Care at a distance need not break the close relationship between GP and patient, but can actually strengthen it. That is one of Arien Mol's conclusions. She investigated whether the Digital Health Center, an initiative of various health and welfare organizations in the IJmond region, fits in with daily practice in general practitioner care.
Arien Mol (pictured left) conducted her research as part of the clinical informatics course at TU/e. Since July 2023, the first patients from the Red Cross Hospital have been participating in the Digital Health Center. The aim of the guidance is to provide people with chronic diseases with more care and support at a distance, thus promoting greater control over their own health. The ideas of positive health are central to this.
The Digital Health Center works closely with various health and welfare organizations in the region, including the Red Cross Hospital, the ViVa! Care Group, GPs Zuid- en Midden-Kennemerland, Heliomare, the Beverwijk social team, the community sports coach and the Vital Living Room. And there are more and more of them.
In the Digital Health Center, nurse telecoaches are the patient's first point of contact via an app. The nurse telecoach guides the patient in various ways, focusing on physical, mental and social aspects of health. For example, by signaling based on home measurements such as blood pressure and heart rhythm. And also by conducting health talks and supporting in achieving health goals, whether or not together with care and welfare partners in the region.
Less care staff needed
This digital remote working fits perfectly with the now-necessary regional initiatives to transform healthcare together with various healthcare partners into a more future-proof form, says Mariëtte Willems, general practitioner and CMIO at Huisartsen Zuid Kennemerland. "Patients would be able to do much more themselves, the quality of care goes up and less care staff is needed. Because that is the huge concern for the coming decades. The Digital Health Center is a step in that direction."
In addition to self-monitoring, the positive health approach is important at the Digital Health Center. That center is based on what the patient himself wants in his health and well-being, from physical to mental and social.
"How can we positively boost a patient's resilience, despite chronic illness? For example, we know that people who have a lot of debt also have a lot of other problems," Willems explains. "Those debts can cause so much stress that it becomes harder to change your lifestyle. You therefore find more chronic diseases in people with a lot of debt."
Connecting with general practitioners
The need is clear, but how do you as general practitioners work towards an integrated model in collaboration with regional care and welfare partners and an important role for technology? More and more scientific literature is available on telemonitoring in the second line, but there is little for the first line. Arien Mol, together with supervisor Mariëtte Willems, set to work investigating how the Digital Health Center could best connect with general practitioners.
She consulted the CMIO Network First Line to gain insight into how other family physicians are handling similar initiatives. And researched the challenges of determining what works and what doesn't. With that input, she set up a working group consisting of a mix of family physicians, practice managers, patients and practice managers. This group organized working sessions that introduced the Digital Health Center concept and then explored how it could be implemented in practice. They also compared the NHG guideline with chain-of-care programs and mapped the application landscape.
Bond between general practitioner and patient remains
There was initially some resistance in the working group to transfer patients from general practice to a central point, Mol says. What was beyond question was that the relationship between GP and patient is very important, Willems adds. "There is increasing evidence that the personal continuity of the GP with the patient actually leads to a longer life, to fewer hospitalizations to fewer complications. These are aspects that we very much want to preserve. So how do you go about doing that while at the same time seeing more care coming your way? The connection with the patient is the core of family physician care. Working with an app, such as the Digital Health Center, can actually support that connection. Patients are given the opportunities to take control of their own health and have contact with the general practice when it is of value and not because the protocol says so."
No bundle of care pathways
In particular, the study focused on patients with chronic diseases such as COPD, diabetes, hypertension and cardiovascular disease. Care is now approached by care pathway. The research shows that that needs to change. "We need to see patients not as a bundle of care pathways, but as a whole," Willems says. "That was a great finding. Many chronic conditions have a large common denominator when it comes to what you can do about lifestyle, as well as psychological problems or more social problems. If you get those basics right as a patient, you can reduce a lot of symptoms. Of course, we already knew this; it was very helpful to see worked out how to address this."
Advisory Report
The findings of the study have been incorporated into an advisory report that is currently in draft form and will be completed soon. In any case, the report concludes that the Digital Health Center is potentially valuable for general practices. It suggests building it with generic building blocks that can be used for different chronic care pathways, starting with hypertension patients.
Willems: "The next step is a pilot. We are going to build this up slowly to see whether this actually leads to fewer consultations with healthcare professionals. And also whether patients and care providers are satisfied with it. "
Hybrid care
Mariëtte Willems emphasizes that it is essential to keep working hybrid and not rely solely on an app. There must first be a plan together with the patient. In it, the patient indicates what he or she considers important. She further advocates more cross-pollination between different sectors, such as hospital care and general practitioner care, where professionals from different sectors learn from each other.
"People should no longer be in one healthcare sector right from their education and not get out of it. We need to learn much more from each other and one way to do that is by doing external assignments in another healthcare sector."
In any case, the Digital Health Center has the potential to improve care, give patients more control over their health and make health professionals more proactive, Willems said. "It's obviously not about the app, which is just a tool, but about what care can look like if you think more broadly."
Remote care is one of the central themes during Care & ICT 2024. The largest health tech event in the Netherlands will be held from April 9 to 11 at Jaarbeurs in Utrecht.
