title: How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions.
abstract: BACKGROUND
  Patient eHealth technology offers potential support for disease self-management, but the value of existing applications for patients with multiple chronic conditions (MCCs) is unclear.
  
  
  OBJECTIVE
  To understand self-management and health care navigation challenges that patients face due to MCCs and to identify opportunities to support these patients through new and enhanced eHealth technology.
  
  
  METHODS
  After administering a screening survey, we conducted 10 focus groups of 3-8 patients grouped by age, sex, and common chronic conditions. Patients discussed challenges associated with having MCCs and their use of (and desires from) technology to support self-management. Three investigators used standard content analysis methods to code the focus group transcripts. Emergent themes were reviewed with all collaborators, and final themes and representative quotes were validated with a sample of participants.
  
  
  METHODS
  Fifty-three individuals with ≥3 chronic conditions and experience using technology for health-related purposes.
  
  
  RESULTS
  Focus group participants had an average of five chronic conditions. Participants reported using technology most frequently to search for health information (96%), communicate with health care providers (92%), track medical information (83%), track medications (77%), and support decision-making about treatment (55%). Three themes emerged to guide eHealth technology development: (1) Patients with MCCs manage a high volume of information, visits, and self-care tasks; (2) they need to coordinate, synthesize, and reconcile health information from multiple providers and about different conditions; (3) their unique position at the hub of multiple health issues requires self-advocacy and expertise. Focus groups identified desirable eHealth resources and tools that reflect these themes.
  
  
  CONCLUSIONS
  Although patients with multiple health issues use eHealth technology to support self-care for specific conditions, they also desire tools that transcend disease boundaries. By addressing the holistic needs of patients with MCCs, eHealth technology can advance health care from a disease-centered to a patient-centered model.
authors.affiliation: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA, dzulman@stanford.edu.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
authors.forename: Emily C
authors.initials: EC
authors.lastname: Jenchura
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Cohen
authors.forename: Eleanor T
authors.initials: ET
authors.lastname: Lewis
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D054626:Consumer Health Information / Q000379:methods; D005260:Female; D017144:Focus Groups; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D012648:Self Care; D017216:Telemedicine / Q000379:methods*