Project 1 | Active and healthy ageing starts in childhood
Lessons learned from the Asthma Adolescent project
Addressing the challenge of non-adherence to treatment among young patients – lessons from the Asthma Adolescent project
Asthma, affecting an estimated 30 million Europeans below the age of 45 years, is the most common chronic disease in childhood. While adequate treatment often leads to the complete cessation of symptoms before adulthood and despite broad availability of effective treatment options across European countries, non-adherence to treatment in childhood and adolescence remains a considerable challenge. We know by now that poor adherence to treatment in adolescence can lead to increases in morbidity, medical complications and use of healthcare services later in life, while quality of life decreases. What we don’t know is why adolescents fail to adhere to treatment and what can be done to increase adherence rates in this age group.
To answer these questions, the EFA asked 200 adolescents aged 12 to 17 in 4 European countries (Germany, Spain, France and UK) about their experiences with asthma treatment. In his summary of results from the Hey Ya! Asthma Adolescent project, Prof. Erkka Valovirta (University of Turku) underlined that while asthma severity, age and gender show no consistent effect, attitudes and the daily impact of the condition explain up to 80% of variability in adherence.
So, where to next? Karin Kadenbach (European Parliament) helped translate the six key impact factors identified by the study in a series of recommendations for families and health care professionals. MHealth tools implementing reminders and alarms, as well as a higher involvement of carers in treatment adherence can combat forgetfulness – the greatest cause of non-adherence. Rebellion (i.e. I don’t do what the doctor says) can be tackled by ensuring sustained parental involvement, support from a psychologist and by providing immediate feedback on the benefits and consequences of adherence. The “good days” effect (i.e. when I feel better I stop taking my medication) can be minimized by raising health literacy to support communication with health professionals and increasing awareness among adolescents that treatment cannot be replaced by healthy lifestyles. Better health literacy and a better understanding of the emotional underpinning of non-adherence also have the potential to limit the effects of carelessness (i.e. I don’t take asthma seriously) and ignorance. Finally, support from doctors that act as mentors and from family members motivated to be constantly involved in the management of asthma, can act as a key enabler for adherence.
In the meanwhile, policy makers at national and European level should work on measures that support multidisciplinary care coordination for patients with chronic conditions of all ages, stimulate the development of technological solutions addressed to young patients and empower adolescents to take responsibility for their health and treatment.
Circling back to some of the main topics of the European Health Forum Gastein this year, the Asthma Adolescent project traces a clear path along the life-course between health literacy in early life, better health attitudes and higher adherence to treatment, all the way to better health outcomes in adulthood and healthy and active ageing. I left the session reassured that with smart policy action we can help today’s adolescents grow into healthier and happier older adults! Hey Ya!
This Blog was written by the Young Gasteiner Stefania Ilinca
Project 4 | Innovating care for people with multiple chronic conditions
Lessons learned from the ICARE4EU project
Supporting multimorbidity through new payment systems across Europe – insights into some solutions
Mieke Rijken, from the Netherlands Institute for Health Services Research, gave an interesting insight into a European wide project focusing on multimorbidity. iCARE4EU (http://www.icare4eu.org/) collected and analysed innovative approaches in multidisciplinary care for people with multiple chronic conditions. Expert organisations from 30 European countries provided data about the characteristics of care programmes aimed at patients with multimorbidity. This dataset was huge with information on the target group of patients, the professional disciplines involved, the systems and procedures used, as well as the financing arrangements to enable new care pathways for patients with multiple chronic conditions to be developed.
This was followed by Wilm Quertin, a Young Gasteiner from the Berlin Institute of Technology, who took up a specific aspect of the iCARE4EU project. He discussed payment methods for people with chronic conditions. After presenting a standard framework, which outlined the main dimensions that determine incentives of payment systems, i.e. patient, provider and service characteristics, he went on to describe some ways payment structures could be better organised to enhance the care for people with multimorbidity. This included higher budgets for providers with multidisciplinary teams trained in multimorbidity, comprehensive case mix adjustment of payments explicitly taking multimorbidity into account and also payments for patient education and counselling as well as polypharmacy reviews. These suggestions were debated by the audience who drew on their own experiences of healthcare in different regions of Europe. We eagerly await the final results of the iCARE4EU project due to be published before the end of this year, so these new payment structures can be considered by the EU parliament and national governments.
This Blog was written by the Young Gasteiner Siobhán O’Connor