What is your role within the ESCAPE project?

Together with my colleague Birgit Herbeck-Belnap from Universitätsmedizin Göttingen I lead the development of ESCAPE’s intervention.

Based on established Blended Collaborative Care (BCC) models, the Meta-Algorithm for Multimorbidity from the German Multimorbidity Guideline, and input from patients and caregivers, we developed the ESCAPE BCC intervention in collaboration with the Fraunhofer Institute. We trained international care manager trainers and continue to support implementation during the ongoing trial through regular trainer meetings and ongoing analysis of the electronic patient documentation system.

Additionally, Hamburg is one of the four trial sites in Germany. So, I support the recruitment of general practitioners (GPs) and patients, collect baseline information, and deliver the BCC intervention.

In exchange with the Italian and Danish sites, our team captures the perspective of care managers and collaborating GPs, to explore barriers and facilitators for the implementation of the intervention.

What led you to this project?

I started my career in health care as a registered nurse, before I started studying medicine. After graduation I completed five years in immunology and transfusion medicine, before turning to social medicine and general practice.

My conviction is that all health care should be patient-centered and based on solid scientific evidence – this led me to the field of evidence-based medicine and health technology assessment. Currently, I am the research coordinator of Department of General Practice and Primary Care.

Over the last years, much of my research focuses on the care of chronically ill and multimorbid patients. Our institute also hosts the multimorbidity living guideline of the German College for General Practitioners. Through our involvement in this research, it became clear that there is a significant need for robust scientific evidence on the effectiveness of interprofessional, patient-centered care models for individuals with multimorbidity. As such, I am personally very happy to collaborate in the ESCAPE project.

Why is ESCAPE important and innovative?

The complexity of multimorbidity poses a challenge not only to care providers, but also to patients and their carers. Trying to follow guidance for every condition and navigating a diverse healthcare system easily becomes overwhelming for patients and may even result in harmful outcomes.

To my view, care management in the ESCAPE BCC intervention can prevent patients from getting lost in complexity. It helps patients to spotlight their personal heath goals and supports their pursuit. Nonetheless, proof for the effectiveness of the intervention on patients’ quality of life and health outcomes is needed and I am confident that the ESCAPE randomised controlled trial will provide it.

How do you see the ESCAPE BCC intervention working within your country’s health care context?

Statutory health insurance covers the health care spending for about 90% of the German population. Prerequisite for a healthcare innovation to be covered by statutory health insurance is solid scientific evidence that it is effective. After successful provision of this evidence by the ESCAPE trial, models can be developed how to integrate BCC into routine care.

To my view, Blended-Collaborative Care should be closely linked to the GPs, since they provide the primary and long-term care for patients with multimorbidity. Not all but many GPs teams include nurses with advanced qualifications, these could be the ones to provide care management, in close collaboration with GP’s and an established network of medical specialist, therapeutic professionals and community resources.