J. Med. Internet Res. - Evaluation of an eHealth intervention in chronic care for frail older people: why adherence is the first target.


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CKGROUND: 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.OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

Resumo Limpo

ckground older peopl suffer frailti often receiv fragment chronic care multipl profession accord literatur urgent need coordin careobject object studi investig effect onlin health communiti ohc intervent older peopl frailti aim facilit multidisciplinari communicationmethod design control beforeaft studi month followup famili practic eastern part netherland particip consist frail older peopl live communiti requir multidisciplinari longterm care intervent use health welfar portal zwip ohc frail elder patient inform caregiv profession zwip contain secur messag system supplement share electron health record primari outcom score instrument activ daili live scale iadl mental health social activ limitationsresult patient intervent group control group intervent group activ use zwip month followup observ signific improv primari patient outcom adl improv intervent group standard score p iadl improv point pconclus small percentag frail elder peopl studi intens use zwip newli develop innov ehealth tool use ohc signific improv patient outcom like due limit use ohc relat short followup time increas actual use ehealth intervent seem precondit largescal evalu earlier adopt frailti develop may improv later use effect zwip

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