ESCAPE’s intervention is based on a concept referred to as Blended collaborative care (BCC). BCC is a patient-centred, holistic approach to improving patients’ health behaviour that considers the patient’s entire physical and mental health, rather than focusing just on one condition.
The BCC approach is implemented through a care manager. In the context of ESCAPE, the care managers are primarily nurses. Care managers support patients with their numerous conditions and healthcare providers, in close collaboration with patients’ general practitioners (GPs) and relevant specialist providers. An approach of systematically integrating the GP’s knowledge of their patients, including their health status and their health goals, is a core element of the intervention.
Our care managers are the patients’ main contact and thus have a number of responsibilities to ensure the patient (and carers) are sufficiently supported. These responsibilities include building a relationship with patients, supporting the adoption of healthy habits, addressing their emotional burden, providing education on conditions and treatment options, and finally monitoring symptoms and patient progress.
In order to implement ESCAPE’s BCC intervention, there were a number of preliminary steps needed to ensure the intervention could be effectively and efficiently executed. This has been the primary focus of WP2 for the first eighteen months of the project.
First, a qualitative interview study was conducted in Denmark, Italy, and Germany to determine patients' and informal carers' needs and preferences related to the ESCAPE intervention. The results yielded eight “patient personas” – these personas were used to inform the intervention’s implementation, ensuring the process most closely reflected the needs of the patients (and carers).
Second, the ESCAPE Care Management Manual, an extensive document containing background information on multimorbidity and its consequences for patients, the principles of BCC and the intervention’s structure was developed. The manual serves as a comprehensive introduction to ESCAPE’s principles of care management for care managers, their trainers, and supervisors.
Third, collaborative care interventions require an information system to collate patient information. As such, the tailoring and testing of imergo© - ESCAPE’s eHealth platform was essential. Addressing patients with multiple conditions requires a complex information system - to support this complexity, the imergo© platform was expanded to sufficiently inform medical recommendations for patients with multimorbidity.
And finally, because BCC and the care manager role is largely new to those implementing the intervention, training the team was essential. Using the “train-the-trainer” technique, trainings occurred in two phases. First, a group of six trainers (one from each of the trial countries) was trained by our experts in English, these trainers, in turn, brought their new skills back to their local care manager teams and trained them in their local language.
As recruitment for the clinical trial continues, the care managers are now trained to execute ESCAPE’s BCC intervention. Our team is eagerly looking forward to learning more about the impacts of BCC within the European context in the coming months.
Train the trainer team comprises of the co-leaders Birgit Herbeck-Belnap at the University Medical Center Göttingen and Dagmar Lühmann at the University Medical Centre Hamburg-Eppendorf, plus Matthew Burg, Yale University, and Josefine Schulze at University Medical Centre Hamburg-Eppendorf.
