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Laurens Touwen
Donderdag 25 november 2010
Care within reach
Can we change behaviour
through e-health??
2
• Not a joint venture, but
• A new entity:
a not-for profit
Foundation- project plan
- money
• I saw idealism
A Foundation
Insurance company
3
Improving access to health care and quality of life
of chronically ill patients and the acquisition of trust
in medical professionals, government and other
authorities and patients by providing and promoting
‘’Care at a distance’’
and
the development and implementation of proven
concepts for remote solutions for
chronically ill patients
Mission statement
4
Increase the coming 15 - 20 years:
• Diabetes 70%
• COPD 35%
• CHF 40% (bron RIVM)
Shortage of 500.000 workers in
2025… in the Netherlands?
Trend in Chronic care
5
New solutions for:
CHF
COPD
Diabetes
With:
e-health
M-healthEngineering
Change management
What is our focus?
6
Concept-ontwikkelingwerkgroepen
Grootschaligtesten
Financiering basis-
verzekeringDe markt
3 year
20121,5 year
1 year
2010
Generating
concepts testingPart of health
care insurance
Free for
market
Our process
7
Behavior change examples
• Banking – everyone a bankcard
from visiting a bank towards internet
• Direct life – movement program
monitoring and coaching your movement
• Example Stockholm http://www.youtube.com/watch?v=2lXh2n0aPyw
Challenging your imagination
Not technology is leading, but the appreciation of Patient and caregiver
So: We did a ‘patient journey’
and a ‘caregiver journey’
Through the patients eyes
Celebrating Jan’s birthday
Insights:• smoking is part of the
fun in life and it’s a strong part of your social life: you smoke together, it’s a form of ‘social cohesion’
Journey of COPD
At the GP’s practice
Insights:• Sometimes, the GP doesn’t
recognize and acknowledge the fact that you have COPD, but deep down, you know something’s wrong.
• You need to feel that youcan tell your story to the GP, that he really listens and that he is direct and honest to you.
At the lung specialist’s office
Emotions:• Shocked• Anger• Self blame
Insights:• You already had an idea deep down
that something’s wrong. The shock comes from the fact that you now become conscious of the fact that you will never heal, which is in big contrast with the idea of a ‘bad condition’.
• You don’t really realize what thedoctors tell you about the need tostop smoking.
• You also tend to forget many of the things the specialist has said.
• When you are proven right, you are angry, but eventually this turns into self blame for not acting more assertively to the GP.
Conflict of interests
Emotions:• (un)safe• Not taken account of• Dependent , angry ,low
self esteem
Insights:• It’s important that family and
friends understand what you have. I.e. they know what to do when it’s clear that the illness causes complaints (during short term wheezyness for example). This makes you feel safe.
• You also expect family and friends to take account of you.
• The feeling that you’re dependent on others is a terrible feeling, it emphasizes that you cannot do things on your own.
13
• Smoking• Bad eating habits• Little exercise• Etc.
Illness:• COPD
• Disrupted relationships with your environment
• Freedom is taken away
• Life doesn’t make sense anymore
• ...
Shortcomings:• Tiredness• Bad physical condition• Short of breath• Etc.
Causes/EffectsCauses Effects
Experience of doctors Experience of patients
1
2
Heal thyself
Two completely different points of views :
1. Doctors conclude you have an illness, whereas patients conclude you have
shortcomings
2. Doctors clearly point to the causes (and dangers) of the illness, while a
patient focuses on the effects of the shortcomings
3. NB: After a longer period of complaints, patients do begin to realize that
there is a connection between smoking and their shortcomings
COPD
3
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Concerns
• Strengthen the relation Patient- Caregiver
• Caregivers less work, more role as coach- more partner than authority
• Psychology is the key in self management- find short-cycle feedback
• Focus is mainly on change of lifestyle
• Web portal- with specific and practical applications- Personal Health Record
15
Lessons learned for web portals
Develop solutions close to patient in 0-and first line:
• The measurement of vital and relevant values at
home or close to home - monitoring
16
Lessons learned for web portals
Personal health record with education and action:
• Combines all patient information in one platform
with self-learning algorithms:
guide disease management
selecting appropriate education
brings peers together
17
• Behavioral Science to ensure compliance
Both compliance to medicine as lifestyle
Work with goal setting and diary
Lessons learned for web portals
movingeating
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• Lead to optimization of the "work flow"
• Managing multiple chronic conditions
• Insight in the quality of care (pi's)
• Supporting treatment at home
• Focus on ‘’Mantelzorger’’
Technology is an "enabler" and not the distinctive
Lessons learned for web portals
19
Can e-health change us?
• There is evidence in many trials that the patient
can profit from e-health:
- patient experiences more freedom
- patient improves his well-being
- patient is taking the lead
20
Can e-health change us?
• Can the caregiver profit??
- only when the care process has been changed
- the workload has to lower
- web tools must be integrated in his system
21
Perspective
We believe e-health will change the future
And behavior will be changed through e-health!
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