Multimorbidity means living with multiple chronic physical and mental health conditions. For example, if a patient suffers from anxiety, high blood pressure, and arthritis, they are multimorbid. A similar term is comorbidity, which means a patient that suffers from two diseases. Multimorbidity is extremely common in seniors, in fact, 75% of people over 65 are multimorbid, making it a pressing global health challenge.
Multimorbidity complicates care for patients and their informal carers because they have several needs simultaneously. Since our healthcare systems are organized around diseases or body parts, and not around the patient, doctors and other health care professionals are often unaware of the patient’s other conditions, unless the patient discloses this information to the physician. This makes it the patient’s responsibility, or in many cases, the responsibility of their informal carer (i.e., a child or spouse) to manage appointments, medications and communicating with various physicians, as the patient suffers from multiple diseases.
In particular situations, medications prescribed by healthcare professionals for different conditions can have serious consequences for patients, due to drug-drug interactions, whereby the drugs are less effective, or even toxic, when taken together. Moreover, managing multiple doctors and appointments can lead to delays for necessary treatments. Not only will this affect a patient’s wellbeing and prognosis, but ineffective and delayed treatment is also expensive. Delays in care and adverse drug interactions are just some of the reasons why multimorbid patients’ care pathways need to be redesigned to improve their overall health and wellbeing and to reduce costs.
Blended collaborative care (BCC) is an approach to improving patients’ health that considers both physical and mental health. BCC acknowledges that improving physical health will benefit from improvements in mental health, and vice versa. ESCAPE’s BCC approach addresses patient and carer needs using the imergo® digital support system alongside care managers.
imergo® is a digital health platform that will be used to support ESCAPE’s BCC intervention and optimize the health of multimorbid patients. imergo® was developed in a previous EU project and will now be tailored specifically to the ESCAPE project. imergo® contains a meta-algorithm for multimorbidity (MAM) designed for ESCAPE which allows it to optimise health for multimorbid patients.
imergo® will provide a unified communication point between care managers, specialists, care providers, and patients. The platform should support the aim to reduce the number of hospitalisations by including a medication database to detect drug-drug and drug-disease interactions.
eHealth or electronic health is a broad term that refers to the use of digital technology in healthcare. Other names for eHealth include Health IT or mHealth. eHealth uses technologies to improve the overall health of a community or region through changes to healthcare services and delivery.
Care pathways describe the “route” a patient takes to receive the care they need. For example, an elderly patient experiencing knee pain will first visit their GP, followed by an orthopaedic specialist, possibly followed by a physiotherapist. The care pathways of patients with multimorbidity are generally very complicated due to their numerous healthcare needs, often resulting in fragmented care. ESCAPE will focus on streamlining, integrating and simplifying these pathways, to improve health outcomes for patients across Europe.
Care managers are healthcare professionals who will deliver the ESCAPE intervention and manage multimorbid patient care using e-Health technologies. In utilising the ESCAPE technologies, the care managers will take responsibility for optimising patient health, relieving the patients of that duty.
Within the scope of ESCAPE, care managers are required to have an EU recognised training as healthcare professionals with experience in patient care, general practice, mental health services, or cardiology. ESCAPE chose this broad definition to accommodate different practices across centres and countries.