What’s the Name of the Game? The Impact of eHealth on Productive Interactions in Chronic Care Management

Wannheden, Carolina; Schwarz, Ulrica von Thiele; Östenson, Claes‐Göran; Härenstam, Karin Pukk; Stenfors, Terese

doi:10.3390/su13095221

Cited by 6 publications

(5 citation statements)

References 40 publications

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“…They shared responsibility for monitoring, which implied a mutual dependency. The shift from traditional care to HTH-supported self-management implicitly implies that tasks are shared to a higher extent, which also implies that the distinction between HCP and patient responsibilities gets blurred as these become more intertwined, similar to what has been reported in previous studies [ 45 – 47 ]. This interaction can contribute to complexity.…”

Section: Discussionsupporting

confidence: 55%

Mind the gap: analysis of two pilot projects of a home telehealth service for persons with complex conditions in a Swedish hospital

Sacchi,

Andersson,

Roczniewska

et al. 2023

BMC Health Serv Res

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Background Developing and implementing home telehealth (HTH) services for patients with chronic conditions is a challenge. HTH services provide continuous and integrated care to patients, but very often pilot projects face non-adoption and abandonment issues. Change processes in healthcare are often complex and require learning to adapt to non-linear and unpredictable events. Complexity science can thus provide a complementary view to the predominant Quality Improvement (QI) approach in healthcare. In this study of two pilot projects in a Swedish hospital, we explore how a theory-driven approach can be used (a) to support the development of a self-monitoring HTH service in hospital care and (b) to evaluate staff and patients’ experiences from early adoption. Methods To plan and evaluate the service for the recipients (i.e., patients and healthcare providers), we used the Plan-Do-Study-Act (PDSA) tool in combination with two complexity-informed frameworks: the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, and the joint Complexity Assessment Tool (CAT). The theory-informed development process led to two pilot projects of an HTH service for patients with heart failure and COVID-19. We collected data from multiple sources (project documents, a survey on readiness for change among staff, and semi-structured interviews with patients and staff) and analyzed the data using descriptive statistics and qualitative content analysis with a deductive approach. Results Patients and staff perceived the services as valuable as they enabled rapid feedback, and improved communication and collaboration between patients and healthcare providers. Yet, despite the extensive development efforts, there was a perceived gap between how individuals valued the service and the capacity of adopters, the organization, and the wider system to effectively integrate these services into routine care. Conclusions The combined use of PDSA, NASSS, and CAT can support the development and evaluation of HTH services that are perceived as valuable by individual patients and staff. For successful adoption, the value for individuals must be supported by organizational efforts to learn how to integrate new routines and tasks into clinical practice and daily life, and how to coordinate multiple providers within and outside the hospital walls.

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Section: Discussionsupporting

confidence: 55%

Mind the gap: analysis of two pilot projects of a home telehealth service for persons with complex conditions in a Swedish hospital

Sacchi,

Andersson,

Roczniewska

et al. 2023

BMC Health Serv Res

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“…One of these studies highlighted that health care professionals may need to communicate their personal boundaries to patients; for example, they would only check messages on certain weekdays [ 56 ]. However, these kinds of social interaction norms have rarely been made explicit in studies where asynchronous interactions were not structured or constrained, which could lead to a blurring of the boundaries that define the contents, extents, and times of interactions [ 67 , 68 ]. The ethical implications of digital patient-professional communication can be complex and require organizational guidelines to promote good practices in the use of digital communication [ 67 ].…”

Section: Discussionmentioning

confidence: 99%

Digital Health Technologies Enabling Partnerships in Chronic Care Management: Scoping Review

Wannheden¹,

Åberg-Wennerholm²,

Dahlberg³

et al. 2022

J Med Internet Res

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Background An increasing number of patients expect and want to play a greater role in their treatment and care decisions. This emphasizes the need to adopt collaborative health care practices, which implies collaboration among interprofessional health care teams and patients, their families, caregivers, and communities. In recent years, digital health technologies that support self-care and collaboration between the community and health care providers (ie, participatory health technologies) have received increasing attention. However, knowledge regarding the features of such technologies that support effective patient-professional partnerships is still limited. Objective This study aimed to map and assess published studies on participatory health technologies intended to support partnerships among patients, caregivers, and health care professionals in chronic care, focusing specifically on identifying the main features of these technologies. Methods A scoping review covering scientific publications in English between January 2008 and December 2020 was performed. We searched PubMed and Web of Science databases. Peer-reviewed qualitative, quantitative, and mixed methods studies that evaluated digital health technologies for patient-professional partnerships in chronic care settings were included. The data were charted and analyzed thematically. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist was used. Results This review included 32 studies, reported in 34 papers. The topic of participatory health technologies experienced a slightly increasing trend across publication years, with most papers originating from the United States and Norway. Diabetes and cardiovascular diseases were the most common conditions addressed. Of the 32 studies, 12 (38%) evaluated the influence of participatory health technologies on partnerships, mostly with positive outcomes, although we also identified how partnership relationships and the nature of collaborative work could be challenged when the roles and expectations between users were unclear. Six common features of participatory health technologies were identified: patient-professional communication, self-monitoring, tailored self-care support, self-care education, care planning, and community forums for peer-to-peer interactions. Conclusions Our findings emphasize the importance of clarifying mutual expectations and carefully considering the implications that the introduction of participatory health technologies may have on the work of patients and health care professionals, both individually and in collaboration. A knowledge gap remains regarding the use of participatory health technologies to effectively support patient-professional partnerships in chronic care management.

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“…Role clarity reflects the patients' perceptions of the boundaries between self-care and healthcare. The possibility of sharing tasks and roles between actors in the co-care system as well as new ways of interacting with each other (e.g., through e-health services or new models of care) can also lead to increasingly blurred boundaries between self-care and healthcare (7). Research has shown that patients may lack clarity about their role in collaborative care models where healthcare professionals, patients, and families work together, which may be linked to insufficient guidance about how to distribute roles (19).…”

Section: Discussionmentioning

confidence: 99%

“…Self-care of chronic conditions involves behaviors to maintain or improve physical and emotional stability (i.e., self-care maintenance), monitoring changes in signs and symptoms (i.e., self-care monitoring), and responding to signs and symptoms when they occur (i.e., self-care management) (6). The continuously rising availability and adoption of digital health technologies to support individuals in their self-care activities and communication within healthcare further blurs the boundaries between self-care and healthcare (7). For example, technology can enable individuals to take on activities traditionally performed by healthcare professionals, such as performing and monitoring blood pressure measurements (8), thereby enabling timely interventions.…”

Section: Introductionmentioning

confidence: 99%

Better self-care through co-care? A latent profile analysis of primary care patients' experiences of e-health–supported chronic care management

Wannheden

Roczniewska

Hasson

et al. 2022

Front. Public Health

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BackgroundEfficient self-care of chronic conditions requires that an individual's resources be optimally combined with healthcare's resources, sometimes supported by e-health services (i.e., co-care). This calls for a system perspective of self-care to determine to what extent it involves demanding or unnecessary tasks and whether role clarity, needs support, and goal orientation are sufficient. This study aims to explore typical configurations of how the co-care system is experienced by individuals with chronic conditions who used an e-health service supporting self-monitoring and digital communication with primary care.MethodWe performed a latent profile analysis using questionnaire data from two waves (7 months apart) involving 180 of 308 eligible patients who pilot-tested an e-health service for co-care at a Swedish primary care center. The five subscales of the Distribution of Co-Care Activities (DoCCA) scale were used to create profiles at Time 1 (T1) and Time 2 (T2). Profiles were described based on sociodemographic variables (age, gender, education level, and health condition) and compared based on exogenous variables (self-rated health, satisfaction with healthcare, self-efficacy in self-care, and perceptions of the e-health service).ResultsWe identified four typical configurations of co-care experiences at T1: strained, neutral, supportive, and optimal. Patients with optimal and supportive profiles had higher self-rated health, self-efficacy in self-care, and satisfaction with healthcare than patients with strained and neutral profiles. Slightly more than half transitioned to a similar or more positive profile at T2, for which we identified five profiles: unsupportive, strained, neutral, supportive, and optimal. Patients with optimal and supportive profiles at T2 had higher self-efficacy in self-care and satisfaction with healthcare than the other profiles. The optimal profiles also had higher self-rated health than all other profiles. Members of the optimal and supportive profiles perceived the effectiveness of the e-health service as more positive than the unsupportive and strained profile members.DiscussionPrimary care patients' co-care profiles were primarily distinguished by their experiences of needs support, goal orientation, and role clarity. Patients with more positive co-care experiences also reported higher self-rated health, self-efficacy in self-care, and satisfaction with healthcare, as well as more positive experiences of the e-health service.

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What’s the Name of the Game? The Impact of eHealth on Productive Interactions in Chronic Care Management

Cited by 6 publications

References 40 publications

Mind the gap: analysis of two pilot projects of a home telehealth service for persons with complex conditions in a Swedish hospital

Mind the gap: analysis of two pilot projects of a home telehealth service for persons with complex conditions in a Swedish hospital

Digital Health Technologies Enabling Partnerships in Chronic Care Management: Scoping Review

Better self-care through co-care? A latent profile analysis of primary care patients' experiences of e-health–supported chronic care management

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