eHealth technology opportunities to support patients with multiple chronic conditions

Donna Zulman dzulman@stanford.edu
Emily Jenchura jenchura.emily@gmail.com
Danielle Cohen daniellecohen86@gmail.com
Eleanor Lewis eleanor.lewis@va.gov
Thomas Houston thomas.houston2@va.gov
Steven Asch sasch@stanford.edu

Abstract

Background: eHealth technology such as personal health records, web-based disease management programs, and mobile applications can support patient self-management and health care navigation. These tools, however, are frequently disease-specific in design. Optimization of eHealth tools for patients with multiple chronic conditions requires an understanding of challenges and technology needs specific to multimorbidity.

Methods: We conducted a qualitative needs assessment of patients with multiple chronic conditions from an academic medical center and a Veterans Affairs facility. A screening questionnaire was used to identify 330 patients with ≥ 3 chronic conditions and with experience using health-related technology. We used purposive sampling to construct 10 groups of 3-8 patients, grouping individuals by age, sex, primary health care setting, and a common chronic condition to facilitate discussion. A trained facilitator moderated the focus groups using a semi-structured guide based on the Fit between Individual, Task, and Technology (FITT) framework to elicit discussion about 1) challenges that patients face when they have multiple chronic conditions, and 2) patients’ use of technology—and opportunities to enhance technology—to address these challenges. Standard content analysis methods were used to code textual data from focus group transcripts. Three investigators generated preliminary codes based on the FITT framework, and two investigators independently read and coded all transcripts using ATLAS.ti software. Emergent themes were reviewed with all collaborators, and final themes and representative quotes were validated through a follow-up survey with a sample of focus group participants.

Results: Among focus group participants (n = 53), the mean (SD) number of chronic conditions was 5(2) with the most common including hypertension (75%), chronic pain (64%), arthritis (49%), diabetes (34%), and depression (40%). Patients described using technology most frequently to search for health information (96%), communicate with health care providers (92%), track medical information (83%), track medications (77%), and support decision-making about treatment (55%). Focus group discussions yielded three overarching themes about multimorbid patients’ challenges that may be amenable to eHealth technology support: 1) Needing to serve as expert and advocate because of a unique combination of health issues (“You have to be your own advocate and research everything you can because sometimes you will be more cutting-edge than your doctor”); 2) Managing a high volume of information, visits, and self-management tasks (“I can save myself easily 15 or 20 visits a year just by messaging my primary or my neurologist”); and 3) Coordinating, synthesizing, and reconciling information from different providers and about different conditions (“My illness crosses so many specialty boundaries…I am always playing tag between one of four doctors”). Several desirable eHealth tools emerged from discussions, including resources that retrieve and synthesize information about multiple conditions and medications, applications that manage tasks and health records across multiple healthcare systems, tools that facilitate communication with multiple providers, and social media that connects patients with similar conditions.

Conclusions: Patients with multiple chronic conditions have holistic, rather than condition-specific, needs from eHealth technology, and desire tools that reconcile information about different conditions and enhance communication across providers and systems.

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