Evaluation of an eHealth intervention in chronic care for frail older people: why adherence is the first target

• Published in: Journal of medical Internet research Vol. 16; no. 6; p. e156
• Main Authors: Makai, Peter, Perry, Marieke, Robben, Sarah H M, Schers, Henk J, Heinen, Maud M, Olde Rikkert, Marcel G M, Melis, René F
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 01-06-2014; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications Inc; JMIR Publications
• Subjects: Activities of Daily Living; Adult Care Services; Aged; Aged, 80 and over; Analysis; Care and treatment; Caregivers; Clinical outcomes; Communication; Continuity of care; Coordination; Data collection; Education; Elderly; Elderly people; Electronic health records; Family medicine; Female; Frail; Frail Elderly; Frailty; Gerontology; Handicapped; Health; Health status; Home care; Humans; Interdisciplinary approach; Internet; Intervention; Long-Term Care - methods; Long-term care of the sick; Male; Mental health; Netherlands; Older people; Organization theory; Original Paper; Patient Compliance; Patient satisfaction; Patient-Centered Care - organization & administration; Patients; Primary care; Professionals; Suffering; Telemedicine - utilization; Virtual Reality; Web portals; Welfare; Netherlands; frail elderly; care coordination; eHealth; chronic care
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.3057

Older people suffering from frailty often receive fragmented chronic care from multiple professionals. According to the literature, there is an urgent need for coordination of care.
The objective of this study was to investigate the effectiveness of an online health community (OHC) intervention for older people with frailty aimed at facilitating multidisciplinary communication.
The design was a controlled before-after study with 12 months follow-up in 11 family practices in the eastern part of the Netherlands. Participants consisted of frail older people living in the community requiring multidisciplinary (long-term) care. The intervention used was the health and welfare portal (ZWIP): an OHC for frail elderly patients, their informal caregivers and professionals. ZWIP contains a secure messaging system supplemented by a shared electronic health record. Primary outcomes were scores on the Instrumental Activities of Daily Living scale (IADL), mental health, and social activity limitations.
There were 290 patients in the intervention group and 392 in the control group. Of these, 76/290 (26.2%) in the intervention group actively used ZWIP. After 12 months follow-up, we observed no significant improvement on primary patient outcomes. ADL improved in the intervention group with a standardized score of 0.21 (P=.27); IADL improved with 0.50 points, P=.64.
Only a small percentage of frail elderly people in the study intensively used ZWIP, our newly developed and innovative eHealth tool. The use of this OHC did not significantly improve patient outcomes. This was most likely due to the limited use of the OHC, and a relatively short follow-up time. Increasing actual use of eHealth intervention seems a precondition for large-scale evaluation, and earlier adoption before frailty develops may improve later use and effectiveness of ZWIP.