BACKGROUND AND AIMS
In 2014, the European Union (EU) H2020 CONNECARE project was initiated in the Netherlands, Spain, Italy, Germany, Israel, and the UK. In this project, clinicians, information technology (IT) professionals, IT companies, and researchers work together to develop an online integrated care platform for complex chronic patients. The European population is ageing and thereby the proportion of people with one or more chronic diseases is increasing. At this moment, many healthcare systems are fragmented into medical specialisations, whereas a large proportion of chronic patients have more than one chronic illness. The aim of the CONNECARE platform is to develop an integrated care system that facilitates co-operation between healthcare professionals and supporting patients in self-management thereby enhancing personalised healthcare. The aim of this study was to evaluate the feasibility and usability of the CONNECARE platform by patients and case managers.
The first prototype consists of a dashboard for case managers and a self-management app for patients, a chat function, symptom questionnaires, and the integration of an activity tracker. The system was evaluated for 6 months in Dutch patients with chronic obstructive pulmonary disease (COPD). A group of COPD patients were randomly assigned to the app with or without weekly messages regarding physical activity. The feasibility was evaluated via questionnaires and focus groups with COPD patients, tracking of step counts, and a comparison between patients who received weekly messages. These messages contained information about the benefits of physical activity, for example “Making a phone call? Good moment for a little walk.” Usability was evaluated by using the system usability scale (SUS), a logbook for technical issues, and an evaluation of case managers’ opinions.
Of the 46 patients with COPD who participated in the study (mean age: 60±13 years; range: 31–82 years; 52% male; 30% had asthma; 65% had COPD; 4% had asthma–COPD overlap), 21 received the weekly messages. The authors found no statistically significant difference in step count between the groups. Patients were able to use the app and to communicate with the case manager via the messaging function in the app. Regular evaluations with patients and stakeholders led to constant optimisation of the application. However, three patients felt uncomfortable when using the activity tracker: “Others can see my data if I use Bluetooth.” The SUS in patients after 3 months was 81% (‘excellent’; n=30) and dropped to 74% after 6 months (‘good’). There was no difference in SUS between patients with low or high social economic status. The chat function was considered to be easy to use.
The initial version of the CONNECARE system was easy to use by patients and feasible to implement even in this COPD population. The ongoing evaluation in patients and case managers and regular communication with IT specialist led to constant optimisation of the system and the communication between all different stakeholders appeared to be essential in the development of this system. There are no significant effects of messages on the effort step count, possibly because of the low number of participants. Future studies should look into the effect of regular stimulating messages on physical activity in a larger group possibly also including individualised messages. The next step for the CONNECARE system is to prepare it for the technical and process integration in existing healthcare systems.