*Donna Zulman, Emily Jenchura, Steven M. Asch, Danielle Cohen, Eleanor Lewis
Poster Presentation – Research Track
Sunday, Sept 30, 2012: 11:25 AM – 12:25 PM – LK Lower Lobby

*Presenting Speaker

Background
Multimorbidity—the presence of multiple chronic conditions—generates complex self-management and care coordination challenges, and often results in excessive health care utilization, disproportionate costs, and poor clinical outcomes. Rapidly advancing patient-facing eHealth technologies offer opportunities to support and activate these patients and their caregivers. Most existing eHealth tools, however, limit their focus to single illnesses, such as diabetes or depression, and rarely address the specific challenges that arise due to interactions among multiple conditions. To examine the role of eHealth technology for multimorbid patients, we developed a formative study guided by the FITT framework—Fit betweenIndividual, Task, and Technology.According to FITT, technology is more likely to be adopted and have a positive impact if it is optimized to support the tasks faced by individual users. In this research-in-progress, we aim to: 1) Understand how patients and their caregivers currently use eHealth technology to manage multiple chronic conditions, 2) Describe barriers and facilitators to such use, and 3) Identify opportunities to enhance eHealth tools to better meet the needs of these individuals.

Methods
This mixed methods study combines quantitative survey findings and qualitative data from in-depth focus groups with patients from Stanford University and the Veterans Affairs Palo Alto Health Care System. Over 1000 patients will complete a survey that queries participants on self-management challenges, eHealth literacy, and comfort and experience using different technologies. Subsequent focus groups with approximately 80 patients and their caregivers will explore opportunities to enhance eHealth technology to better address these individuals’ needs. We will conduct a total of 12 focus groups, each with 6-8 individuals grouped by age and one or more health conditions (e.g., heart failure, diabetes, anddepression). In the context of the FITT framework, we will use a semi-structured focus group guide and standard content analysis techniques to examine current and potential eHealth technology use by patients and caregivers to manage multiple chronic conditions.

Preliminary Results
Pilot tests of study instruments suggest that multimorbid patients face unique challenges that may be addressed through targeted eHealth tools. For example, some patients report that medications taken for one condition exacerbate symptoms of another condition. eHealth technology could potentially address this challenge by enabling patients to visually display and monitor their medication use and concurrent symptoms, and to share this information with their health care providers.

Conclusion
This in-depth exploration of self-management challenges and technology use patterns among patients with multiple chronic conditions and their caregivers will ultimately inform the development of novel—and the adaptation of existing—eHealth tools that better support their needs.