Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy.
Biomed Res Int. 2020 Apr 8;2020:9025326. doi: 10.1155/2020/9025326. eCollection 2020.
eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics.
In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country).
85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development.
Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.
电子健康应用程序有可能为患有多种疾病（MM）的患者提供新的综合护理服务，同时也支持多学科护理。本文的目的是探索在欧洲国家，电子健康工具在针对患有多种疾病（MM）的（老年）人群的综合护理计划中目前的采用程度如何，包括根据一些基本的卫生系统特征，采用这些工具的益处和障碍。
在 2014 年，在 ICARE4EU 项目的框架内，24 个欧洲国家的专家组织确定了 101 个综合护理计划。选定计划的管理人员完成了一份在线问卷，涵盖了几个方面，包括电子健康的使用。我们分析了这份问卷的数据，此外还分析了通过案例研究方法深入研究的六个创新计划的定性信息，这些计划的信息是根据国家卫生系统的特点得出的：国家卫生模式（融资系统）、初级保健（PC）的整体实力（结构/服务提供过程）以及卫生系统的去中心化程度（国家的行政权力）。
85 个计划（101 个中的 85 个）采用了至少一种电子健康工具，其中 42 个计划专门针对老年人。在大多数情况下，使用了电子健康记录（EHR），并且出现了一些益处，例如改善了护理管理和整合，尽管资金不足的机制是一个主要障碍。通过卫生系统特征的分析表明，在去中心化的国家、采用国民健康服务（NHS）模式的国家和具有强大/中等水平的 PC 发展的国家，电子健康应用的采用率更高。
尽管存在一些限制，但研究结果表明，电子健康工具的使用与卫生系统的基本特征之间存在关系，卫生系统的去中心化、NHS 模式以及强大/中等水平的 PC 发挥着关键作用。然而，为了提供更具创新性和综合性的护理，似乎有必要对欧洲卫生系统进行调整。
