Integrating Digital Interventions into Patient Self-Management Support (DIPSS)

Aims Our aim is to determine the most feasible, acceptable, effective and cost-effective methods of integrating digital interventions (DIs) into primary care in order to support patient self-management of long-term conditions. By the end of the programme we will have i) evaluated two new DIs for common conditions that could be integrated into NHS practice rapidly and at low cost, and ii) provided important evidence about the optimal methods of integrating DIs into primary care. Background DIs can empower patients by providing better access to personalised information and support for active involvement in treatment; these include resources such as instant automated advice (tailored to current symptoms and preferences), email or text medication reminders or motivational messages, self-care videos, decisional and lifestyle change support, and facilities for remote monitoring of progress by primary care staff. DIs have the potential to make significant savings by automating routine aspects of patient education, monitoring and support, freeing up health professional resources for when patients most need them. These savings can play an essential part in meeting the NHS QIPP agenda to achieve increased efficiency gains despite the growing demand created by an expanding and ageing population. There is accumulating evidence that DIs can deliver better and more efficient healthcare, but substantial barriers to wider uptake remain. New healthcare technologies will only be implemented successfully if they are designed to fit the aims, abilities and contexts of both patients and health professionals, and if their ease of use, benefits and cost-effectiveness are clearly demonstrated. This programme of research will undertake the rigorous development and evaluation necessary to maximise the likelihood of successful integration of DIs within the NHS. Research plan This research programme will focus specifically on improving management and outcomes for two common, contrasting conditions (hypertension and asthma) which are currently sub-optimally managed, leading to excess deaths, illness, disability and costs to the NHS. We propose three closely linked parallel workstreams. A behavioural and economic workstream (WS1) will focus on identifying factors influencing cost-effective integration of digital interventions (DIs) into primary care, while two clinical workstreams will develop and trial DIs for self-management of hypertension (WS2) and asthma (WS3). Contrasting clinical conditions have been selected for WS2 and WS3 to allow comparison of prevention (hypertension) vs. symptom management nd prevention (asthma), mainly older (hypertension) vs mainly younger (asthma) clinical populations and very different self-management regimes; this will facilitate identification of what factors may be common to successful DI delivery across different conditions and treatment regimes and which are condition- or treatment-specific. WS1 will undertake intervention planning to identify factors influencing acceptable and cost-effective integration of DIs into primary care, and hence the required elements and characteristics of the interventions and support to be offered for hypertension and asthma self-management in WS2 and WS3. To inform our planning we will carry out a) systematic reviews of the relevant quantitative and qualitative literature, b) studies of patient and health professional views and experiences, and c) cost-effectiveness analyses of different approaches to delivering DIs. WS2 and WS3 will develop DIs for self-management of hypertension and asthma (respectively), using iterative qualitative research to ensure that they are viewed as acceptable and useful by patients and primary care staff. Both workstreams will then carry out feasibility trials of the DIs, using quantitative and qualitative methods to evaluate patient and primary care experiences of different delivery formats. WS2 will also carry out a full randomised controlled trial