PMID- 28566268 OWN - NLM STAT- MEDLINE DCOM- 20171214 LR - 20181202 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 19 IP - 5 DP - 2017 May 31 TI - High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design. PG - e185 LID - 10.2196/jmir.7037 [doi] LID - e185 AB - BACKGROUND: Worldwide, nearly 3 million people die of chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM in several settings, but it remains unknown which factors influence usage of eHealth and change in behavior of patients. OBJECTIVE: Our study, e-Vita COPD, compares different levels of integration of Web-based self-management platforms in IDM in three primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-management platform for COPD patients. METHODS: The e-Vita COPD study compares three different approaches to incorporating eHealth via Web-based self-management platforms into IDM of COPD using a parallel cohort design. Three groups integrated the platforms to different levels. In groups 1 (high integration) and 2 (medium integration), randomization was performed to two levels of personal assistance for patients (high and low assistance); in group 3 there was no integration into disease management (none integration). Every visit to the e-Vita and Zorgdraad COPD Web platforms was tracked objectively by collecting log data (sessions and services). At the first log-in, patients completed a baseline questionnaire. Baseline characteristics were automatically extracted from the log files including age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ), dyspnea scale (MRC), and quality of life questionnaire (EQ5D). To predict the use of the platforms, multiple linear regression analyses for the different independent variables were performed: integration in IDM (high, medium, none), personal assistance for the participants (high vs low), educational level, and self-efficacy level (General Self-Efficacy Scale [GSES]). All analyses were adjusted for age and gender. RESULTS: Of the 702 invited COPD patients, 215 (30.6%) registered to a platform. Of the 82 patients in group 1 (high integration IDM), 36 were in group 1A (personal assistance) and 46 in group 1B (low assistance). Of the 96 patients in group 2 (medium integration IDM), 44 were in group 2A (telephone assistance) and 52 in group 2B (low assistance). A total of 37 patients participated in group 3 (no integration IDM). In all, 107 users (49.8%) visited the platform at least once in the 15-month period. The mean number of sessions differed between the three groups (group 1: mean 10.5, SD 1.3; group 2: mean 8.8, SD 1.4; group 3: mean 3.7, SD 1.8; P=.01). The mean number of sessions differed between the high-assistance and low-assistance groups in groups 1 and 2 (high: mean 11.8, SD 1.3; low: mean 6.7, SD 1.4; F1,80=6.55, P=.01). High-assistance participants used more services (mean 45.4, SD 6.2) than low-assistance participants (mean 21.2, SD 6.8; F1,80=6.82, P=.01). No association was found between educational level and usage and between GSES and usage. CONCLUSIONS: Use of a self-management platform is higher when participants receive adequate personal assistance about how to use the platform. Blended care, where digital health and usual care are integrated, will likely lead to increased use of the online program. Future research should provide additional insights into the preferences of different patient groups. TRIAL REGISTRATION: Nederlands Trial Register NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6qO1hqiJ1). CI - (c)Esther PWA Talboom-Kamp, Noortje A Verdijk, Marise J Kasteleyn, Lara M Harmans, Irvin JSH Talboom, Mattijs E Numans, Niels H Chavannes. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.05.2017. FAU - Talboom-Kamp, Esther Pwa AU - Talboom-Kamp EP AUID- ORCID: 0000-0001-9917-9052 AD - Public Health and Primary Care Department, Leiden University Medical Centre (LUMC), Leiden, Netherlands. AD - Saltro Diagnostic Centre, Utrecht, Netherlands. FAU - Verdijk, Noortje A AU - Verdijk NA AUID- ORCID: 0000-0002-6859-4832 AD - Public Health and Primary Care Department, Leiden University Medical Centre (LUMC), Leiden, Netherlands. AD - Saltro Diagnostic Centre, Utrecht, Netherlands. FAU - Kasteleyn, Marise J AU - Kasteleyn MJ AUID- ORCID: 0000-0001-7751-7516 AD - Public Health and Primary Care Department, Leiden University Medical Centre (LUMC), Leiden, Netherlands. FAU - Harmans, Lara M AU - Harmans LM AUID- ORCID: 0000-0001-9277-3374 AD - Saltro Diagnostic Centre, Utrecht, Netherlands. FAU - Talboom, Irvin Jsh AU - Talboom IJ AUID- ORCID: 0000-0001-5744-0742 AD - Zorgdraad Foundation, Oosterbeek, Netherlands. FAU - Numans, Mattijs E AU - Numans ME AUID- ORCID: 0000-0002-0368-5426 AD - Public Health and Primary Care Department, Leiden University Medical Centre (LUMC), Leiden, Netherlands. FAU - Chavannes, Niels H AU - Chavannes NH AUID- ORCID: 0000-0002-8607-9199 AD - Public Health and Primary Care Department, Leiden University Medical Centre (LUMC), Leiden, Netherlands. LA - eng PT - Journal Article DEP - 20170531 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - Aged MH - Cohort Studies MH - *Disease Management MH - Female MH - Humans MH - Internet/*statistics & numerical data MH - Male MH - Middle Aged MH - Pulmonary Disease, Chronic Obstructive/*therapy MH - Self-Management/*methods MH - Surveys and Questionnaires MH - Telemedicine/*methods PMC - PMC5471344 OTO - NOTNLM OT - COPD OT - Web-based platform OT - blended care OT - chronically ill OT - eHealth OT - integrated disease management OT - primary care OT - self-efficacy OT - self-management COIS- Conflicts of Interest: None declared. EDAT- 2017/06/02 06:00 MHDA- 2017/12/15 06:00 PMCR- 2017/05/31 CRDT- 2017/06/02 06:00 PHST- 2016/11/24 00:00 [received] PHST- 2017/04/24 00:00 [accepted] PHST- 2017/02/28 00:00 [revised] PHST- 2017/06/02 06:00 [entrez] PHST- 2017/06/02 06:00 [pubmed] PHST- 2017/12/15 06:00 [medline] PHST- 2017/05/31 00:00 [pmc-release] AID - v19i5e185 [pii] AID - 10.2196/jmir.7037 [doi] PST - epublish SO - J Med Internet Res. 2017 May 31;19(5):e185. doi: 10.2196/jmir.7037.