Strategies for the follow-up of patients with chronic diseases and polypharmacy: development and implementation of a new health care approach based on mobile technology (DIPP-mHeart Study). (Preprint)
Authors: Gomis-Pastor Mar , Rodriguez-Murphy Esther , Feliu Anna , Ontiveros Gerardo , Garcia-Cuy�s Francesc , Salazar Albert , Roig Eulalia , Mangues Maria Antonia 
Published: March 2018

BACKGROUND

Multimorbidity is related to a high increase in costs for the health system and a poorer quality of life for patients. It is the professional’s responsibility to establish new care models oriented to improve health outcomes in high complexity patients. We have developed a comprehensive care program for these patients based on carrying out sustainable highly effective interventions for the health system through technology.
The use of new technologies to improve health results is an unstoppable trend. The implementation in practice of new forms of healthcare based on telemedicine leads to a need for professionals to specialize in an often unfamiliar area.

OBJECTIVE

The main aim of the study is to design and Develop, Integrate and implement an mHealth tool to support monitoring of the chronic Patient with Polypharmacy (DIPP-mHeart Study).
The secondary aim of our study is to make the development of these new technologies easier for other research groups through describing the limitations encountered by our team during the development of the project and the corresponding solutions implemented to overcome those limitations.

METHODS

The study was carried out in four stages: design, development, integration and implementation, followed by ensuring the quality, security and legal requirements of the mHeart® prototype. The design and development of the tool was based on a review of the bibliography and several surveys done to the main stakeholders (patients, health professionals, Health Authorities and experts in mHealth). All these findings allow us to focus mHeart functionalities on the user’s expectations and the polymedicated patient’s real needs as well as to discover realistic solutions to overcoming the main limitations of implementing the new tool within the health environment. The tool was adapted to the solid organ transplant population, a perfect example of the chronic patient of high complexity.

RESULTS

133 chronic patients, 26 stakeholders, as well as health authorities, patients’ associations and scientific societies were interviewed. Based on the information gathered, the design of the new tool was focused on improving the management of polytherapy and the flow of communication between professionals, patients and care levels. After carrying out diverse tests, the final mHeart® platform prototype was obtained (website and mobile application). Its functionalities allow for the sustainable intervention of a multidisciplinary team in real time and in a patient’s habitual context, thus empowering the patient through clinician feedback. The main limitations encountered were the integration of the tool with our health system’s information technology system, ensuring quality and safety, as well as considering other legal aspects which the clinical team were not familiar with.

CONCLUSIONS

The DIPP-mHeart project resulted in a new holistic eHealth tool that will be extremely useful for the follow-up of chronic patients with polypharmacy. Not only was this platform to be designed and developed, but its safety and quality, its implementation in our environment, and its continued use in the long term were also to be ensured. Sharing the key aspects involved in overcoming the major difficulties encountered could be highly interesting for the scientific community and widely applicable in our setting.