eHealth's potential in providing healthcare for the elderly with risk of falling due to balance disorders, in a global health perspective

Introdução: O processo global e progressivo de envelhecimento populacional e a vulnerabilidade a doenças crónicas, distúrbios do equilíbrio e quedas têm representado um dos principais desafios aos sistemas de saúde. Isto tem motivado o desenvolvimento de estratégias, incluindo a utilização de tecnologia na prestação de cuidados de saúde. Portugal e Cabo Verde têm acompanhado esta tendência, investindo em sistemas e tecnologias de informação. Contudo, a aplicabilidade clínica das soluções digitais no contexto do idoso com alterações do equilíbrio e risco de queda precisa ser explorada. Objetivo: O objetivo desta investigação foi estudar, elaborar, implementar, demonstrar e avaliar uma solução digital para a prestação complementar de cuidados de saúde a idosos com alterações do equilíbrio e risco de queda no contexto português, alinhando posteriormente a sua utilização numa perspetiva global, com o exemplo de Cabo Verde. Métodos: Utilizando Design Science Research Methodology, foi realizado um estudo de métodos mistos com estratégia explanatória sequencial. Inicialmente, foi disponibilizado um questionário no website da Ordem dos Médicos de Portugal para identificar a satisfação e constrangimentos quanto aos dados clínicos disponíveis e a relevância do eHealth no contexto da prestação de cuidados de saúde a idosos com distúrbio do equilíbrio. Foram conduzidas entrevistas individuais a médicos, explorando estratégias para o desenvolvimento de uma solução digital neste contexto. As sugestões contribuíram para o desenho e elaboração do serviço digital, inicialmente testado por cinco idosas e seus cuidadores, como prova de conceito. Este serviço foi avaliado por estes utilizadores e oito médicos com experiência em coordenação de serviços, através de dois grupos focais. Relativamente a Cabo Verde, foi conduzido um Policy Dialogue Workshop (PDW), incluindo a Direção do Hospital Central Doutor Agostinho Neto (HCDAN), para explorar o interesse e potencial utilização do serviço digital no contexto cabo-verdiano. Resultados: A identificação de constrangimentos médicos quanto aos dados clínicos disponíveis e a verificação da relevância do eHealth neste contexto motivaram a elaboração de uma solução digital. Considerando as sugestões dos entrevistados, foi desenhado o serviço digital “EQUILÍBRIO” para monitorização remota, deteção precoce de agravamento clínico, atempada adequação do tratamento e maior interação médica com os doentes. As avaliações dos doentes, cuidadores e médicos foram positivas, com o reconhecimento de vários benefícios, tais como, conforto do doente, maior proximidade médico-doente e potencial redução de recursos presenciais. No caso de Cabo Verde, a Direção do HCDAN e participantes do PDW manifestaram interesse e reconheceram o potencial de utilização do serviço digital, inclusive junto a doentes mais jovens. Conclusão: O serviço digital “EQUILÍBRIO” foi desenhado, implementado e avaliado em contexto clínico. Verificou-se um significativo potencial para aplicabilidade clínica na prestação complementar de cuidados de saúde, permitindo monitorização remota, maior interação médico-doente e participação ativa dos doentes. A implementação deste serviço em Cabo Verde representa uma oportunidade para futura investigação. O envolvimento de outros profissionais de saúde e outros países podem ser considerados como uma promissora cooperação de cuidados de saúde entre os Estados membros da Comunidade dos Países de Língua Portuguesa.Introduction: The global and progressive aging of the populations and vulnerability to chronic diseases, balance disorders and falls have represented one of the main challenges to health systems. This has motivated the development of strategies, including the use of technology for provision of health care. Portugal and Cape Verde have followed this trend, investing in technology-based information systems. However, the clinical applicability of these digital solutions in the context of elderly people with balance disorders and risk of falling needs to be explored. Objective: The objective of this research was to study, develop, implement, demonstrate and evaluate a digital solution for the complementary provision of health care for elderly people with balance disorders and risk of falling in the Portuguese context, subsequently aligning its use in a global perspective, with the example of Cape Verde. Methods: Using the Design Science Research Methodology, an explanatory sequential mixed methods study was performed. Initially, a questionnaire was made available on the website of the Portuguese General Medical Council to identify the satisfaction and difficulties with clinical data availability, and the relevance of eHealth in the context of elderly people with balance disorders. Individual interviews were carried out with physicians, exploring strategies for the development of a digital solution in this context. The suggestions contributed to the design and development of the digital service, initially tested with five elderly women and their caregivers, as a proof-of-concept. This service was evaluated through two focus groups, including these users and eight physicians with experience in coordinating services. In the case of Cape Verde, a Policy Dialogue Workshop (PDW) was carried out, including the Direction of the Hospital Central Doutor Agostinho Neto (HCDAN), to explore the interest and potential use of the digital service in the Cape Verdean context. Results: The identification of medical constraints with availability of clinical data and the identification of the relevance of eHealth in this context encouraged the development of a digital solution. Considering the suggestions of the interviewees, the digital service “BALANCE” was designed, allowing remote monitoring, early detection of clinical deterioration, timely optimization of treatment and greater medical interaction with patients. The patient, caregiver and medical evaluations were positive, with the recognition of several benefits, such as patient comfort, closer physician-patient interaction and potential lower consumption of face-to-face resources. Regarding Cape Verde, the Direction of HCDAN and the participants of the PDW expressed interest and recognized the potential for using the digital service, including among younger patients. Conclusion: The digital service “BALANCE” was designed, implemented and evaluated in the clinical context. There was significant potential for clinical applicability in the provision of complementary health care, allowing remote monitoring, closer physicianpatient interaction and active patient participation. The implementation of this service in Cape Verde is an opportunity for future research. The involvement of other health professionals and countries could be considered as a promising health care cooperation between the member states of Community of Portuguese-Speaking Countries

How Can We Develop an Efficient eHealth Service for Provision of Care for Elderly People with Balance Disorders and Risk of Falling? A Mixed Methods Study

This study aimed to identify relevant topics for the development of an efficient eHealth service for elderly people with balance disorders and risk of falling, based on input from physicians providing healthcare to this patient group. In the quantitative part of the study, an open multiple-choice questionnaire was made available on the website of the Portuguese General Medical Council to assess the satisfaction with electronic medical records regarding clinical data available, the time needed to retrieve data and the usefulness of the data. Of the 118 participants, 55% were dissatisfied/very dissatisfied with data availability and 61% with the time spent to access and update data related to the focused patient group. Despite this negative experience, 76% considered future e-Health solutions as pertinent/very pertinent. Subsequently, these findings were further explored with eight semi-structured interviews. The physicians confirmed the reported dissatisfactions and pointed out the lack of comprehensive data and system interoperability as serious problems, causing inefficient health services with an overlap of emergency visits and uncoordinated diagnostics and treatment. In addition, they discussed the importance of camera and audio monitoring to add significant value. Our results indicate considerable potential for e-Health solutions, but substantial improvements are crucial to achieving such future solutions

A Design Science Approach

Funding Information: This research was partially supported by Fundação para a Ciência e Tecnologia (FCT) for funds to Global Health and Tropical Medicine (GHTM) (UID/04413/2020 to LVL). Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.In this study, a design science research methodology was used aiming at designing, im-plementing and evaluating a digital health service to complement the provision of healthcare for elderly people with balance disorders and risk of falling. An explanatory sequential mixed methods study allowed to identify and explore the dissatisfaction with electronic medical records and the opportunity for using digital health solutions. The suggested recommendations helped to elaborate and develop “BALANCE”, a digital service implemented on the METHIS platform, which was re-cently validated for remote monitoring of chronic patients in primary healthcare. “BALANCE” pro-vides clinical and interactive data, questionnaire pre and post-balance rehabilitation, tutorial videos with balance exercises and patient-recorded videos of the exercises. This digital service was demon-strated, including five elderly patients with clinical recommendations for balance rehabilitation at home. Finally, the authors conducted two focus groups with the participants and their caregivers as well as with physicians. The focus groups aimed at exploring their satisfaction level, needs of adjustment in the “BALANCE” service and strategies for applicability. The digital healthcare service evaluation revealed a significant potential for clinical applicability of this digital solution for elderly people with balance disorders and risk of falling.publishersversionpublishe