Er is een toename van het aanbod van e-health-toepassingen in Nederland, dat blijkt onder meer uit de e-health monitor 2016 (www.e-health-monitor.nl). Eén van de aanbevelingen uit deze monitor is dat meer onderzoek moet plaatsvinden naar veilige en effectieve e-health-toepassingen. In dit artikel bundelen onderzoekers van verschillende kenniscentra hun ervaringen en beschrijven de door hen geleerde lessen die zijn gebaseerd op diverse onderzoeksprojecten.
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E-health in de mondzorg. Is eHealth de sleutel tot een effectieve bijdrage aan de mondzorg bij thuiswonende ouderen? NTvM, januari 2017 , nummer 1
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In deze literatuurstudie werden vier databanken doorzocht met behulp van trefwoorden zoals chronic disease, e-health, factors en suggested interventions. Kwalitatieve, kwantitatieve en mixed methods-studies werden meegenomen. Uit de data van de 22 artikelen die werden geïncludeerd in de studie, blijken leeftijd, geslacht, inkomen, opleidingsniveau, etnische achtergrond en woonplaats (stad of platteland) in meer of mindere mate van invloed te zijn op het gebruik van e-health. Het artikel is een Nederlandstalige samenvatting van het artikel: Reiners, Sturm, Bouw & Wouters (2019) uit Int J Environ Res Public Health 2019;16(4)
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Purpose: To systematically review the literature on effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders. Materials and methods: Using online data sources PubMed, Embase, and Cochrane in adults with musculoskeletal disorders with a pain-related complaint. Remote physiotherapeutic e-Health interventions were analysed. Control interventions were not specified. Outcomes on effect of remote e-Health interventions in terms of pain intensity. Results: From 11,811 studies identified, 27 studies were included. There is limited evidence for the effectiveness for remote e-Health for patients with back pain based on five articles. Twelve articles studied chronic pain and the effectiveness was dependent on the control group and involvement of healthcare providers. In patients with osteoarthritis (five articles), total knee surgery (two articles), and knee pain (three articles) no significant effects were found for remote e-Health compared to control groups. Conclusions: There is limited evidence for the effectiveness of remote physiotherapeutic e-Health interventions to decrease pain intensity in patients with back pain. There is some evidence for effectiveness of remote e-Health in patients with chronic pain. For patients with osteoarthritis, after total knee surgery and knee pain, there appears to be no effect of e-Health when solely looking at reduction of pain. Implications for rehabilitation This review shows that e-Health can be an effective way of reducing pain in some populations. Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain. Autonomous e-Health is more effective than no treatment in patients with chronic pain. There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.Implications for rehabilitation* This review shows that e-Health can be an effective way of reducing pain in some populations.* Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain.* Autonomous e-Health is more effective than no treatment in patients with chronic pain.* There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.
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Background: Changes in reimbursement have been compelling for Dutch primary care practices to apply a disease management approach for patients with chronic obstructive pulmonary disease (COPD). This approach includes individual patient consultations with a practice nurse, who coaches patients in COPD management. The aim of this study was to gauge the feasibility of adding a web-based patient self-management support application, by assessing patients’ self-management, patients’ health status, the impact on the organization of care, and the level of application use and appreciation. Methods: The study employed a mixed methods design. Six practice nurses recruited COPD patients during a consultation. The e-Health application included a questionnaire that captured information on demographics, self-management related behaviors (smoking cessation, physical activity and medication adherence) and their determinants, and nurse recommendations. The application provided tailored feedback messages to patients and provided the nurse with reports. Data were collected through questionnaires and medical record abstractions at baseline and one year later. Semi-structured interviews with patients and nurses were conducted. Descriptive statistics were calculated for quantitative data and content analysis was used to analyze the qualitative data. Results: Eleven patients, recruited by three nurses, used the application 1 to 7 times (median 4). Most patients thought that the application supported self-management, but their interest diminished after multiple uses. Impact on patients’ health could not be determined due to the small sample size. Nurses reported benefits for the organization of care and made suggestions to optimize the use of the reports. Conclusion: Results suggest that it is possible to integrate a web-based COPD self-management application into the current primary care disease management process. The pilot study also revealed opportunities to improve the application and reports, in order to increase technology use and appreciation.
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Background: Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health. Purpose: To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD. Methods: A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience. Results: Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application. Conclusions: Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitation The rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications. Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care. Especially during the treatment process, there is a need for clear animated videos and reminders for the patients.
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Introduction: Success of e-health relies on the extent to which the related technology, such as the electronic device, is accepted by its users. However, there has been limited research on the patients’ perspective on use of e-health-related technology in rehabilitation care. Objective: To explore the usage of common electronic devices among rehabilitation patients with access to email and investigate their preferences regarding their usage in rehabilitation. Methods: Adult patients who were admitted for inpatient and/or outpatient rehabilitation and were registered with an email address were invited to complete an electronic questionnaire regarding current and preferred use of information and communication technologies in rehabilitation care. Results: 190 out of 714 invited patients completed the questionnaire, 94 (49%) female, mean age 49 years (SD 16). 149 patients (78%) used one or more devices every day, with the most frequently used devices were: PC/laptop (93%), smartphone (57%) and tablet (47%). Patients mostly preferred to use technology for contact with health professionals (mean 3.15, SD 0.79), followed by access to their personal record (mean 3.09, SD 0.78) and scheduling appointments with health professionals (mean 3.07, SD 0.85). Conclusion: Most patients in rehabilitation used one or more devices almost every day and wish to use these devices in rehabilitation. https://doi.org/10.1080/17483107.2017.1358302
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Background: To prevent deterioration after admission to the intensive care unit (ICU), and to improve rehabilitation, the ICU team should use digital technologies to provide comprehensive and practical information alongside personalised support for survivors and their family members. However, a knowledge gap exists on the users’ preferences for such an e-health platform in ICU follow-up services. Objectives: This study aims to explore the opinions and priorities for an e-health platform, including choices in digital elements, according to survivors of critical illness and their family members. Methods: A cross-sectional survey was used among members and other interested individuals of the Dutch volunteer organisation ‘Foundation Family- and Patient-Centred Intensive Care’. An investigator-developed questionnaire was disseminated through the newsletter and social media channels of the Foundation Family- and Patient-Centred Intensive Care. The results of this member consultation were analysed and reported as descriptive statistics on demographic variables and outcome measures in opinions and priorities of the participants. Results: Most of the 227 participants were female (76%), aged 46–55 years (33%), and completed higher education (70%). The participants reported high confidence in advice delivered through an e-health platform (72%). They prioritised the provision of a guide including relevant professionals who may support them during their recovery when using an e-health platform. Conclusions: ICU survivors prioritised the provision of relevant professionals who may support them during their recovery when using an e-health platform; however, selection bias means the population studied is likely to be more digitally connected than the general ICU population. Digital solutions could cater to their information and support needs. For family members, the highest priority reported was receiving help in managing their emotional distress. The development of an e-health platform considering the opinions and priorities of this target group could contribute to a personalised recovery trajectory promoting self-management while including digital elements addressing relevant ICU follow-up services.
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Purpose eHealth projects in the Netherlands have various backgrounds. First, the number of persons aged 65 and over will have increased by 400,000 between 2008 and 20131. Over the same period, the potential workforce will have decreased from 4.2 persons at present to 3.6 persons for each 65 plus. Second, there is a shift from institutional care to care provided at home. The Dutch government promotes healthy behaviour and emphasises the importance of disease prevention2. People prefer to continue living in the community, even when their health is declining. Finally, Dutch policies stimulate the use of e-health in order to (i) support ageing-in-place (AiP), (ii) to enhance the quality of life of older adults, and (iii) to reduce the workload of professional carers. Method Vilans’ Centre of Excellence for Long-Term Care3 database of 85 projects was analyzed. The projects included in the database date from 2004 and after. Some of these projects have been completed and terminated; other projects are still ongoing. Although the database includes the majority of the projects, a complete coverage of all projects in The Netherlands is not guaranteed. To analyse the barriers, all projects were sorted according to one type of e-Health project (videoconferencing, activity monitoring, other types). In this study, basic, functional and economic values from the Model of Integrated Building Design4 were considered as relevant stakeholder values deemed necessary for a successful implementation. Results & Discussion Most projects in the database use e-Health for the support of older adults with (48 projects) or without (35 projects) care needs. In addition, dementia (19 projects), COPD and diabetes (both 11 projects) are the three health conditions that e-Health applications are most often used for. A major barrier for implementation is that only 11 out the 85 projects have a social business case. Another barrier is that requirements to building construction, building systems, e-Health applications or (building) services are hardly ever considered in the projects that also aim to support ageing-in-place. There are many stakeholders involved in the e-Health projects, and not all of the needs of these stakeholders are met in the design and implementation of the accompanying technologies. The execution of these projects seems to consist merely of an analysis of the technological applications with emphasis on the needs of the care recipient and other primary users. To date, e-Health projects in The Netherlands have not been fully implemented5. As well as a failure to include stakeholder needs and accounting for potential barriers, another reason may be that use of e-Health in care will imply innovating care protocols. Care provision shifting from a medical disease oriented model towards a care and wellbeing model. A structural exchange of knowledge and experience in functionalities and user needs will be necessary to take away barriers to a large-scale and successful implementation of e-Health in The Netherlands.
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SAMENVATTING Mensen met een ernstige psychiatrische aandoening (EPA) hebben een sterk verminderde levensverwachting in vergelijking met de algemene populatie, vooral veroorzaakt door fysieke aandoeningen. Een ongezonde leefstijl speelt een belangrijke rol in de verminderde levensverwachting bij mensen met EPA. Ter bevordering van de fysieke gezondheid van deze doelgroep is de nurse-led e-health-interventie GILL (Gezondheid in Lichaam en Leefstijl) ontwikkeld voor somatische screening en het stimuleren van een gezonde(re) leefstijl. Door het uitvoeren van een cluster-gerandomiseerde studie (RCT) wordt onderzocht of de GILL e-health-interventie effectiever is dan de standaardzorg in het verbeteren van de fysieke gezondheid en leefstijl van mensen met EPA. De primaire uitkomstmaat van deze studie is de score voor de ernst van het metabool syndroom. Naast de RCT wordt een procesevaluatie uitgevoerd om de implementatie en de ervaringen van zowel de deelnemende cliënten als de hulpverleners met de GILLinterventie systematisch te evalueren.
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