Scoping Review of Information and Communication-Technology to Support Patients and Health Care Providers in Person Centered Care Management of Chronic Diseases
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Abstract
Background: Information and communication-technology (ICT) could involve patients to take an active part in their care and decision-making process, and make it possible for patients to interact directly with healthcare providers and services about personal health concerns. Yet, little is known about which ICT-interventions dedicated to connected care interactions and person centered care (PCC) are studied, in particular with respect to shared care management of chronic diseases. The aim of this research is to investigate the extent, range and nature of these research-activities and identify research gaps in the existing evidence base of health studies regarding the ‘big five’ of chronic disease namely diabetes mellitus, cardiovascular and chronic respiratory diseases, cancer and stroke.
Objective: The objective of this paper is to review the literature and scope the field with respect to: Which ICT-interventions have been studied to support patients and healthcare professionals in PCC-management of the 'big five' of chronic diseases?, and: What is the impact of these interventions, such as Health Related Quality of Life and costs benefits?
Methods: This research adopts a scoping review method, employing the methodological framework of Arksey and O’Malley’s (2005) with five stages of systematic and rigorous literature review. Three electronic medical databases were accessed: PubMed, EMBASE and Cochrane Library. Only studies published between January 1985 and December 2013 were included. After (1) Identifying the research question, we continued with (2) Identifying relevant studies in the three databases by a comprehensive composed search syntax; (3) Study selection with discussed and outlined inclusion and exclusion criteria by two reviewers; (4) Charting the data and finally (5) Collating, summarizing and reporting the results.
Results: From the initial 9380 search results, we identified 350 studies that qualified for inclusion. Classified according to the participation of persons with chronic condition, the volume of studies related to diabetes mellitus is n=103, cardiovascular diseases n=89 chronic respiratory diseases n=73, cancer (n=67) and stroke n=18 (acute stroke was excluded).
Persons with a chronic condition used ICT mainly for self-measurement of the body for interacting with healthcare providers in a Person Centered Care approach. Overall, we found 60 relevant studies (17%) on shared decision-making ICT, mainly using telemonitoring and/or-medicine systems as personalized ICT-interventions (n=159).
The highest impact of person-centered care ICT-interventions related to the increase of person outcomes is empowerment (15%). Health Related Quality of Life accounts for 8%. The highest impact measured connected to health professionals is an increase in clinical outcome (12%). The impacts on organization outcomes are: decrease of hospitalization (12%) and cost efficiency (11%).
Conclusion: This scoping review has outlined different types of ICT-interventions, for each type of chronic care management to support patients to take an active part in their care and decision-making process, and make it possible to interact directly with healthcare providers and services about personal health concerns. Remarkably, the most studied impact on organization outcome is not cost efficiency itself, but the related less hospitalization (12%), closely followed by cost efficiency (11%). Hardly any of the ICT-interventions could be regarded as ‘fully’ person centered care. This review will be especially helpful to those deciding on areas where further development into research or implementation of ICT for PCC may be warranted.
References
1. Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, et al. Person-centered care—Ready for prime time. European Journal of Cardiovascular Nursing. 2011;10(4):248-51.
2. Van De Belt TH, Engelen LJ, Berben SA, Schoonhoven L. Definition of Health 2.0 and Medicine 2.0: a systematic review. Journal of medical Internet research. 2010;12(2).
3. Kwankam SY. Successful partnerships for international collaboration in e-health: the need for organized national infrastructures. Bulletin of the World Health Organization. 2012;90(5):395-7.
4. Alwan A. Global status report on noncommunicable diseases 2010: World Health Organization; 2011.
5. Gruman J, Rovner MH, French ME, Jeffress D, Sofaer S, Shaller D, et al. From patient education to patient engagement: implications for the field of patient education. Patient education and counseling. 2010;78(3):350-6.
6. Solid outcomes show e-health and chronically ill senior populations are compatible. Dis Manag Advis. 2001 Jul;7(7):103-6, 97. PubMed PMID: 11496438. Epub 2001/08/11. eng.
7. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. Journal of medical Internet research. 2008;10(3).
8. van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, et al. A holistic framework to improve the uptake and impact of eHealth technologies. Journal of medical Internet research. 2011;13(4).
9. Aarts JW, van den Haak P, Nelen WL, Tuil WS, Faber MJ, Kremer JA. Patient-focused internet interventions in reproductive medicine: a scoping review. Human reproduction update. 2012 Mar-Apr;18(2):211-27. PubMed PMID: 22108381. Epub 2011/11/24. eng.
10. Ekman I, Wolf A, Olsson L-E, Taft C, Dudas K, Schaufelberger M, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. European heart journal. 2012;33(9):1112-9.
11. Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: a decade of evolution. Journal of medical Internet research. 2013;15(5).
12. Liu S, Dunford SD, Leung YW, Brooks D, Thomas SG, Eysenbach G, et al. Reducing Blood Pressure With Internet-Based Interventions: A Meta-analysis. Canadian Journal of Cardiology. 2013;29(5):613-21.
13. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. Bmj. 2004;328(7449):1166.
14. Bensing J. Bridging the gap.: The separate worlds of evidence-based medicine and patient-centered medicine. Patient education and counseling. 2000;39(1):17-25.
15. Arksey H OML. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology: Theory & Practice. 2005;8(1):19-32.
16. Searls D. The Intention Economy: When Customers Take Charge: Harvard Business Press; 2013.
[Comment: The template does not enable Endnote references in the text, so the references are given without an indication in the abstract itself.]
Objective: The objective of this paper is to review the literature and scope the field with respect to: Which ICT-interventions have been studied to support patients and healthcare professionals in PCC-management of the 'big five' of chronic diseases?, and: What is the impact of these interventions, such as Health Related Quality of Life and costs benefits?
Methods: This research adopts a scoping review method, employing the methodological framework of Arksey and O’Malley’s (2005) with five stages of systematic and rigorous literature review. Three electronic medical databases were accessed: PubMed, EMBASE and Cochrane Library. Only studies published between January 1985 and December 2013 were included. After (1) Identifying the research question, we continued with (2) Identifying relevant studies in the three databases by a comprehensive composed search syntax; (3) Study selection with discussed and outlined inclusion and exclusion criteria by two reviewers; (4) Charting the data and finally (5) Collating, summarizing and reporting the results.
Results: From the initial 9380 search results, we identified 350 studies that qualified for inclusion. Classified according to the participation of persons with chronic condition, the volume of studies related to diabetes mellitus is n=103, cardiovascular diseases n=89 chronic respiratory diseases n=73, cancer (n=67) and stroke n=18 (acute stroke was excluded).
Persons with a chronic condition used ICT mainly for self-measurement of the body for interacting with healthcare providers in a Person Centered Care approach. Overall, we found 60 relevant studies (17%) on shared decision-making ICT, mainly using telemonitoring and/or-medicine systems as personalized ICT-interventions (n=159).
The highest impact of person-centered care ICT-interventions related to the increase of person outcomes is empowerment (15%). Health Related Quality of Life accounts for 8%. The highest impact measured connected to health professionals is an increase in clinical outcome (12%). The impacts on organization outcomes are: decrease of hospitalization (12%) and cost efficiency (11%).
Conclusion: This scoping review has outlined different types of ICT-interventions, for each type of chronic care management to support patients to take an active part in their care and decision-making process, and make it possible to interact directly with healthcare providers and services about personal health concerns. Remarkably, the most studied impact on organization outcome is not cost efficiency itself, but the related less hospitalization (12%), closely followed by cost efficiency (11%). Hardly any of the ICT-interventions could be regarded as ‘fully’ person centered care. This review will be especially helpful to those deciding on areas where further development into research or implementation of ICT for PCC may be warranted.
References
1. Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, et al. Person-centered care—Ready for prime time. European Journal of Cardiovascular Nursing. 2011;10(4):248-51.
2. Van De Belt TH, Engelen LJ, Berben SA, Schoonhoven L. Definition of Health 2.0 and Medicine 2.0: a systematic review. Journal of medical Internet research. 2010;12(2).
3. Kwankam SY. Successful partnerships for international collaboration in e-health: the need for organized national infrastructures. Bulletin of the World Health Organization. 2012;90(5):395-7.
4. Alwan A. Global status report on noncommunicable diseases 2010: World Health Organization; 2011.
5. Gruman J, Rovner MH, French ME, Jeffress D, Sofaer S, Shaller D, et al. From patient education to patient engagement: implications for the field of patient education. Patient education and counseling. 2010;78(3):350-6.
6. Solid outcomes show e-health and chronically ill senior populations are compatible. Dis Manag Advis. 2001 Jul;7(7):103-6, 97. PubMed PMID: 11496438. Epub 2001/08/11. eng.
7. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. Journal of medical Internet research. 2008;10(3).
8. van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, et al. A holistic framework to improve the uptake and impact of eHealth technologies. Journal of medical Internet research. 2011;13(4).
9. Aarts JW, van den Haak P, Nelen WL, Tuil WS, Faber MJ, Kremer JA. Patient-focused internet interventions in reproductive medicine: a scoping review. Human reproduction update. 2012 Mar-Apr;18(2):211-27. PubMed PMID: 22108381. Epub 2011/11/24. eng.
10. Ekman I, Wolf A, Olsson L-E, Taft C, Dudas K, Schaufelberger M, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. European heart journal. 2012;33(9):1112-9.
11. Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: a decade of evolution. Journal of medical Internet research. 2013;15(5).
12. Liu S, Dunford SD, Leung YW, Brooks D, Thomas SG, Eysenbach G, et al. Reducing Blood Pressure With Internet-Based Interventions: A Meta-analysis. Canadian Journal of Cardiology. 2013;29(5):613-21.
13. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. Bmj. 2004;328(7449):1166.
14. Bensing J. Bridging the gap.: The separate worlds of evidence-based medicine and patient-centered medicine. Patient education and counseling. 2000;39(1):17-25.
15. Arksey H OML. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology: Theory & Practice. 2005;8(1):19-32.
16. Searls D. The Intention Economy: When Customers Take Charge: Harvard Business Press; 2013.
[Comment: The template does not enable Endnote references in the text, so the references are given without an indication in the abstract itself.]
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