title: Integrating a tailored e-health self-management application for chronic obstructive pulmonary disease patients into primary care: a pilot study.
abstract: BACKGROUND
  Changes in reimbursement have been compelling for Dutch primary care practices to apply a disease management approach for patients with chronic obstructive pulmonary disease (COPD). This approach includes individual patient consultations with a practice nurse, who coaches patients in COPD management. The aim of this study was to gauge the feasibility of adding a web-based patient self-management support application, by assessing patients' self-management, patients' health status, the impact on the organization of care, and the level of application use and appreciation.
  
  
  METHODS
  The study employed a mixed methods design. Six practice nurses recruited COPD patients during a consultation. The e-Health application included a questionnaire that captured information on demographics, self-management related behaviors (smoking cessation, physical activity and medication adherence) and their determinants, and nurse recommendations. The application provided tailored feedback messages to patients and provided the nurse with reports. Data were collected through questionnaires and medical record abstractions at baseline and one year later. Semi-structured interviews with patients and nurses were conducted. Descriptive statistics were calculated for quantitative data and content analysis was used to analyze the qualitative data.
  
  
  RESULTS
  Eleven patients, recruited by three nurses, used the application 1 to 7 times (median 4). Most patients thought that the application supported self-management, but their interest diminished after multiple uses. Impact on patients' health could not be determined due to the small sample size. Nurses reported benefits for the organization of care and made suggestions to optimize the use of the reports.
  
  
  CONCLUSIONS
  Results suggest that it is possible to integrate a web-based COPD self-management application into the current primary care disease management process. The pilot study also revealed opportunities to improve the application and reports, in order to increase technology use and appreciation.
authors.affiliation: CAPHRI, Department of Family Medicine, Maastricht University Medical Center, Maastricht, Netherlands. viola.voncken@maastrichtuniversity.nl.
authors.forename: Viola
authors.initials: V
authors.lastname: Voncken-Brewster
authors.forename: Huibert
authors.initials: H
authors.lastname: Tange
authors.forename: Albine
authors.initials: A
authors.lastname: Moser
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Nagykaldi
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine