Title: Integrating Digital Interventions into Patient Self-Management Support (DIPSS)
Funder: Department of Health and Social Care

Abstract: Aims Our aim is to determine the most feasible, acceptable, effective and cost-effective methods of integrating digital interventions (DIs) into primary care in order to support patient self-management of long-term conditions. By the end of the programme we will have i) evaluated two new DIs for common conditions that could be integrated into NHS practice rapidly and at low cost, and ii) provided important evidence about the optimal methods of integrating DIs into primary care. Background DIs can empower patients by providing better access to personalised information and support for active involvement in treatment; these include resources such as instant automated advice (tailored to current symptoms and preferences), email or text medication reminders or motivational messages, self-care videos, decisional and lifestyle change support, and facilities for remote monitoring of progress by primary care staff. DIs have the potential to make significant savings by automating routine aspects of patient education, monitoring and support, freeing up health professional resources for when patients most need them. These savings can play an essential part in meeting the NHS QIPP agenda to achieve increased efficiency gains despite the growing demand created by an expanding and ageing population. There is accumulating evidence that DIs can deliver better and more efficient healthcare, but substantial barriers to wider uptake remain. New healthcare technologies will only be implemented successfully if they are designed to fit the aims, abilities and contexts of both patients and health professionals, and if their ease of use, benefits and cost-effectiveness are clearly demonstrated. This programme of research will undertake the rigorous development and evaluation necessary to maximise the likelihood of successful integration of DIs within the NHS. Research plan This research programme will focus specifically on improving management and outcomes for two common, contrasting conditions (hypertension and asthma) which are currently sub-optimally managed, leading to excess deaths, illness, disability and costs to the NHS. We propose three closely linked parallel workstreams. A behavioural and economic workstream (WS1) will focus on identifying factors influencing cost-effective integration of digital interventions (DIs) into primary care, while two clinical workstreams will develop and trial DIs for self-management of hypertension (WS2) and asthma (WS3). Contrasting clinical conditions have been selected for WS2 and WS3 to allow comparison of prevention (hypertension) vs. symptom management nd prevention (asthma), mainly older (hypertension) vs mainly younger (asthma) clinical populations and very different self-management regimes; this will facilitate identification of what factors may be common to successful DI delivery across different conditions and treatment regimes and which are condition- or treatment-specific. WS1 will undertake intervention planning to identify factors influencing acceptable and cost-effective integration of DIs into primary care, and hence the required elements and characteristics of the interventions and support to be offered for hypertension and asthma self-management in WS2 and WS3. To inform our planning we will carry out a) systematic reviews of the relevant quantitative and qualitative literature, b) studies of patient and health professional views and experiences, and c) cost-effectiveness analyses of different approaches to delivering DIs. WS2 and WS3 will develop DIs for self-management of hypertension and asthma (respectively), using iterative qualitative research to ensure that they are viewed as acceptable and useful by patients and primary care staff. Both workstreams will then carry out feasibility trials of the DIs, using quantitative and qualitative methods to evaluate patient and primary care experiences of different delivery formats. WS2 will also carry out a full randomised controlled trial of the cost-effectiveness for reducing blood pressure over one year of the optimum method(s) of delivering the DI compared with usual care. Dissemination The main outputs will be a) two DIs that have been rigorously developed and evaluated and can be rapidly and inexpensively rolled out to the target clinical populations, b) findings with wider implications for the cost-effective integration of DIs into primary care, and the management of hypertension and asthma. Dissemination pathways will include: close collaboration with the major relevant patient groups; reporting findings to all participants; interactive workshops with all stakeholders; conference presentations and a planned series of papers in open access peer reviewed journals; links with professional societies and relevant NHS organisations and policy-makers; regular press releases. Relevant expertise Our team combines leading international expertise in e-health, hypertension, asthma, behaviour change and developing, trialling and implementing complex healthcare interventions. We will build on our extensive experience of successfully collaborating on previous studies with direct relevance to this proposal. PPI This proposal has been developed with input from four PPI representatives and two patient organisations (Blood Pressure UK and Asthma UK). We will continue to work closely with our patient representatives throughout this programme, involving them in our Steering Committee, intervention planning and the design and interpretation of our studies of user views and factors influencing the acceptability, feasibility and effectiveness of DIs.

Lay abstract: Our aim is to investigate the best way of providing patients with a web-based service, which we call a digital intervention (DI), that can help patients self-manage their health conditions, with support as needed from healthcare professionals. DIs can potentially improve the efficiency of healthcare by automating routine aspects of patient education, monitoring and support, whilst improving services by giving patients convenient 24 hour access to detailed, personalised feedback and allowing health professionals to remotely monitor patient status. For example, our DI for self-monitoring blood pressure provides instructions (with videos) for self-monitoring, sends text message reminders when the patient chooses, allows patients to enter their blood pressure and provides instant, personalised advice, and allows doctors to check the patient s progress. Our research will identify methods of making DIs a useful and acceptable part of primary care. We will carry out three streams of work (WS) that are closely linked: WS1: We will assess previous research on DIs, looking at costs and benefits to find the most successful methods of providing them. We will also research the views of patients and health professionals to find the most acceptable ways of designing and providing DIs. WS2: We will develop a DI for self-management of high blood pressure (hypertension) and carry out a small study of the most acceptable and practical way to make this part of primary care. We will then carry out a large trial of whether our DI for hypertension can help patients with high blood pressure keep it well controlled. WS3: We will develop a DI for self-management of asthma and carry out a small study of the most acceptable and practical way to make this part of primary care. We have chosen contrasting clinical conditions for WS2 & WS3, to allow comparison of patients from different age groups, with very different patterns of symptoms and different self-management regimes. This will help us decide which findings are specific to one condition and which may be more common across different conditions. Our team brings together experts in primary care management of high blood pressure and asthma with experts in developing DIs. We have experience in how to make DIs accessible and acceptable to a wide range of people. Already nearly 4 in 5 of all households have access to the internet, including over half of people aged 65-75, and by the end of this project most patients will be online. Our research could help millions of patients with high blood pressure and asthma (and potentially other conditions in the future), by finding out how to provide a service which meets the needs of patients who wish to use the internet for instant access to help 24 hours a day.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: RESPIRATORY;CARDIOVASCULAR