Shifting Responsibilities: Developing a Pan-European Service Model for an eHealth Technology Supporting Self-Management of People with Chronic Obstructive Pulmonary Disease and Comorbidities.

Introduction: Active participation of patients in their care via self-management is an important pillar to manage chronic conditions. Self-management education and continuous support are needed to improve patients' confidence to take such active role. One way to do this is through eHealth technologies. However, those technologies can only be successful when actively used in daily practice and when integrated in overall care. Therefore, this study investigated how a self-management eHealth technology could be implemented that emphasises the active role of patients in their care. Methods: The service modelling method was utilized as implementation strategy. The design process consisted of five phases with salient stakeholders and consortium members of a European project to develop the service model. Studies with salient stakeholders were carried out in three different countries (Italy, Estonia, the Netherlands). A combination between face-to-face and online methods facilitated the participatory design process. Results: Due to the pan-European context, different stakeholders in the three countries were identified. Research nurses and case managers were not yet established in practice but once implemented, expected to contribute to optimal implementation. During service modelling, a crucial step was revealed: providing self-management training before technology use to let patient familiarise with the concept of taking an active role. As HCPs felt that they were not necessarily equipped to guide patients in terms of self-management, they also should have access to such self-management training. Conclusion: By demonstrating a way for implementation while emphasising patients' active role, we also showed the complexity of the method in two ways. First, by demonstrating the fine line between the descriptive and prescriptive model. Thus, showcasing the need to recognize that prescriptive models may be hampered by the delay in changing work practices. Second, by highlighting the importance of identifying country-specific differences in the pan-European context, revealing that service modelling is not a one-size-fits-all approach.

Technology-supported shared decision-making in chronic conditions: A systematic review of randomized controlled trials.

OBJECTIVES: To describe the role of patients with a chronic disease, healthcare professionals (HCPs) and technology in shared decision making (SDM) and the use of clinical decision support systems (CDSSs), and to evaluate the effectiveness of SDM and CDSSs interventions. METHODS: Randomized controlled studies published between 2011 and 2021 were identified and screened independently by two reviewers, followed by data extraction and analysis. SDM elements and interactive styles were identified to shape the roles of patients, HCPs and technology. RESULTS: Forty-three articles were identified and reported on 21 SDM-studies, 15 CDSS-studies, 2 studies containing both an SDM-tool and a CDSS, and 5 studies with other decision support components. SDM elements were mostly identified in SDM-tools and interactions styles were least common in the other decision support components. CONCLUSIONS: Patients within the included RCTs mainly received information from SDM-tools and occasionally CDSSs when it concerns treatment strategies. HCPs provide and clarify information using SDM-tools and CDSSs. Technology provides interactions, which can support more active SDM. SDM-tools mostly showed evidence for positive effects on SDM outcomes, while CDSSs mostly demonstrated positive effects on clinical outcomes. PRACTICE IMPLICATIONS: Technology-supported SDM has potential to optimize SDM when patients, HCPs and technology collaborate well together.

Structured medication reviews in Parkinson's disease: pharmacists' views, experiences and needs - a qualitative study.

Background: Executing structured medication reviews (SMRs) in primary care to optimize drug treatment is considered standard care of community pharmacists in the Netherlands. Patients with Parkinson's disease (PD) often face complex drug regimens for their symptomatic treatment and might, therefore, benefit from an SMR. However, previously, no effect of an SMR on quality of life in PD was found. In trying to improve the case management of PD, it is interesting to understand if and to what extent SMRs in PD patients are of added value in the pharmacist's opinion and what are assumed facilitating and hindering factors. Objectives: To analyse the process of executing SMRs in PD patients from a community pharmacist's point of view. Design: A cross-sectional, qualitative study was performed, consisting of face-to-face semi-structured in-depth interviews. Methods: The interviews were conducted with community pharmacists who executed at least one SMR in PD, till data saturation was reached. Interviews were transcribed verbatim, coded and analysed thematically using an iterative approach. Results: Thirteen pharmacists were interviewed. SMRs in PD were considered of added value, especially regarding patient contact and bonding, individualized care and its possible effect in the future, although PD treatment is found already well monitored in secondary care. Major constraints were time, logistics and collaboration with medical specialists. Conclusion: Although community pharmacist-led SMRs are time-consuming and sometimes logistically challenging, they are of added value in primary care in general, and also in PD, of which treatment occurs mainly in secondary care. It emphasizes the pharmacist's role in PD treatment and might tackle future drug-related issues. Improvements concern multidisciplinary collaboration for optimized SMR execution and results.

Structured medication reviews in Parkinson's disease: pharmacists' views, experiences and needs Why is this research done? In Parkinson's disease (PD), drug therapy is still the most important treatment strategy. Due to disease progression, patients often face complicated medication regimens, polypharmacy, and potential drug-related problems. The execution of structured medication reviews (SMR) in primary care is considered standard care of community pharmacists in the Netherlands, aiming to optimise drug treatment. Although it might also affect clinical outcomes, we found no effect of an SMR in PD on quality of life in our previous study. In trying to improve case management of PD, we need to understand if and to what extent SMRs in PD patients are of added value in the pharmacist's opinion, and what are assumed facilitating and hindering factors. What did the researchers do? We conducted semi-structured interviews with 13 community pharmacists who recently executed ⩾1 SMR in PD. What did the researchers find? We found that SMRs in PD are considered of added value with regard to patient bonding and individualised care. By being known by the pharmacist, and vice versa, by knowing the patient's situation, future drug problems might be tackled earlier. However, executing SMRs comes with barriers, of which lack of time, logistic constraints and difficulties in cooperation with the medical specialist are the most important. What do these findings mean? Taking into account both the pharmacist's effort and additional costs when performing an SMR in the current setting, the valuable time of a pharmacist could potentially better be spent on more (cost-)effective interventions, or a structural solution should be sought for the experienced hindering factors. Since we do not doubt the importance of periodic medication optimization in complex diseases or high-risk patients, we have to focus on either improving the current setting of SMRs in PD, or searching for other strategies in which this can be achieved.