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

Carolina Wannheden,Terese Stenfors,Claes-Göran Östenson,Karin Pukk Härenstam,Ulrica Von Thiele Schwarz

doi:10.3390/su13095221

Carolina Wannheden, Terese Stenfors + Show 3 more

Open Access

https://doi.org/10.3390/su13095221

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Abstract

Chronic care management is dependent on productive interactions between patients and healthcare professionals. Digital health technologies (eHealth) open up new possibilities for improving the quality of care, but there is a limited understanding of what productive interactions entail. This study explores characteristics of productive interactions to support self-care and healthcare in the context of eHealth use in diabetes care. We collected qualitative data based on interviews with nurses and responses to open-ended survey questions from patients, prior to and post using an eHealth service for self-monitoring and digital communication. We found that eHealth’s influence on productive interactions was characterized by unconstrained access, health parameter surveillance, and data-driven feedback, with implications for self-care and healthcare. Our findings indicate that eHealth perforates the boundaries that define interactions under traditional, non-digital care. This was manifested in expressions of uncertainty and in blurred boundaries between self-care and healthcare. We conclude that the attainment of a sustainable eHealth ecosystem will require healthcare to acknowledge eHealth as a disruptive change that may require re-organization to optimally support the productive use of eHealth services for both patients and staff, which includes agreement on new routines, as well as social interaction rules.

Highlights

Chronic care management requires collaboration and integration of resources from several actors, including patients, healthcare professionals, and the community
The model outlines how outcomes are achieved by productive interactions between patients and healthcare professionals, which in turn depend on effective selfmanagement support, delivery system design, decision support, and clinical information systems [2]
The study was conducted in a Swedish primary care setting with diabetes nurses and diabetes patients who participated in an eHealth intervention pilot for self-monitoring and digital communication at two primary care centers (PCCs)

Summary

Introduction

Chronic care management requires collaboration and integration of resources from several actors, including patients, healthcare professionals, and the community. This has been emphasized in the Chronic Care Model (CCM), which was first presented in the late. More recently published models include the House of Care [3], and the model of healthcare coproduction [4]. All these models exemplify an effort to conceptualize how people, technology, and resources can be integrated to co-create sustainable value in networked healthcare [5].

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