Going digital: a narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management

Smartphone health applications (apps) are being increasingly used to assist patients in chronic disease
self-management. The effects of such apps on patient outcomes are uncertain, as are design features that maximise usability and efficacy, and the best methods for evaluating app quality and utility.

Headroom approach to device development: current and future directions

Headroom analysis as a method to estimate the potential for a cost-effective implementation of self-management interventions

The COMPAR-EU project aims to rank the most (cost-)effective interventions for self-management. To estimate the cost-effectiveness of self-management interventions (SMIs) health economic models were used to predict the lifetime health benefits and (healthcare) costs for a scenario assuming one-time implementation of a SMI in comparison with a scenario assuming care as usual.

One of the important components of a cost-effectiveness analysis is the cost of the intervention. However, in some cases these costs are not readily available. As an alternative to standard cost-effectiveness analysis a headroom analysis can then be performed. In a headroom analysis (1), a headroom is estimated indicating how much an intervention or treatment may maximally cost to be considered cost-effective given the health benefits associated to the intervention and a threshold for the cost associated to these health benefits. Health benefits are often expressed in quality-adjusted life-years (QALYs). A threshold for the cost per QALY reflects the maximum cost society is willing to pay to gain one additional QALY.

In the COMPAR-EU project data on the characteristics and health benefits of SMIs were obtained from published data. The cost of SMIs is determined by factors such as the type of healthcare provider involved, the time spend per patient and the mode of delivery. The majority of published studies on self-management did not provide enough detailed information on these factors to be able to estimate the cost of SMIs. Therefore, a headroom analysis was conducted to estimate what SMIs may maximally cost to be considered cost-effective given its health benefits and a certain threshold for cost-effectiveness. Headrooms were estimated for two different threshold values: €20,000 per QALY gained, as this is a figure that is often used in the context of preventive interventions, and €50,000 per QALY gained, as this value is more often used for curative interventions in for instance COPD and heart failure patients. Overall, headrooms for SMIs varied across diseases and countries and were estimated to range from €0 to €2,400 and from €200 to €8,000 at a threshold of €20,000 and €50,000, respectively.

A lower headroom for a particular SMI implies that the SMI needs to be delivered at lower cost in order to achieve cost-effectiveness. As such, headroom estimates are relevant for policymakers and health care providers as they give guidance to when (and when not) to consider SMIs a tool to gain health at reasonable costs, and in what disease areas and patient groups it might be more efficient to invest in SMIs.

Hoogendoorn-Lips_Martine

Martine Hoogendoorn

Martine Hoogendoorn is a Senior Researcher at iMTA with more than 15 years experience in modelling the disease COPD. She holds a Master´s degree in Human Nutrition from Wageningen University and a PhD in Health Economics from the Erasmus University Rotterdam. She has extensive experience in disease modelling using different types of models (e.g. cohort, patient-level, Markov, DES).

de_Groot_ Saskia

Saskia de Groot

Saskia is a Medior Researcher at iMTA. She holds a Master´s degree in Health Economics, Policy & Law from the Erasmus University Rotterdam, a Master´s degree in Clinical Epidemiology from the Netherlands Institute for Health Science of the Erasmus Medical Center and a PhD in Health Economics from the Erasmus University Rotterdam.

Reference

[1] Girling A, Lilford R, Cole A, Young T. Headroom approach to device development: current and future directions. Int J Technol Assess Health Care. 2015 Jan;31(5):331-8.

Qualitative interviews to facilitate a smooth transition from the evidence of self-management interventions to practice

During digitization in the healthcare system and the continuously advancing process toward patient-centred care, the responsibility of patients for their own health is becoming increasingly important. Particularly in the case of chronic diseases, it is important that patients are enabled to actively participate in the management of the disease [1]. This is where self-management interventions (SMIs) play a significant role. SMIs aim to equip patients and informal caregivers if appropriate to actively participate in the management of their disease [2].

SMIs have good evidence and are very well researched. We are developing the COMPAR-EU interactive platform with different types of decision-making tools that summarize this evidence about SMI in a structured and transparent way. The decision tools can support decision-making on SMIs and so integrating the evidence into practice for different end users such as patients, clinicians, policymakers or guideline developers.

Many well evidenced and exhaustively developed decision-making tools and interventions do not deliver their potential impact because their use requires changes in clinical workflows as well as organizational structure. In addition to this there is insufficient support for these changes [3]. This leads to the question how decision-making tools can facilitate and disseminate the use of the most effective SMIs into the real life? How can it be made visible at the right time and what incentives are there for healthcare professionals and managers to use decision-making tools and the other way around SMIs?

Interviews with managers and clinicians

These are the questions we want to explore with qualitative implementation interviews with managers and health care professionals at the organisational level in COMPAR-EU countries. We will use their insights to build and refine business plans for the various provider and health system context. This means that a manager or clinician working in any relevant provider can look at the business plan and identify any key actions they should take which would help themselves and their colleagues make use of the decision tools produced by COMPAR-EU.

Collecting information on different health systems represented in COMPAR-EU countries illustrates that Germany and Spain provide a good representation of health system feature, in particular due to the differences in organisational enablers in insurance-based system than purely public system. Therefore, we have conducted a total of 40x qualitative interviews with managers and clinicians in Spain and Germany. The participants were recruited from different settings (primary care practice, hospital or special care practice) so we can obtain the implementation factors of innovations from different perspectives. We developed a semi-structured interview guide with reference to the TICD framework and a realist review by Joseph-Williams et. al (2020).

Figure 1 The overall process of qualitative implementation study

Directed qualitative content analysis

Currently, the interviews need to be analysed. We will use directed qualitative content analysis (QCA). This approach allows combining the development of deductive as well as inductive codes, and so allowing the use of existing evidence. A guide for analysis will be provided, based on the work of Hsieh and Shannon [4], Hamilton [5], and Gale et al. [6]. A codebook will be developed by OptiMedis based on the TICD framework [7] (inductive) and interviews conducted (deductive).

Challenges of the cross-national research

As the translation of the interview guide in different languages is considered to be challenging task [8], we had several meetings to adjust and translate the interview guide to ensure the cultural meaning of the questions and the shared understanding between both teams, as the interviewers from different countries may have different views and experience.

Additionally, we agreed to conduct the interviews in the local language of the respective country to avoid any language difficulties for both the participants and the interviewers. After pretesting of the developed coding system, we will discuss and add possible additional themes if needed. Similar as in other studies [9] [10], each country team will analyse the data in the native language as long as possible and not translate all interview data into one language. This form of rapid qualitative analysis yields similar results compared to traditional qualitative analysis and is therefore a useful tool for this analysis [11].

Business plans with key actions for implementation

In summary, the interviews aim to identify drivers and barriers for the use of decision tools on the COMPAR-EU platform capturing the evidence of SMIs in practice. These results will serve to develop business plans for organisations who will actually be making use of the decision-making tools. These business plans will focus on how to implement evidence based decision aids about SMI at the organizational level into the healthcare system.

Nina Sofie Krah_Quadrat

Nina Sofie Krah

Nina has a background in Health Economics & Health Care Management as well as Ethics in Health Care and works at OptiMedis as a working student. With a keen interest in the use of evidence in the health care system, her master’s thesis explores the conditions under which self-management interventions can be meaningfully implemented into clinical workflow.

Porträt_Zietzsch_Paula

Paula Zietzsch

Paula has a background in Health Economics and works at OptiMedis in different national and EU projects with a particular interest in shared decision-making. As a Research & Innovation Manager, she focuses on implementing evi-dence-based interventions in routine clinical care.

References

[1] Aujoulat I, Marcolongo R, Bonadiman L, Deccache A. Reconsidering patient empowerment in chronic illness: a critique of models of self- efficacy and bodily control. Soc Sci Med. 2008;66(5):1228-1239. https://doi.org/10.1016/j.socscimed.2007.11.034.

[2] Tattersall RL. TThe expert patient: a new approach to chronic disease management for the twenty-first century. Clin Med (Lond). 2002;2(3):227-229. https://doi.org/10.7861/clinmedicine.2-3-227.

[3] Orrego C, Ballester M, Heymans M, et al; the COMPAR-EU Group. Talking the same language on patient empowerment: Development and content validation of a taxonomy of self-management interventions for chronic conditions. Health Expect. 2021;00:1–13. https://doi.org/10.1111/hex.13303.

[4] Hsieh H-F, Shannon SE. Three Approaches to Qualitative Content Analysis . Qual Health Res 2005;15:1277–88.

[5] Hamilton AB, Finley EP. Qualitative methods in implementation research: An introduction. Psychiatry Res 2019;280. https://doi.org/10.1016/j.psychres.2019.112516.

[6] Gale RC, Wu J, Erhardt T, Bounthavong M, Reardon CM, Damschroder LJ, et al. Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implement Sci 2019;14:1–12. https://doi.org/10.1186/s13012-019-0853-y.

[7] Flottorp SA, Oxman AD, Krause J, Musila NR, Wensing M, Godycki-Cwirko M, et al. A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci 2013;8:1–11. https://doi.org/10.1186/1748-5908-8-35.

[8] McGreevy J, Orrevall Y, Belqaid K, Bernhardson BM. Reflections on the process of translation and cultural adaptation of an instrument to investigate taste and smell changes in adults with cancer. Scand J Caring Sci. 2014 Mar;28(1):204-11. DOI: 10.1111/scs.12026.

[9] Woolhead G, Tadd W, Boix-Ferrer JA, Krajcik S, Schmid-Pfahler B, Spjuth B, Stratton D, Dieppe P; Dignity, and Older Europeans (DOE) project. “Tu” or “Vous?” A European qualitative study of dignity and communication with older people in health and social care settings. Patient Educ Couns. 2006 Jun;61(3):363-71. doi: https://doi.org/10.1016/j.pec.2005.04.014. Epub 2005 Jun 20. PMID: 15970421.

[10] Knutsen, I., Foss, C., Todorova, E., Roukova, P., Kennedy, A., Portillo, M., . . . Rogers, A. (2015). Negotiating diet in networks: A cross-European study of the experiences of managing Type 2 diabetes. Qualitative Health Research. 1-12. https://doi.org/10.1177/1049732315610318.

[11] Nevedal, A.L., Reardon, C.M., Opra Widerquist, M.A. et al. Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implementation Sci. 2021; 16(67).

Invitation: COMPAR-EU workshop May 2022, digital

The COMPAR-EU project team invites you to join a workshop on Exploring market opportunities of self-management tools. It will take place on 19/05/22 – digital.

What do we want to explore with you?

  • How decision tools could be embedded in the value chain and assess commercial issues surrounding market exploitation, such as competition and procurement procedures?
  • How to market the decision tools to different stakeholder groups?
  • What are the opportunities for implementation and what are the barriers to the use of self-management decision tools?

Attending the workshop, you will get an opportunity to:

  • Learn about new innovations, self-management tools, and state-of-the-art research developed by the COMPAR-EU consortium
  • Network and exchange knowledge with other companies working in the same field
  • Be a part of the transformation of research results into the practice
  • Start a new cooperation to implement self-management tools in real life

Please register here: WORKSHOP 19/05/22

We look forward to seeing you!

For more information, please contact Paula Zietzsch via e-mail contact@self-management.eu

Your COMPAR-EU Team

Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease: Are Current Models Suitable to Evaluate Personalized Medicine?

Call for tender for design work on the COMPAR-EU project

On 15 February 2022, the European Patients’ Forum published a new call for tender to produce attractive and accessible leaflet and video designs as part of its work in the COMPAR-EU project.

COMPAR-EU is a Horizon 2020 project aiming to identify, compare, and rank the most effective and cost-effective self-management interventions in four chronic conditions. In this project, EPF leads the workstream that aims to identify what outcomes are most important to patients, and ensure that their views, gender, and socioeconomic dimensions are taken into account.

As part of this work, EPF has developed lay summaries and leaflets to adapt the technical reports of the project into language that is accessible for lay-users including patients, but also the wider public. These materials – the leaflets and videos – must also be visually appealing in a way that facilitates their readability.

Does this sound like it is within your expertise, or the expertise of someone you have worked with?

Applications must be sent in by 11 March 2022, 23:59.
Further details at this link: https://bit.ly/3LzLKKe

Conducting a multicentre and multinational qualitative study on patient transitions

Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

Self-Management Europe has great ambitions!

In this way we want to create a network of researchers, health care professionals, developers, industry and other stakeholders whose common goal is to improve patient self-management and empowerment of patients with chronic diseases in Europe. SME is a spin-off of COMPAR-EU and initiated by four COMPAR-EU partners that all have a broad experience on self-management, patient empowerment and personalized health care: FAD, Nivel, OptiMedis and EPF.

SME aims to raise public, professional and political awareness of the critical role patients play in living with chronic disease by providing the most updated and innovative multidisciplinary knowledge about self-management interventions and empowerment and how to address these topics in Europe in policy and practice; SME wants to provide practical tools to encourage and support health care professionals to adopt SMI in their real life contexts; work with organizations and industry to develop approaches to incorporate SMI in practice; will organize training courses on implementing approaches which support patients’ self-management and empowerment, and make the expertise of experienced programs and interventions available to others.

During the last year we worked on a website and on a mission paper on SME (in progress). While we are looking for some structural funding to carry out the ambitious activities outlined above, we are giving small steps on some areas that, in our opinion, complement the work done in COMPAR-EU. The first dissemination activity of SME were two “ALERTS” for healthcare professionals, managers and other stakeholders looking for practical recommendations to implement practices that enhance self-management and patient empowerment. The first alert was on empowerment of patient to take an active role in health care, the second alert on health literacy.

Click here to read more about Self-Management Europe.

Monique

Monique Heijmans

Monique Heijmans is a Health Psychologist and works as a Senior Researcher at Nivel since 1998. She is an expert in the area of (determinants of) self-management and chronic illness and has extensive research experience in the area of psychosocial factors and their interaction with health behavior and health.