Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of middle-aged people with multimorbidity: A randomized controlled trial.

Alba Campillejo, Ileana Gefaell Larrondo, Vanesa Ramos García, Débora Koatz, Anthea Santos Álvarez, Jaime Barrio Cortes, Amaia Calderon, Patricia Cifuentes, Francisco Javier García García, Santiago Domínguez Coello, Sofia Garrido Elustondo, Beatriz González De León, Maria Candelaria Martin González, Maria Consuelo Company Sánchez, Pedro Parra Caballero, Patricia Quiroga Colina, Ana Belén Ramirez Puerta, Marta Ruiz López, Carmen Suárez Fernández, Maria Eugenia Tello Bernabé, Jose Ramón Vázquez, Esther Vicente Rabaneda, Beatriz Ugalde Abiega, Andrea Duarte Diaz, Analía Abt Sacks, Aránzazu Hernández Yumar, Alezandra Torres Castaño, Yolanda Álvarez Pérez, Carola Orrego, Lilisbeth Perestelo Pérez, Ana Isabel González González

Keywords: Multimorbidity, Therapeutic Community, Social Cohesion, Community Networks, Technology Assessment, Biomedical, Empowerment, eHealth Strategies, general medicine (see internal medicine); Middle Aged; Chronic Disease

Background:

Virtual Communities of Practice (VCoP) offer information and exchange possibilities for people with chronic diseases. This could be especially valuable for self-management in patients with multimorbidity. We aim to evaluate the effectiveness of a VCoP versus individual, self-administered online education to improve the activation of patients with multimorbidity.

Research questions:

How does Patient Activation improve after a Virtual Community of Practice web platform-based intervention compared to a self-administered content-focused education?

Method:

Study design: Randomized controlled hybrid-1, pragmatic trial. Setting: Primary healthcare and hospitals, Spain. Participants: Adults 30-60 years old with ≥2 chronic diseases. Intervention: VCoP for 12 months. Control group: Content-focused education through self-administered web-platform. Primary outcome: Patient Activation Measure (PAM) questionnaire. Secondary outcomes: Sociodemographic, levels of depression and anxiety, treatment burden, health-related quality of life and implementation outcomes.The development of the research will be done in three phases. Analysis: Mixed-effects linear regression to determine the effects of VCoP on PAM scores at baseline, 6, 12, and 18 months.

Results:

Exploratory phase 1: Patients and professionals participated addressing barriers and needs. They built the trajectory of care, so their needs could be addressed by the vCoP. The experiences facilitated designing a Patient Journey Map. Three stages were recognized:
a) Pre-diagnosis and diagnosis: Diagnoses may be unexpected, affecting patients emotionally. Some people may deny their situation or exploit it for personal gain. Social determinants are important.
b) After diagnosis: Patients' environment is impacted. Health education consultations can aid in accepting and understanding. Gender and mental health influence empowerment.
c) Follow-up: Social determinants, patient’s associations, and polypharmacy act as barriers or facilitators.

Conclusions:

A person-centered co-design process of a vCoP may facilitate the empowerment of multimorbid patients. e-EMPODERA-3 project aims to improve the patients' understanding of their chronic diseases and enhance self-care quality.

Points for discussion:

Does anyone in the audience have any experience with vCoPs?

Which patterns of multimorbidity will benefit from the intervention?

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