Digital CAre Contribution to the Transformation of User Services

In European countries, about 40% of adults have long-term conditions (LTCs), and 25% have multiple long-term chronic conditions (MLTCs). Healthcare systems are ill-equipped to handle this current rise of MLTCs as they are 1) reactive rather than proactive, 2) fragmented (i.e., patients receive care from several clinicians with little coordination between them), 3) limited in time and space (i.e., care can only be sought during business-hours at designated locations), and 4) clinician- or disease-centered rather than patient-centered. Healthcare organizations are investigating blended care models that augment traditional face-to-face interactions with technology-mediated ones. Blended care tools form a continuum from active communication tools, such as video consultation, phone calls, or asynchronous message exchanges, to continuous remote patient monitoring tools and automated just-in-time interventions. Blended care models can support person-centered, proactive care, reduce the need for face-to-face visits and tailor care to the patients’ lives. However, poor implementation of blended care may disrupt workflows, cause digital exclusion or alter patient-clinician relationships. Digital-CACTUS proposes providing health authorities with evidence on which technological solutions should be implemented and how, to optimize the delivery of patient-centered healthcare services. Our multidisciplinary research program aims at uncovering the potential gains and side effects of blended care at both patient and health system levels with a comprehensive research program with three work packages (WP). WP1. Anticipating how the digital transformation of care may change patient–clinician relationships. We will conduct several qualitative studies involving patients and clinicians to capture their perspectives on the impact and side-effects of the digital transformation of care (balance between autonomy and vulnerability, transformation of relational dimensions of care: presence, listening, empathy, support, attention to individual values, emotions, stories, and journey). Results from these studies will be combined with existing knowledge in a qualitative meta-synthesis. Finally, we aim to validate and enrich the results from the meta-synthesis with an international online survey with open-ended questions. WP2. Developing a validated patient-reported tool to identify when and where care could benefit from digital solutions. The tool is intended for care organizations to help them pinpoint the specific situations where care generated failures for patients. In short, patients will dynamically recreate their precise care journey using a visual interface and indicate 1) when and where the current organization of care has generated “failures in care” (i.e., the burden of treatment, unmet expectations or negative consequences); and 2) whether blended care tools could have avoided or alleviated these failures. WP3. Mapping the potential impact of implementing each technological tool of blended care in Europe. We will conduct a large international survey of patients with MLTCs in primary and secondary care, using the tool developed in WP2. The map will account for 1) the specificities of the population surveyed (e.g., age, disease, health and digital literacy), 2) the organizations involved, and 3) patients’ preferences towards each technology. The consortium brings together five renowned teams in MTLCs, digital medicine and patient centered care, as well as a private partner which will translate research results into actionable tools. Our project aims to provide health authorities and policymakers with evidence on how technological tools should be implemented to optimize the delivery of health and care services (what approach to care works best, for whom, and in which circumstances) while preserving the humanistic values of patient-clinician relationships. This will help increase the sustainability of the care system and of life while experiencing care.