A life- and disease course approach to health protection and chronic care

Taking advantage of data and trustworthy collaboration is the way to go when it comes to a life- and disease course approach to health protection and chronic care, argues Prof Dr Freimut Schliess, Director of Science & Innovation at Profil GmbH

The first thing to say here is that the demographic transition is one of the main challenges for global societies. Although ageing is not a disease, older age in itself is the main risk factor for dying. Following the conception of personalised medicine, that means ageing dramatically affects the interpretation of traditional risk factors and conditions, as well as the definition of healthcare goals. Adding quality of life to the amount of life and adding function to chronic disease, therefore, become a higher priority.

The diversity of human beings in general and ageing societies in particular call for a combined life- and disease course approach. Innovative investments in health promotion, disease and frailness prevention, as well as person-centred healthcare should be adjusted to the individual’s cultural habits, biological ageing and functional status, to only name a few relevant domains of life.

A life- and disease course approach to innovative investments in health promotion, targeted disease prevention, and person-centred healthcare

Healthcare can be considered a societal investment in the health of the citizens. Thus, society must seek to get the most out of this investment by dedicated efforts to bring citizens who fall ill as fast and as far as possible back to their normal level of function. The goal is to eventually restore the individual’s contribution to society at the level it can be under the specific conditions.

Here, we propose a combined life- and disease course approach which fully acknowledges the wide spectrum of common risk factors and conditions, time and timing of risk exposure, the presence of pathogenetic signatures far before current diagnostic criteria are met, and the diversity of individual (pre)disease courses and susceptibilities to interventions. We also suggest that the interdependence between physical and mental vulnerability and functional decline related to universal ageing traits on the one hand, and chronic disease and comorbidity on the other should be fully acknowledged.

In the field of personalised medicine, the definition of personal health targets related to overall functioning and frailty, musculoskeletal and cognitive integrity and the presence of chronic diseases deserves special attention.

Ambitions in health promotion and management of disabling conditions

Western living and working environments are obesigenic and inherently pose health risks by promoting physical immobility and unhealthy food choices. There is a gap between medical knowledge and public awareness of disease-promoting behaviour. Education in how to prevent frailty and disability at an older age is underdeveloped.

Therefore, policies implementing the design of health-promoting anti-obesigenic living environments are needed. The potential of health promotion at work to reach a large part of the population, to positively synergise with individual health activities and to have a positive impact on the employee’s families and communities should be exploited. Policies about food advertising and presentation should facilitate healthy food choices.

Ambitions in person-centred treatment of chronic diseases and comorbidity prevention

A curative therapy of most chronic diseases is still missing. Personalised disease modifying and regenerative therapies are currently under development and may be more broadly implemented during the next 20 years. Much earlier evidence-based concepts and companion diagnostics, as well as validated digital biomarkers will facilitate shared decision-making about personalised treatment targets and corresponding therapies. The patient needs to be empowered to act as a co-producer of his or her health. This will improve the patient’s adherence to treatments and health-promoting behaviour. Patients should be increasingly involved in defining/achieving R&D goals, drug approval and additional benefit evaluation.

Ambitions in multimorbidity-adjusted chronic disease management

Elderly people with chronic disease are the most heterogeneous in regard to physical and cognitive functionalities, morbidity and health outcomes. Individual functional reserves critically determine self-management capabilities, benefiting from single disease-specific interventions, and the likelihood of hospitalisation. Fortunately, clinical practice guidelines increasingly include evidence obtained from the stratification of trial results, balance risk and the benefit of interventions specifically in reference to health and living conditions of older patients.

It has been recommended that chronic disease management programmes should be replaced by a more integrated case management approach that is tailored to older people with chronic diseases. Case management programmes integrating chronic disease care could adapt elements of the Chronic Care Model (CCM), i.e. support a proactive release of care by interprofessional teams, strengthen the patient’s self-efficacy and self-management, link the programme to scientific evidence and patient preferences, take advantage from a clinical information system, and mobilise coordinated community resources. Based on the identification of cost-intensive disability and multimorbidity patterns associated with a high risk of hospitalisation, case finding algorithms should be advanced which, for instance, using digital biomarkers for identifying people who most likely to benefit from dedicated case management programmes.

The telemedical consulting centre will have a role in ensuring high-quality care, especially in areas of rural depopulation with a high proportion of older people and a low density of general medical practices. Telemedical monitoring could be particularly effective in monitoring vulnerable patients, for example, those with heart failure, to detect early signs of disease deterioration Valuable business models may include a centrally controlled management of chronic diseases within the hospital and primary care provider networks.

Improving the sustainability of healthcare: the power of patient-generated data

Digital (medical) products and services relying on patient-generated data are considered to be key enablers for the provision of personalised health protection, disease prevention and chronic care. They will become gradually integrated as part of interconnected ecosystems combining digital health and social care. Here, sensor-based monitoring of health signatures and parameters reflecting patterns of everyday behaviour will produce a huge amount of real-world data which will be processed by self-learning control algorithms. The outcome will trigger a personalised adjustment of therapies, treatments and behavioural patterns which again, will feedback to the parameters captured from each individual patient. As highlighted in the recently published EIT Health Think Tank report on the use of existing data to improve healthcare (1), the advantages of big data analyses go beyond simply improving profit margins and reducing resource wastage. Big data will also be of value in predicting epidemics, improving the quality of life, providing better outcomes, and avoiding preventable deaths, particularly from chronic diseases.

The power of collaboration

There is no single (type of) organisation able to solve the urgent healthcare problems resulting from the demographic transition. Public-private partnerships having a reasonable budget and forcing collaboration between key stakeholders including citizens and policymakers to provide attractive innovation environments. For example, the European EIT Health knowledge and innovation community leverages the expertise of more than 140 leading organisations spanning key areas of healthcare, such as pharma, MedTech, payers, research institutions and universities (2).

It is only together that we can tackle the complex cross-sectional issues related to the societal acceptance for digital health products and services. The curation of innovation endeavours integrating R&D, education and training and entrepreneurship is the path towards effective products, services and business models. Making a tangible impact on the health of the citizens while improving the sustainability of healthcare systems is the ultimate measure of success for innovation communities like EIT Health.

References

(1) EIT Health Think Tank “The use of existing Big Data to improve healthcare” Summary Report, December 2018. https://www.eithealth.eu/documents/21805/0/EIT+Health+Think+Tank+2018+-+Big+Data+-+Final+Report/c03a9184-e8f6-b345-a861-0d94563bf93b

(2) https://www.eithealth.eu/

 

Please note: This is a commercial profile

Prof Dr Freimut Schliess

Director, Science & Innovation

Profil GmbH

Tel: +49 2131 4018 225

Freimut.Schliess@profil.com

www.profil.com

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