Suchergebnisse

The objective of our work was to improve healthcare services supported by eHealth applications in sub-Saharan Africa (SSA) by proposing interoperability that is proportional, in terms of costs and benefits, to immediate demands and is capable to enable future scenarios of growth. (e)Health represents a very complex system with many stakeholders, services and technologies, varying objectives and forces that play out on separate hierarchical levels with inconsistent and sometimes even contradicting prerequisites as well as requirements. To provide individual patients with the integrated care they need and to meet the distinct however interrelated interests of the other primary stakeholders and society alike, interoperability guidance is required. To improve effectiveness and efficiency of eHealth in SSA, interoperability solutions that stimulate and consolidate cooperation on various levels (e.g., local, district, national, international) and in different dimensions (e.g., social and political, regulatory, organisational, technical, semantic, financial) is key. To that end, we have conducted research towards a flexible interoperability framework that can cope with various demands from these different levels and dimensions, and facilitates different operational models of cooperation while preserving interoperability. Since a top-down approach too often results in unworkable, one-size-fits-all paradigms, and a bottom-up approach generates heterogeneous, non-interoperable islands of operations, we propose a value-driven, hybrid approach with intense user involvement and incremental steps towards higher levels of interoperability. By building on successful initiatives on any level, with proven cooperative solutions in at least one dimension, and guiding further development by addressing dimensional issues at each level proportionally, interoperable centers of cooperative eHealth emerge that are governed by African ownership towards future growth, yet remain proportional to current demands and flexible to future scenarios.

Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others. ; final draft ; peerReviewed