The European Union has included 2,000 patients from five countries in a Prevention and Care Programme to tackle one of the major challenges of public health services: chronicity

      EFFICHRONIC is based on previous evidence that people with chronic illness that adopt healthier lifestyles and better manage their illness achieve better health outcomes, improve their quality of life and make more efficient use of health resources.

Based on a scientific methodology developed by the Stanford University, the main aim is that passive patients take an active role in the participation in decision making and greater responsibility for their health.

The consortium is currently preparing the design, implementation and evaluation framework of the Chronic Disease Self-Management Programme (CDSMP) for addressing chronicity. This is one of the major challenges for health care in Europe as 35 % and 25% of women and men, respectively, are affected by a chronic disease.

The EFFICHRONIC strategy will be key to address the burden of the health systems caused by patients with chronic conditions, and has the support of the Regional Ministry of Health of the Principality of Asturias and the University of Valencia (Spain), the Center Hospitalier Universitaire de Montpellier (France), Qismet (UK), the Erasmus Universitair Medisch Centrum Rotterdam (The Netherlands) and the Ospedaliero Ospedal Galliera (Italy).

EFFICHRONIC is based on the evidence that people with chronic diseases who acquire skills and tools to adopt healthier lifestyles and manage their illness improve significantly their quality of life and make a more efficient use of health resources.

Following a scientific methodology developed by the Stanford University, the objective is that passive patients take up an active role to increase their abilities for self-care and self-management of their illness.

Background

The approach of using cost-effective treatments for people with chronic diseases, as well as the support to their caregivers, is a fundamental issue that needs to be further investigated. In particular, EFFICHRONIC addresses:

1. Magnitude. According to the World Health Organization (WHO), the percentage of people affected by chronic diseases at a global level can be estimated at around 35 % of women and 29 % of men. It is estimated that 50 % of Europeans will have at least one chronic illness when they retire.
2. Reorientation of Attention Models. The health approach that tackles acute pathology does not consider the underlying needs from chronic or non-infectious pathologies. These needs are not curable and require the intervention of the care services. To face this problem, EFFICHRONIC will investigate a strategy of care based on the Chronic Care Model of Wagner (Chronic Care Model). This model identifies six key elements that interact with each other to improve the quality of care: community, health system, self-management support, design of the delivery system, decision support, and clinical information systems. This model is based on interactions between informed patients, who take an active part in their care, and care givers with resources and experience.
3. Person-Centered Care. Productive interactions between informed and activated patients and health professionals are the key to achieve the best health outcomes.
4. Enhancing People’s Empowerment. Increasing the abilities and skills of the patients will allow them to manage their health condition effectively, and adapt themselves to the environment where they live. EFFICHRONIC will use the method of empowerment of the CDSMP which has been developed by the Stanford University.
5. Salutogenesis. EFFICHRONIC is based on the approaches of health promotion and positive health. This project will be developed under a problem-solving framework to reach individual solutions through collaborative work.  This will strengthen the capacity of the individuals to find the right way to acquire a healthier lifestyle through motivation, proactive behavior, nutrition and physical activity.
6. Inclusion of socio-economic criteria. Economic and educational levels, ethnicity, gender, etc are factors that determine the lifestyles of individuals and create goals.

EFFICHRONIC arises from the need of reducing the morbidity and mortality burden of the most common chronic diseases. This will lead to an increase in the sustainability of health systems by providing cost-efficiency data on the investment in evidence-based chronic disease self-management programmes.

EFFICHRONIC will implement the CDSMP in 5 different European countries (France, Italy, the Netherlands, Spain and the United Kingdom), with a total sample of more than 2000 people with chronic diseases and their committed caregivers.

We propose to show evidence on the effectiveness and efficiency of the investment in this programme that is based on socioeconomic determinants of health. In addition, we will identify and address risk factors that have been linked with a greater burden of chronic disorders in our societies.

The specific objectives of EFFICHRONIC are:

1. To carry out a multidimensional analysis and stratification methodologies to identify vulnerable individuals in five different European countries.
2. To develop a comprehensive framework for impact assessment that includes cost-benefit analysis and health economics. This will give evidence on the effectiveness and efficiency of investment in the prevention and management of chronic conditions.
3. To implement the CDSMP programme in the five countries and promote the prevention and empowerment policies in other countries. To achieve this, guidelines for good practices will be developed.

Methodology

EFFICHRONIC is based on the design and implementation of the CDSMP, as well as the evaluation of the impact on health and socioeconomic status. This study will be developed with a sample of 2,000 people with chronic diseases and their caregivers in 5 European countries. The population will be stratified according to clinical social and psychological criteria, vulnerability, and socioeconomic determinants.

After recruitment of the population and before carrying out the intervention programme, people will be stratified by using the Multidimensional Prognostic Index (MPI). This index, that was developed for people over 75 years old during a project financed by the European Comission, will be adjusted to incorporate socio-economic criteria to be used for general population.

The methodology of EFFICHRONIC is based on three steps:

1. Stratification of population and individuals for recruitment

The stratification of the population will be carried out considering the identification of vulnerable geographical areas. Urban areas will be measured using the MEDEA Index (Strategic Action of the Spanish Biomedical Research Network on Epidemiology and Public Health) and the EVRI (Effichronic Vulnerability rural index) will be used in urban and rural areas, respectively. Then, the vulnerable population in each country will be identified and be invited to participate in the programme by using the best recruitment strategies including the dissemination and the communication plan.

2. Implementation of the training programme

During this stage we will recruit the leaders, carry out their training and prepare the materials that will be used to organize the training workshops. We estimate that inclusion of 2000 people that meet the inclusion criteria of the programme will take one and a half years

3. Evaluation, benefit and health economics

The results of EFFICHRONIC will be evaluated continuously based on:

−        The effectiveness of the programme to improve treatment adherence, perform regular exercise and develop healthy eating habits.

−        The increase in the daily social activities of the individuals.

−        The impact of the intervention programme on the health outcomes and other relevant variables for the health services.

−        Cost-effectiveness analysis to provide relevant information about the costs and benefits of the intervention.

The findings of EFFICHRONIC will provide data on efficacy and quality of life outcomes, including the benefits of the self-management and healthier behaviors, and cost-efficiency of self-management programmes. This is key to assess the impact of the programme on the sustainability of health systems.

Relevant strategies

Socioeconomic and cultural differences produce short- and long-term differences related with self-care and health, and these could lead to high-risk behaviors. There are also differences in the use and adherence to health resources, which also influence the impact of chronic diseases on individuals through specific social determinants. Research on prevention programmes has not been targeted at individuals with specific vulnerability profiles, and has focused primarily on a specific chronic condition.

From a global and integral approach of the individual, segmented approaches are not suitable in the promotion of good habits of life. The promotion of healthy physical and mental habits and lifestyles are holistic, inclusive and universal. The major strategy of EFFICHRONIC is applying a methodology in a general way for all individuals to promote positive and healthy habits in life. Creating networks of support for the people in their community, work and social areas is another strategic line. That is why EFFICHRONIC aims to provide people with chronic illness and their caregivers with close support networks, which give real support to daily self-care and to achieving health goals.

Another strategy EFFICHRONIC is to expand the view of the vulnerability of people. This project will consider both clinical and social criteria for inclusion of individuals in the programme to manage the progress of their diseases.

The use of economic indicators is also important to measure the impact of the intervention on the individual health of the trainers and also to measure the cost-efficiency and cost-utility after the implementation of the programme in vulnerable population.

Contribution of the project to health programs

The main contribution is to provide data on the cost-effectiveness and cost-effectiveness of a programme for empowerment of people with chronic illness and their caregiver to managers and with policy makers.

The outcomes of EFFICHRONIC will contribute to the sustainability of the health care systems. In addition, EFFICHRONIC uses also equity criteria to reduce inequality gaps in public health. This will aid setting up a framework that can be integrated into other indicators of impact in terms of chronicity.

EFFICHRONIC moves forward to the development of new models of health care that are person-centered, favor the interaction of the individuals with other members of their communities, and allow individuals to manage their own conditions of health and illness.

This is an innovative programme based on scientific evidence that will allow us not only to improve the health outcomes of the population and their quality of life, but also to determine the impact of the application of the programme on the economic and financial sustainability of the health systems.

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