This chapter provides a basic overview of care process management and active patient engagement principles. It builds upon these principles to describe in more detail the way information and communication technology can provide support for them. It later discusses their impact on quality and cost-efficiency of care. The authors specify care models suitable for ICT support, specific process support characteristics related to health care, standards and communication devices that are being used. The chapter also provides a description of development and implementation of such an environment to support treatment of patients with depression.
TopBackground
Health care in the developed world is facing a combination of changes that forces the health care systems to rethink the principles of care provision and to reinvent themselves especially in terms of cost-efficiency, access to care, and quality of care (Bloom, 2002).
The changes on the horizon are on one side a growing population of elderly combined with an increasingly growing numbers of chronically ill patients and patients with one or more chronic conditions - such as hypertension, diabetes mellitus, depression, obesity, asthma, and chronic obstructive pulmonary disease. On the other side is a powerful drive of the health care and pharmaceutical industry to introduce more advanced treatments and procedures, sell more expensive drugs and lower the threshold of diagnosis and consequent earlier treatment initiation (as has been seen in hyperlipidemia with lipid-lowering drugs).
Combining the two trends – demographic changes and ever present industry interest – we can foresee a further need and drive for increase in the scope and extent of health services to be provided. The increase in scope is almost invariably combined with an increase in cost. This poses a threat to cost-sustainability of health care systems as the costs are already spiraling upwards (Bodenheimer, 2005a; Bodenheimer, 2005b; Marmor, Oberlander & White, 2009) . There are several measures to prevent the uncontrolled increase of system - level health care cost. Most of them are restrictive in nature and are focused on readjusting the extent of services provided within the public health care, introducing co-payments and concomitant new insurance schemes, often reducing the availability of services (Bodenheimer, 2005c; Marmor et al., 2009).
Besides these measures a change of thinking is needed for health care systems to provide accessible and affordable future care to the growing population of patients with long-term conditions (Wilson, Bunn & Morgan, 2009). Some of the aspects of needed changes are described in more detail below.