Abstract
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.
Highlights
EHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), supporting multidisciplinary care
On the basis of these considerations, the aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for people with MM in Europe, according to three characteristics of health systems: the type of national health model (NHS, Social Insurance System (SIS), and Transition Country (TC)), strength of primary care (PC) development, and level ofcentralization of a health system
Regarding barriers in relation to some characteristics of health systems, the fact that we found them significantly more perceived in centralized and Social Insurance System/Transition Countries (SIS/TC) countries and countries with weak PC is in line with opposite findings from our study concerning a greater implementation of care programs adopting eHealth applications in decentralized countries, with a National Health Service (NHS) model, and a strong/medium PC
Summary
EHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), 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. 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). 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. MM estimates in older adults vary according to the different data sources [10]
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