DEDICATE: proposal for a conceptual framework to develop dementia-friendly integrated eCare support.

BACKGROUND: Evidence shows that the implementation of information and communication technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual's whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used. METHODS: Starting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements. RESULTS: We identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients' and informal caregivers' preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (formal support services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (care coordination services, CCS). CONCLUSIONS: The proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation).

Proposal for innovative and integrated approaches to the unmet needs of patients with irritable bowel syndrome. Preliminary Vigour report.

Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy rarely relieves bothersome symptoms for all patients. The objective of this study was to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. A qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. A Survey was administered to a group of patients in anonymous form. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and homebased digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. KEY WORDS: Digital Health, Irritable bowel syndrome, mHealth, Nutrition, Physical activity, Psychological support.

Innovative approaches to service integration addressing the unmet needs of irritable bowel syndrome patients and new approaches for the needs of IBS patients.

Background: Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra. Objective: To analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions: The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main outcome: Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion: The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention.

Can Integrated Care Help in Meeting the Challenges Posed on Our Health Care Systems by COVID-19? Some Preliminary Lessons Learned from the European VIGOUR Project.

The COVID-19 pandemic puts health and care systems under pressure globally. This current paper highlights challenges arising in the care for older and vulnerable populations in this context and reflects upon possible perspectives for different systems making use of nested integrated care approaches adapted during the work of the EU-funded project VIGOUR ("Evidence based Guidance to Scale-up Integrated Care in Europe", funded by the European Union's Health Programme 2014-2020 under Grant Agreement Number 826640).

The attitudes, expectations and needs of elderly people in relation to e-health applications: results from a European survey.

We have carried out a survey of elderly people in Europe relating to e-health and telemedicine issues. Telephone-based interview techniques were used in 13 countries and face-to-face interviews were used in Ireland and Portugal, where there are significant numbers of houses without telephones. Altogether 9661 interviews were performed. Most respondents (65%) lived in rural areas or small towns; the remainder lived in suburban areas or large towns. Virtually all respondents (98%) had access to a television set. About 30% received cable television and 13% had access to digital television. Almost half (48%) had access to mobile phones (with 42% actually using them), 36% had access to PCs (with 27% being active users) and 22% had access to the Internet (with 17% being active users). The respondents showed interest in various e-health applications, although this declined considerably with age. The survey showed that the older people get, the more they depend on medical and social care, and the more they tend to live alone, without a family member to look after them. Policy measures relating to infrastructure as well as training, education and awareness activities will be required to avoid a medical divide between those senior citizens who have access to advanced medical advice and services and those who do not.

Каким образом телездравоохранение может помочь в предоставлении интегрированной помощи?

Телездравоохранение, или оказание помощи на расстоянии, вне всякого сомнения, станет одной из ключевых составляющих в будущейинформационно-коммуникационной инфраструктуре, необходимой для организации интегрированной помощи. Лица, формирующие политику, уже сейчас возлагают на него большие надежды, рассматривая его как возможный способ решения обостряющихся проблем кадров. Для того,чтобы обеспечить интегрированность помощи, необходимо включить обособленные сегодня прикладные задачи, решаемые с помощьютелездравоохранения, в более комплексные стратегии электронного здравоохранения, в которых были бы предусмотрены полная координация протоколов ведения больных и процессов оказания услуг и безопасный обмен данными о пациентах. Несмотря на то, что пока в Европе и в других регионах имеется мало примеров применения телездравоохранения в порядке повседневнойпрактики (в противоположность огромному объему исследований в этой области), формируется база все более убедительных фактических данных, свидетельствующих о том, что телездравоохранение можно успешноиспользовать для того, чтобы помочь обеспечить более высокое качество интегрированной помощи, в частности, тем, кто страдает продолжительными хроническими заболеваниями.

How can telehealth help in the provision of integrated care?

Telehealth, the provision of care at a distance, is certain to be a key component in future ICT infrastructure for integrated care. It has already raised high hopes among policy-makers with regard to its potential for delivering solutions forgrowing capacity problems. For integrated care, today's segregated telehealth applications still require linking into more comprehensive eHealth strategies, in which clinical pathways and service delivery processes are fully coordinated andpatient data safely shared. Although few instances of routine application have yet emerged in Europe or elsewhere – in contrast with an enormous breadth of research activities – anincreasingly solid evidence base is emerging indicating that telehealth can be used effectively to help support better integrated care, in particular for those with long-term chronic conditions.