The Future of Healthcare: Complex Needs Require Patient-Centered Solutions

Healthcare has traditionally involved care of patients with single acute medical conditions and mental disorders. Patients received treatment, got better, and were then discharged. However, this traditional approach is becoming increasingly untenable in the modern world. This is due to a growing number of patients with multiple chronic conditions. These conditions require ongoing active management rather than a single pointed and definite cure (which is usually not possible).

Today, one in three adults live with two or more medical conditions which require attention (Hajat & Stein, 2018). Multiple comorbidities are associated with a higher provision of healthcare and higher costs. It is also difficult to provide care for patient groups with multiple complex conditions. Patients can end up seeing multiple specialists and taking numerous medications. The combination of some medications can interact badly, making the patient’s health status even worse. This problem of comorbidities used to be one that was confined to the western world – however it is becoming increasingly common in all countries. It also used to be a problem of old age – however today comorbidities are common in young to middle aged people also.

The COVID-19 pandemic has made this problem even more obvious than it was before. Within a few months of the outbreak, itt became clear that patients with multiple non-communicable chronic diseases (NCDs) were among those most likely to become seriously ill with COVID-19. Also, the diagnosis, treatment and follow-up of people living with NCDs have been interrupted or delayed in most countries due to the pandemic, leading to a growing backlog of unmet care needs in this patient group. It is also a general problem that detection and intervention happens too late in the disease cycle of chronic diseases, with negative consequences to both treatment outcomes and quality of life for these patients.

One final concern is that comorbidities are often neglected or overlooked when a patient presents with an acute condition. This is certainly the case, and among the most overlooked comorbid conditions in this context are mental health conditions. Depression, anxiety and dementia are all too common among patients with physical diseases. Similarly, people who live with untreated mental health conditions are at increased risk of developing different types of physical ailments or diseases.

This means that patients who are seeking care within today’s healthcare system have multifaceted needs and that the prevailing fragmented and siloed approach within healthcare is not a good way to meet those diverse and complex needs. Moreover, it shows the need for a more holistic and integrative approach to care, which is provided by an interdisciplinary team of healthcare professionals.

The potentials of digital and multimodal interventions

Digital technologies – including disruptive technologies such as artificial intelligence or machine learning, digital reality, blockchain, 5G connectivity, and pervasive smartphones – are providing new opportunities in the realm of both physical and mental healthcare. These innovative tools, and the types of digital health interventions they enable, unlock new avenues for tackling ailments and diseases by giving clinicians new ways of interacting with patients, empowering people via self-guided treatment, and allowing for ‘mass personalization’ of treatments that can be delivered virtually and at scale. When it comes to mental health services, these technologies can help reduce stigma, cater for populations that traditionally lacked access to such services, and promote prevention early in the disease life cycle.

In general, digital interventions have the potential of providing more person-centered, integrative and personalized care, where service users are at the center of their own care experiences.

They also offer the opportunity to improve the continuity of care. To bring such potentials to life, it is important that digital tools, platforms and solutions are integrated into care systems and clinicians’ workflows in a way that supports and empowers both providers and patients.

When it comes to more complex or comorbid medical and mental health conditions, multimodal care, which integrates digital interventions with traditional modalities of care, will probably be the preferred and most effective choice. This approach allows us to integrate the best from both traditional and digital interventions within the same care framework.

In brief, digital and multimodal interventions allow (and support) person-centered and integrative approaches that address a range of different needs and dimensions of health within the same health and care framework.

The need for frameworks and tools that helps tackle increased complexity

In light of the increased prevalence of comorbidities across the globe, it is becoming evident that healthcare professionals need resources that will help them care for patients with a range of different ailments and diseases. One such resource is the BMJ Best Practice Comorbidities Manager. This resource offers guidance on how to manage two or more conditions in the same patient. Examples include the coexistence of COVID-19 and heart failure, or acute asthma and hypertension. This tool acknowledges and supports both the needs of healthcare professionals and the needs of their patients. Healthcare professionals worry that treating one condition might make another one worse. And patients worry about having too many hospital appointments, having too many tests, and taking too many medications. The purpose of the BMJ Best Practice Comorbidities Manager is to help improve the quality of care for this important and growing number of patients. At the same time, the resource offers guidance that is evidence based, continually updated, actionable and practical.

A recent framework for developing and evaluating complex interventions (Skivington et al., 2021) could be helpful in navigating, evaluating, and improving care in increasingly complex care landscapes. This framework consists of different elements of complex interventions research. It includes the following four phases: 1) Development or identification of the intervention, 2) feasibility, 3) evaluation, and 4) implementation. Each phase has a common set of core actions – considering context, developing and refining program theory, engaging stakeholders, identifying key uncertainties, refining the intervention, and economic considerations. These elements should be considered early and continually revisited throughout the research and implementation process, with the aim of increasing the quality of complex interventions within healthcare.

Another framework which could be helpful in navigating increasing complexity, is the newly published User Experience Framework for health interventions (Søvold & Solbakken, 2022). This framework, which is based on a scoping review of existing literature, aims to fill gaps in existing approaches to understand and evaluate service users’ experiences with health interventions – as well as the implications of these experiences – in clinical contexts. It consists of five overarching categories or domains: 1) Perception of self as patient/user, 2) Perception of the intervention provider, 3) Perception of the therapeutic relationship/alliance, 4) Perception of the intervention/modality, and 5) Perception of contextual factors. Each of these domains consists of several subordinate facets, which all contribute to the overall service user experience.

The user experience framework can be a useful tool to help understand the multifaceted nature of the user experience and to evaluate and promote this experience in a more integrative and systematic way – both within quantitative and qualitative research and in clinical practice. Also, integrating this framework into clinical contexts and evaluating the user experience on an ongoing basis can help improve both the quality of care delivered and the outcomes – for the benefit of patients and care providers.

Lastly, a recent toolkit developed by the World Economic Forum in partnership with Deloitte focuses on the use of digital interventions for mental health treatment. The toolkit draws on and builds on previous assessments to provide a holistic framework to give governments, regulators, and independent assurance bodies the means to create and adapt policies that tackle ethical, efficacy, and privacy concerns surrounding the integration of disruptive technologies into policy frameworks.

Conclusions 

Increased complexity in patient and provider needs, make the need for multifaceted solutions, including digital tools, clear. The mentioned evidence-based frameworks, tools and solutions may all contribute to reducing the current fragmentation within today’s healthcare systems and move us towards more person-centered and integrative services where service users' needs and experiences are at the center of the matter.

To ensure that new healthcare innovations reach their highest value and impact, all stakeholders – including governments, researchers, care units, employers, and insurance companies – must align around the principles of co-production and collaboration and help ensure that new frameworks, technological innovations and innovative tools and solutions are implemented and used in a way that is efficacious, ethical, and clinically-validated.