic conditions (MCC). The purpose of this review is to identify the current Federal Initiatives funded by the Affordable Care Act that are being used to demonstrate and promote the use of self-management practices in patients who are living with MCCs. Patients with MCCs who engage in self-management practices have shown to have a reduction in disease complications and exacerbations, less hospitalization and readmission rates, improved physical functioning, and adherence to their medical plan.

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