40 Millionen Gesundheitssurfer in Deutschland- Auswirkungen auf den Gesundheitsmarkt, Potentiale und...

Seite 1 Welldoo Panorama, 24. Okt. 2014, Bertelsmann Forum Berlin 2014, Berlin © Dr. Alexander Schachinger EPatient RSD Gmbh

Vortrag 40 Millionen Gesundheits-‐Surfer in Deutschland: Status Quo, Innova<onspfade, Herausforderungen Dr. Alexander Schachinger Geschä7sführer EPa<ent RSD GmbH, Berlin as@epa<ent-‐rsd.com


Na<onale Wirtscha7spresse Q3 2014


Schau hin. Unabhängig, strukturiert, regelmäßig, interdisziplinär, na<onal, global


© facebook 2011

Der digitale Gesundheitsmarkt

Die Nachfrageseite: Gesunde, Pa<enten, Angehörige

Die Angebotsseite: alle internetbasierten Inhalte und Dienste zum Thema Krankheit & Gesundheit

(egal welches Endgerät, Format, Quelle, Land)


Der digitale Gesundheitsmarkt (ca. zwöl7ausend Webdienste im D,A,CH-‐Raum)


Globale Health 2.0 Innova<onspfade

1998 2000 2002 2004 2006 2008 2010 2012 2014

Portale (nur Text)

Foren, Communi4es Gesundheitsportale

Bewertungen (kollabora4ve Datenerstellung

Coaching, Beratung

Personal Tracking + Health Records

Mobile Apps / mHealth

Real World Data, Pa4ent Generated Research

Informa4on Therapy

Connected To Provider

Evidence Based Interven4ons And Outcome

Digital Adherence

Compara4ve Effec4veness

Innova<on


“2,800 People with Acid Reflux Report Which Treatments Work Best”

http://curetogether.com/blog/2011/09/26/acid-reflux/


Case: Patient Generated Stoma Product Innovation (DK)


Medical Internet Research – ein globaler Forschungszweig bisher völlig unbekannt in Deutschland. Warum?

Review

Adherence in Internet Interventions for Anxiety and Depression:Systematic Review

Helen Christensen, PhD, MPsych, BA; Kathleen M Griffiths, PhD, BSci; Louise Farrer, BPsychCentre for Mental Health Research, The Australian National University, Canberra, Australia

Corresponding Author:Helen Christensen, PhD, MPsych, BACentre for Mental Health ResearchAustralian National UniversityCanberra ACT 0200AustraliaPhone: +61 2 6125 8409Fax: +61 2 6125 0733Email: [email protected]

AbstractBackground: Open access websites which deliver cognitive and behavioral interventions for anxiety and depression arecharacterised by poor adherence. We need to understand more about adherence in order to maximize the impact of Internet-basedinterventions on the disease burden associated with common mental disorders.Objective: The aims of this paper are to review briefly the adherence literature with respect to Internet interventions and toinvestigate the rates of dropout and compliance in randomized controlled trials of anxiety and depression Web studies.Methods: A systematic review of randomized controlled trials using Internet interventions for anxiety and depression wasconducted, and data was collected on dropout and adherence, predictors of adherence, and reasons for dropout.Results: Relative to reported rates of dropout from open access sites, the present study found that the rates of attrition inrandomized controlled trials were lower, ranging from approximately 1 - 50%. Predictors of adherence included disease severity,treatment length, and chronicity. Very few studies formally examined reasons for dropout, and most studies failed to use appropriatestatistical techniques to analyze missing data.Conclusions: Dropout rates from randomized controlled trials of Web interventions are low relative to dropout from openaccess websites. The development of theoretical models of adherence is as important in the area of Internet intervention researchas it is in the behavioral health literature. Disease-based factors in anxiety and depression need further investigation.

(J Med Internet Res 2009;11(2):e13) doi:10.2196/jmir.1194

KEYWORDSPatient dropouts; depression; depressive disorder, major; anxiety disorders; Internet; mental health services; treatment outcome

IntroductionWeb-based interventions are effective for a range of mentalhealth disorders including depression, panic, post-traumaticstress disorder (PTSD), perceived stress in schizophrenia, stress,insomnia, and eating disorders [1]. While efficacy trials of Webinterventions show good-to-excellent levels of adherence, openaccess websites have been associated with poor adherence anddropout, with substantial numbers of users not completing allWeb pages and exiting websites before the full completion ofan offered program [2,3]. For example, Farvolden [4] foundthat only 1% of participants completed a 12-week open accesspanic program, and Christensen and colleagues [5] reported that

less than 1% of users completed all modules in an open accesswebsite for depression.

There is little reason to expect that the rates of adherence towebsites offered as open access on the Web would be as strongas those reported for websites which are examined in the contextof an efficacy trial. Open access websites provide informationand Web content directly to community users at no, or minimal,cost. Data on adherence from these sites is based on the activityof spontaneous users who “visit” these sites, where many userswill have no expectation that they will be offered “programs”.In contrast, data from efficacy trials of websites are based onresponses from participants who are recruited to the trial on thebasis of elevated symptoms; consent in advance of the trial; are

J Med Internet Res 2009 | vol. 11 | iss. 2 | e13 | p.1http://www.jmir.org/2009/2/e13/(page number not for citation purposes)

Christensen et alJOURNAL OF MEDICAL INTERNET RESEARCH

XSL•FORenderX

Original Paper

Quantitative and Qualitative Usage Data of an Internet-BasedAsthma Monitoring Tool

Jacob Anhøj1, MD, DIT; Lene Nielsen2, MA, PhD Student1AstraZeneca A/S, Business Communication, Albertslund, Denmark2Copenhagen Business School, Department of Informatics, Frederiksberg, Denmark

Corresponding Author:Jacob Anhøj, MD, DITAstraZeneca A/SBusiness CommunicationRoskildevej 22DK-2620 AlbertslundDenmarkPhone: +45 43666275Fax: +45 43666100Email: [email protected]

AbstractBackground: In May 2000, AstraZeneca launched a Web service for asthma patients and health-care providers called LinkMedica,which includes an asthma diary for monitoring and self-management. In the diary, the patient enters his or her peak flow, numberof doses of rescue medication, and if there have been any asthma symptoms during the previous 24 hours. The patient receivesan immediate response from LinkMedica, telling him or her if the asthma is under control and what to do if not, eg, increase thedose of inhaled steroid. Health-care providers have access to the patient diary.Objectives: The primary objective of the study was to describe patients' and health-care providers' use of LinkMedica. Secondaryobjectives were to evaluate their perception of the system and how the users' interaction with the system is influenced by theireveryday lives.Methods: Site statistics regarding number of registered users and diary usage were analyzed. An online survey among users(85 respondents), a mailed questionnaire to health-care providers (131 respondents; response rate 26.8%), as well as in-depthinterviews with 10 patients and 5 general practitioners, elicited further quantitative and qualitative data on users' perceptions.Results: In February 2003, a total of 7653 users had registered. During 2002, the growth in registered users averaged 50 permonth. In the same period, the number of unique diary users per month decreased from 307 to 138. Patients usually stopped usingthe diary after a short time; the doctors were reluctant to introduce the diary to patients because of time constraints. Several usersubtypes were identified among patients and their relatives.Conclusion: The self-selected survey responses and in-depth interviews indicated that LinkMedica is generally considered atrustworthy and reliable site by both patients and doctors. However, there was a contrast between users' positive perception ofLinkMedica and their unwillingness to use the site for more than short periods. The primary reason for this was that LinkMedicadid not fit into their everyday lives because of technical and psychological aspects. A number of recommendations to improveLinkMedica are suggested.

(J Med Internet Res 2004;6(3):e23) doi:10.2196/jmir.6.3.e23

KEYWORDSInternet; asthma; self care; physician-patient relations; computer-assisted decision making; human-computer interaction

IntroductionThe cornerstone of modern asthma care is self-management,allowing the patient to monitor his or her disease severitycontinuously and to adjust the dose of inhaled corticosteroidbased on symptoms, lung function, and use of rescue medication

[1]. A recent Cochrane Review concluded that self-managementmight improve asthma outcomes significantly [2]. Severalstrategies have been developed, including patient education andwritten actions plans.

With the appearance of the World Wide Web, new opportunitiesfor communication and interaction between patients and


Anhøj & NielsenJOURNAL OF MEDICAL INTERNET RESEARCH

XSL•FORenderX

Review

Effects of eHealth Interventions on Medication Adherence: ASystematic Review of the Literature

Annemiek J Linn1, MSc; Marcia Vervloet2, MSc; Liset van Dijk2, PhD; Edith G Smit1, PhD; Julia CM Van Weert1,PhD1Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands2Netherlands Institute for Health Services Research, Utrecht, Netherlands

Corresponding Author:Marcia Vervloet, MScNetherlands Institute for Health Services ResearchP.O. Box 1568Utrecht, 3500 BNNetherlandsPhone: 31 30 2729713Fax: 31 30 2729729Email: [email protected]

AbstractBackground: Since medication nonadherence is considered to be an important health risk, numerous interventions to improveadherence have been developed. During the past decade, the use of Internet-based interventions to improve medication adherencehas increased rapidly. Internet interventions have the potential advantage of tailoring the interventions to the needs and situationof the patient.Objective: The main aim of this systematic review was to investigate which tailored Internet interventions are effective inimproving medication adherence.Methods: We undertook comprehensive literature searches in PubMed, PsycINFO, EMBASE, CINAHL, and CommunicationAbstracts, following the guidelines of the Cochrane Collaboration. The methodological quality of the randomized controlled trialsand clinical controlled trials and methods for measuring adherence were independently reviewed by two researchers.Results: A total of 13 studies met the inclusion criteria. All included Internet interventions clearly used moderately or highlysophisticated computer-tailored methods. Data synthesis revealed that there is evidence for the effectiveness of Internet interventionsin improving medication adherence: 5 studies (3 high-quality studies and 2 low-quality studies) showed a significant effect onadherence; 6 other studies (4 high-quality studies and 2 low-quality studies) reported a moderate effect on adherence; and 2 studies(1 high-quality study and 1 low-quality study) showed no effect on patients’ adherence. However, most studies used self-reportedmeasurements to assess adherence, which is generally perceived as a low-quality measurement. In addition, we did not find aclear relationship between the quality of the studies or the level of sophistication of message tailoring and the effectiveness ofthe intervention. This might be explained by the great difference in study designs and the way of measuring adherence, whichmakes results difficult to compare. There was also large variation in the measured interval between baseline and follow-upmeasurements.Conclusion: This review shows promising results on the effectiveness of Internet interventions to enhance patients’ adherenceto prescribed long-term medications. Although there is evidence according to the data synthesis, the results must be interpretedwith caution due to low-quality adherence measurements. Future studies using high-quality measurements to assess medicationadherence are recommended to establish more robust evidence for the effectiveness of eHealth interventions on medicationadherence.


KEYWORDSInternet interventions; medication adherence; compliance; systematic review; tailoring; eHealth; effects; RCT


Linn et alJOURNAL OF MEDICAL INTERNET RESEARCH

XSL•FORenderX

Original Paper

Long-Term Outcomes of Internet-Based Self-Management Supportin Adults With Asthma: Randomized Controlled Trial

Johanna L van Gaalen, MD; Thijs Beerthuizen, MD; Victor van der Meer, MD, PhD; Patricia van Reisen, MD; GeertjeW Redelijkheid, MD; Jiska B Snoeck-Stroband, MD, PhD; Jacob K Sont, PhD; SMASHING Study GroupLeiden University Medical Center, Department of Medical Decision Making, Leiden, Netherlands

Corresponding Author:Jacob K Sont, PhDLeiden University Medical CenterDepartment of Medical Decision MakingAlbinusdreef 2, J-10-86Leiden, 2333 ZANetherlandsPhone: 31 715264578Fax: 31 715266838Email: [email protected]

AbstractBackground: Long-term asthma management falls short of the goals set by international guidelines. The Internet is proposedas an attractive medium to support guided self-management in asthma. Recently, in a multicenter, pragmatic randomized controlledparallel trial with a follow-up period of 1 year, patients were allocated Internet-based self-management (IBSM) support (Internetgroup [IG]) or usual care (UC) alone. IBSM support was automatically terminated after 12 months of follow-up. In this study,IBSM support has been demonstrated to improve asthma-related quality of life, asthma control, lung function, and the numberof symptom-free days as compared to UC. IBSM support was based on known key components for effective self-managementand included weekly asthma control monitoring and treatment advice, online and group education, and communication (bothonline and offline) with a respiratory nurse.Objective: The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support ascompared to UC alone.Methods: Two hundred adults with physician-diagnosed asthma (3 or more months of inhaled corticosteroids prescribed in thepast year) from 37 general practices and 1 academic outpatient department who previously participated were invited by letter foradditional follow-up at 1.5 years after finishing the study. The Asthma Control Questionnaire (ACQ) and the Asthma Quality ofLife Questionnaire (AQLQ) were completed by 107 participants (60 UC participants and 47 IG participants). A minimal clinicalimportant difference in both questionnaires is 0.5 on a 7-point scale.Results: At 30 months after baseline, a sustained and significant difference in terms of asthma-related quality of life of 0.29(95% CI 0.01-0.57) and asthma control of -0.33 (95% CI -0.61 to -0.05) was found in favor of the IBSM group. No such differenceswere found for inhaled corticosteroid dosage or for lung function, measured as forced expiratory volume in 1 second.Conclusions: Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSMsupport for 1 year, even up to 1.5 years after terminating support. Future research should be focused on implementation of IBSMon a wider scale within routine asthma care.Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 79864465;http://www.controlled-trials.com/ISRCTN79864465 (Archived by WebCite at http://www.webcitation.org/6J4VHhPk4).


KEYWORDSasthma; quality of life; self-management; long-term; eHealth; Internet; telemedicine


van Gaalen et alJOURNAL OF MEDICAL INTERNET RESEARCH

XSL•FORenderX


Prak<kgemeinscha7, „Like Me“-‐Phänomen, Ins<tu<onelle Unabhängigkeit, Marktauswirkungen

(E<enne Wenger, Mark Granoveeer, Yochai Benkler, Clay Shirky, Barry Wellman, Journal of Medical Internet Research, Journal of Par<cipatory Healthcare)

„Pa<enten im Internet“


Traditionelle Versorgungswelt Digitale Gesundheit

Zwei nicht vernetzte Parallelwelten Massive Inkompetenz der Behörden und Regulatorien gegenüber der neuen Wirklichkeit; Industrie mangelt es an Markt-‐, Strategie-‐ und Mehrwertwissen


Grundlegende Ansätze

Gesundheits-‐Surfer / EPa<enten (Nachfrageseite)

Digitaler Gesundheitsmarkt (Angebotsseite)


Survey Rekru<erung

§ Portale und Newsleeer von Krankenkassen und Kliniken §  Führende Gesundheitsportale und Pa<enten-‐Communi<es § Reichweitenstarke Presse-‐ und Publikumsportale § Apps zum Thema Krankheit, Therapie, Coaching, Gesundheit

§ Portale der Sponsorpartner basierend individueller Links, welche individuelle zusätzliche Fragestellungen erlauben

§ Anonyme Online-‐Befragung auf Globalpark® Survey-‐So7ware § Auswertung und Visualisierung der Ergebnisse durch Infografiken


Grafik 1: Altersverteilung der Teilnehmer (n=3166, Angaben in Prozent)


Grafik 50: Auswirkungen der Internetnutzung auf den Gesundheitsmarkt (n=2019, Angaben in Prozent hier: „trifft voll zu“ und „trifft eher zu“, Mehrfachnennungen)

69,9%%

53,9%%

33,6%%

31,7%%

30,7%%

29,6%%

22,7%%

0%% 20%% 40%% 60%% 80%%

Ich%stelle%dem%Arzt%defini=v%jetzt%andere%oder%mehr%Fragen.%

Ich%kann%den%Arzt%jetzt%besser%verstehen%G%die%Kommunika=on%mit%dem%Arzt%ist%besser%geworden.%

Dadurch%habe%ich%einen%anderen%Arzt%aufgesucht.%

Durch%das%Surfen%im%Internet%entschied%ich%mich%schon%mal%für%ein%anderes%Krankenhaus/Klinik.%

Durch%mein%InternetGSurfen%habe%ich%von%meinem%Arzt%schon%mal%ein%anderes%Medikament%oder%eine%andere%Therapie%bekommen.%

Ich%habe%bei%meiner%Krankenkasse%andere%Fragen%gestellt,%andere%Formulare%ausgefüllt%oder%ErstaTungsthemen%anders%behandelt.%

Dadurch%habe%ich%nochmal%extra%einen%Termin%bei%meinem%Arzt%gemacht.%


Grafik 41 : Auswirkungen der Internetnutzung auf EPatienten (n=2020, Angaben in Prozent, hier: „triff voll zu“ und „trifft eher zu“, Mehrfachnennungen)

78,9%&

67,3%&

63,1%&

59,3%&

53,3%&

19,0%&

14,4%&

0%& 20%& 40%& 60%& 80%& 100%&

Ich&kann&jetzt&besser&meine&Krankheit&verstehen&(z.B.&auch&was&wichDg&ist,&worauf&ich&achten&muss&etc.).&

Ich&kann&selbstbewusster&Entscheidungen&für&oder&gegen&eine&besDmmte&Therapie&oder&Therapieänderung&treffen.&

Ich&kann&besser&mit&meiner&Erkrankung&in&meinem&prakDschen&Alltag&umgehen.&

Ich&lebe&jetzt&gesünder&&bzw.&tue&etwas&für&meine&Gesundheit.&

Ich&kann&psychisch&und&emoDonal&besser&mit&meiner&Erkrankung&umgehen.&

Die&InformaDonen&im&Internet&waren&für&mich&in&der&Praxis&nicht&umsetzbar.&

Die&InformaDonen&im&Internet&waren&für&mich&nicht&hilfreich&und&eher&verwirrend.&

Quelle: www.epatient-research.com


Grafik 47: Auswirkungen der Internetnutzung auf Therapie und Adhärenz (n=2019, Angaben in Prozent, hier: „trifft voll zu“ und „trifft eher zu“, Mehrfachnennungen)

64,4%%

61,8%%

52,1%%

0%% 20%% 40%% 60%% 80%%

Ich%kann%jetzt%besser%verstehen,%was%für%meine%Heilung%und%Reha%wichDg%is%(z.B.%nach%einer%OP%oder%besDmmten%Behandlung).%

Ich%kann%jetzt%die%Anweisungen%und%Empfehlungen%von%meinem%Arzt%besser%verstehen%und%befolgen.%

Ich%kann%jetzt%mit%meinen%Medikamenten%und%der%richDgen%Einnahme%besser%umgehen.%

Quelle: www.epatient-research.com


Der digitale Gesundheitsmarkt

Strategien, Methoden, Use-‐Case-‐/

Diensteformate, Innova<onen

Marktübersicht

Zielgruppen/

Nutzer

Unternehmen/

Produkte

Segmente

Wer, wo, was, wann?

Auswirkungen

Suchverhalten

Player,

Reichweiten, Dienste, Struktur

Erfolgsmessung / KPI´s

Weebewerbsanalyse,

Benchmark

Status Quo

vs. Innova<onspfade

Player,

Reichweiten, Dienste, Struktur

Unternehmens-‐/ Produktziele, Maßnahmen

Interne / Externe Prozesse,

Voraussetzungen, Best Prac<ce


Innova<onspfad webbasierter GKV/PKV Dienste für Versicherte Von einer „Webseite mit Broschüreninhalt“ zum digitalen Versorgungsmanagement

Webseite

Webseite als

App

1999 2006 2012 2014 2016

Dienste von StartUps (Content)

Dienste von StartUps (Therapie)

Digitale Versorgungs-‐forschung, Integra<on,

...


„Stellen Sie sich vor: Der Pa<ent erhält von seiner Klinik einen Zugang zu Informa<onen, Videos, Terminen und Services, welche genau auf seine Behandlung in seiner Klinik und seine Nachsorge zugeschnieen sind. Dieser Service ist von seinem Handy, Tablet oder Laptop abruuar. Er verwendet ihn vor, während und nach seinem Klinikaufenthalt. Eine neue Form digitaler Versorgung.“

Integra<on in die tradi<onelle Versorgung/Therapie


Echt-‐Welt-‐Versorgungsdaten


Digitale Adhärenz

+


+ +

Evalua<on digitaler Adhärenzforschung/ -‐ansätze im Rahmen klassischer Versorgungsforschung �


Merci vielmals. Dr. Alexander Schachinger Geschä7sführer EPa<ent RSD GmbH, Berlin as@epa<ent-‐rsd.com


Die EPatient RSD GmbH Das erste EPatient Full-Service Unternehmen im deutschsprachigen Raum Die EPatient RSD GmbH ist zum einen als Strategieberatung zum anderen als EU-weites Marktforschungsunternehmen mit dem Fokus auf Patienten und Nutzer auf dem webbasierten Gesundheitsmarkt positioniert. Der Kernbereich ist die wissenschaftlich fundierte Analyse, Strategie- und Produkterstellung patientenzentrierter digitaler Dienste für die Gesundheits-wirtschaft. Der interdisziplinäre Forschungs-, Strategie- und Entwicklungsansatz bildet das Bindeglied zwischen der digitalen Wirklichkeit von Patienten und dem traditionellen Gesundheits-system. Nutzer- und Nutzenzentriertheit sowie eine geprüfte Wirkung der Dienste ist dabei der Fokus.

Bei unseren beiden komplementären Marktforschungs-Produkten handelt es sich um

•  eine jährlich erstellte Marktanalyse des digitalen Gesundheitsmarktes im deutschsprachigen Internet (DGM Reports),

•  ein nationaler sowie basierend Auftrag durchgeführter EPatient Online-Survey auf nationaler Ebene.

•  Durch die drei Kernbereiche (Marktanalyse, Strategieberatung und

Produktentwicklung) erhalten Unternehmen auf dem Gesundheitsmarkt erstmalig unabhängiges, strategisch direkt umsetzbares und auf Unternehmensziele und Indikationen zugeschnittenes Markt- und Patientenwissen.

•  Die seit 2009 gewachsene internationale Vernetzung zu akademischen Netzwerken, Start-Up Clustern und Unternehmen mit Innovationsführerschaft ermöglicht wissenschaftlich und praktisch fundiertes sowie wirkungseffektives Arbeiten.

•  Die Verknüpfung von marktforschungsbasiertem Wissen des Patienten im Internet, der Strategieerstellung basierend Marktdaten des webbasierten Gesundheits-marktes sowie global erprobter Best Practice im Bereich digitaler Patientendienste bildet die Stärke der Strategie- und Produkterstellung der EPatient RSD GmbH.

40 Millionen Gesundheitssurfer in Deutschland- Auswirkungen auf den Gesundheitsmarkt, Potentiale und...

Healthcare

Transcript of 40 Millionen Gesundheitssurfer in Deutschland- Auswirkungen auf den Gesundheitsmarkt, Potentiale und...