Each month, the BEAMER project convene several partner organisations to discuss one of the six dimensions of quality care – safety, effectiveness, patient – centeredness, timeliness, efficiency and equity – as it relates to adherence to treatments. This month the project focuses on Equity.
My name is Kristina Livitckaia. I hold a PhD in Medical Informatics, an MSc in Computer Science (eHealth), and an MSc in Economics. My PhD thesis focused on patient adherence. Over the past ten years, I have been involved in various roles within academia, industry, and Research and Development (R&D) facilities across several European countries, focusing on health and safety aspects. In BEAMER, I represent the Information Technologies Institute at the Centre for Research and Technologies Hellas (CERTH/ITI), where I work as a postdoctoral researcher and Research and Development Manager. CERTH/ITI is one of the leading research facilities in Greece, with a strong focus on health research and projects. We are truly interested and aim to provide the most suitable decisions, evidence, and knowledge to improve the lives of patients and healthcare consumers.
I am Kathrin Scheckenbach, representing the ENT (Ear, Nose, Throat) Department of the Düsseldorf University Hospital, Germany. I am a certified ENT specialist and for more than 10 years I have been Head of our Neck and Cancer Centre. ENT is a very diverse and interesting speciality. We care for patients of all age groups and our patients experience different diseases that are not comparable to each other in terms of physical, functional, psychological, as well as social impairment. Surgery, conservative treatment methods, and the use of medical health devices all play a role in the therapeutic options that we can offer to our patients. Thus, we have to manage adherence across different situations and for very diverse patients.
I am the co-founder and general manager of MEDIDA and full Professor of Clinical Research at Porto University Medical School (FMUP), where I’m currently the Head of the Department of Community Medicine, Information and Health Decision Sciences. I am a physician and Head of the Allergy Unit at CUF Porto Hospital and Institute. My main interests are Patient-centered innovation, mobile Health, Patient-Reported Outcomes and health technologies assessment.
MEDIDA is an SME established in 2007 as a spin-off of Porto University. Its motto is “Supporting the patient, improving health”, as it aims to improve (i) the quality of healthcare through R&D&I and (ii) the quality of life of patients with respiratory and allergic diseases by providing personalized healthcare services and solutions. MEDIDA is credited by the Portuguese government agency for Innovation (ANI) for R&D services in health and information and communication technologies applied to health. MEDIDA’s expertise ranges from the development of health technologies, especially PROMs and digital health tools directed to chronic patients, to clinical care services and health technology assessment studies.
MEDIDA has been developing mobile health apps since 2012 with a focus on adherence to treatment since 2018 with the INSPIRERMUNDI and INSPIRERS HTN apps. INSPIRERMUNDI aims to improve adherence to inhaled treatments using image processing technology and gamification concepts. INSPIRERS HTN aims to improve hypertension treatment adherence and blood pressure self-monitoring also using an embedded smartphone camera and advanced image processing.
I think it is smart to ask for personal and professional perceptions of the quality of care. In BEAMER, we bring together diverse expertise and experiences within healthcare. The quality of care defies a single definition because it encompasses numerous dimensions, such as care efficiency, patient safety, personalization, knowledge integration and many others. From my perspective, quality care involves an approach that integrates multiple approaches and technologies to drive personalization and patient/consumer satisfaction, considering the specific circumstances of the condition. Quality care is about precision health: timely, tailored, and informed decisions based on the best available evidence, supported by medicine and technologies.
Quality care represents the ultimate aim of patient care. It comprises professional, ideally evidence-based diagnostics and treatment options, as well as supportive and appreciative interactions among medical stakeholders for the well-being of the patient.
The meaning of quality care can differ depending on the context and personal factors. Overall, I would highlight the perception of the patient and the degree to which the aims of care are met. In other words, it concerns how patients experience care and how well it aligns with the goals and expectations of the various stakeholders.
There are indeed many challenges. Firstly, adherence is a complex and subjective matter, varying across different settings, making it difficult to define. Secondly, there is a lack of comprehensive patient profiles, highlighting the need for a better understanding of patients’ psychological, behavioural, and environmental factors. Recognising that patients are unique individuals with their own motivations, beliefs, and external influences is crucial. Thirdly, there is a need for cohesive approaches that consider an integrative vision of influencing factors, combining different dimensions of adherence. Lastly, more evidence is needed for disease-agnostic approaches that can be applied across various healthcare contexts.
Defining ‘equity’ can be challenging as it can encompass various aspects. Our patients differ in terms of age, basic health and mental status, social status, income, family status, external support, living situations, and more. It becomes complex to define ‘equity’ given these diverse factors. Poor adherence may be influenced by all these mentioned points and many others.
The quality of care can vary significantly, and patient characteristics play a major role in unwarranted variation. Healthcare systems face significant equity challenges, ranging from access to care to personalization of treatment. Even geographic factors, such as where individuals live, can impact the care they receive and have access to. As chronic diseases become increasingly prevalent in healthcare, poor adherence to treatments emerges as a major threat to achieving desired outcomes. It is often under-recognised that adherence is a key driver of treatment success.
I come from a technical and economics background, focusing on solutions for healthcare throughout my entire career, and what I envision is essential to be delivered is the importance of data-driven cohesive approaches and an interdisciplinary blend of aspects for decision-making. However, I am not the only one in the CERTH/ITI team who supports the project – we are a team of highly motivated and experienced people. Together, we aim to deliver quality technical outputs such as BEAMER and Adherence Data Lab Platforms that will serve both the clinical and research community, ensuring that each aspect of the technology selected is fit for each BEAMER setting.
We are in direct contact with patients of a broad spectrum of diseases with varying impacts on their personal condition and ongoing life. Thus, we are able to contribute to the project by bringing in our experience with a view on diversity. Since the overarching idea of the BEAMER project is disease-agnostic adherence, our scientific and clinical experience with a very diverse group of patients and diseases could help to identify and test aspects of adherence that are relevant across all of these patient groups and disease entities.
MEDIDA’s experience in health technology assessment helped the projects’ efforts to systematically review the literature to inform the ‘BEAMER model’. Data from previous studies have shown how adherence to treatment can contribute to necessary insights into patients’ perspectives. We can participate in the design of new clinical studies on adherence and the collection of new data. As mentioned from the start, MEDIDA would like to use the mHealth technologies we developed to monitor patients’ adherence in real-life settings. Given our experience, we are available to help with data analysis using data from different sources.