Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care.

BACKGROUND: Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. OBJECTIVE: This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. METHODS: Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. RESULTS: The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. CONCLUSIONS: For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.

Physical therapy management of low back pain has changed.

BACKGROUND: Since the 1990s, new insights in the physical therapy management of low back pain have been described in guidelines. Furthermore, insurance companies introduced a volume policy to control the costs for physical therapy. OBJECTIVE: This study aims to establish if developments in knowledge and health policy since the 1990s have resulted in changes in the physical therapy management of patients with low back pain (LBP) in the Netherlands. METHODS: Data from 3148 patients, referred because of LBP, were selected from the databases of two registration studies (1989-1992 and 2002-2003) of patients treated by physical therapists. Descriptive statistics were used to compare patient characteristics. A multi-level regression analysis was carried out to determine a change in the number of treatment sessions adjusting for patient and disease characteristics, and to control for different levels (patient and physical therapist). RESULTS: A small decline in the number of treatment sessions was observed. In 2002, exercise therapy was the most frequently applied intervention, while massage and physical modalities were the interventions of first choice in the early 1990s. CONCLUSION: Our results suggest that since 1990 the management of patients with LBP by physical therapists in the Netherlands has changed. Both quality management by the profession and volume policy by government and insurance companies seem to have been instrumental in bringing about a decline in the number of treatment visits and an increase in the use of evidence-based interventions.