Assessing a Patient-Centered E-Health Approach to Chronic Disease Self-Management

Introduction

This chapter examines a number of key challenges related to the emerging discourses on “empowering patients” and “e-health.” The implications of these challenges are explored in a detailed case study. The case study presented in the second part of this book chapter highlights the inherent challenges of moving towards a patient-centred model of healthcare. The case study focuses on a controlled trial that aims to assist people with chronic respiratory conditions, including chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), to achieve increased levels of self-efficacy for self-management through interactions with case mentors (community health nurses), and the adoption and use of Web and mobile information systems.

This chapter promotes a patient-centred e-health approach. It is argued that benefits from such an approach can only be realised if systems are specifically designed and implemented on the basis of a detailed understanding of end-users, their needs and complex interactions with one another, the health system, and the wider environment. Without such a holistic approach, there is a concern that the existing inequities of access to quality healthcare faced by many patients will be further compounded by an emerging e-health divide. We must avoid widening this divide to allow the existing inequalities between information “haves” and “have-nots” to be compounded by presenting additional financial, technological, and skill barriers to chronically ill patients (many of the poorest, oldest, and most vulnerable members of our societies) as more health information and services come to be provided primarily online.