JMIR Publications

ABSTRACT

Background:

Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practice around the provision of well-coordinated, person-centred care for persons with multimorbidity (PwMs). Present health systems across the European Union (EU) focus on supporting a single disease framework of care; the primary challenge is to create a patient centric integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale Horizon 2020 funded project, that involved the design, development and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged 65+) living with multimorbidity.

Objective:

This paper describes the trial implementation protocol of a proof of concept (PoC) digital health platform (ProACT) in two EU member states (Ireland and Belgium) to support older persons with multimorbidity self-managing at home, supported by their care network.

Methods:

Research was conducted across two EU member states, Ireland and Belgium. A twelve month action research trial design, divided into three evaluation cycles, lasting three months each, with a reflective re-design phase of one month after cycles 1 and 2 was conducted. Participants were 120 (n=60 in Ireland and Belgium respectively) older persons with multimorbidity (PwMs) diagnosed with two or more of the following chronic conditions: diabetes; chronic obstructive pulmonary disease (COPD); chronic heart failure (CHF); cardiovascular diseases (CVDs). With permission from the PwM, members of their care network (CN) were invited to participate in the study. PwM participants were provided with ProACT technologies (tablet/devices/sensors) to support them in self-managing their conditions. CN members also received access to an application to remotely support their PwM. Qualitative and quantitative feedback and evaluation data from PwM and CN participants was collected across 4 time-points: baseline (T1); at the end of each 3-month action research cycle (T2; T3) and in a final post-trial interview (T4). Thematic analysis was used to analyse qualitative interview data. Quantitative data were analysed via platform usage statistics (to assess engagement) and standardised questionnaires (using descriptive and inferential statistics). This study was approved by ethics committees in Ireland and Belgium.

Results:

The trial implementation phase for this 44 month (2016-2019) funded study was April 2018 to June 2019. Trial outcomes are at various stages in the process towards publication from 2021.

Conclusions:

ProACT aims to co-design and develop a digital intervention with PwMs and their CN, incorporating clinical guidelines with the state of the art in; human computer interaction, behavioural science, health psychology and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive integrated model of supported person-centred care.