Can digital self-management tools and care integration contribute to sustainable health systems?

Abstract Introduction Digitalisation and integration of care are frequently promoted as policy options in response to population ageing to ensure social and financial sustainability of future health and care systems. Aim and methods To support evidence-informed policymaking, we conducted a series of systematic reviews to synthesise the evidence of the effects of selected technologies and integrated care on outcomes in Quintuple Aim domains: user experience, health outcomes, cost/service utilisation, professional experience/wellbeing, and equity. Selected technologies were personal medication management devices (medication dispensers, reminder technologies), because of their potential to support self-management and safety among the growing populations of community-dwelling older adults. For all systematic reviews, we followed internationally acknowledged methods for the literature searches, screening of abstracts/titles and full text, data extraction and quality appraisal. Results Effects of medication management devices were mostly assessed on health outcomes, showing some evidence of a beneficial effect of using dispensers or reminder technology on clinical outcomes, and no evidence of a beneficial effect on quality of life. For other outcomes, no or only limited evidence for the effectiveness of medication management devices was found. For care integration, there is no consistent evidence of a beneficial effect on clinical health or patient-reported outcomes, nor on service utilisation/cost, though some evidence was found of care integration reducing the use of acute care or inpatient services, or related costs. However, this evidence was not found in all reviews and seem to apply to populations with complex care needs only. Conclusions The potential of medication management devices may lie in their ability to improve clinical health outcomes of older populations. For integrated care it may be in reducing the use of potentially avoidable care or expensive inpatient care.