Telehealth enthusiasm dampened

Feb 28 2013

By Caroline Price, Senior medwireNews Reporter

A home-based telehealth system being pushed by the UK Government does not benefit patients with long-term conditions in terms of their quality of life or psychologic wellbeing, research has shown.

The telehealth intervention did not improve health-related quality of life (HRQoL), anxiety, or depressive symptoms in patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure, report Stanton Newman (City University London, UK) and colleagues in the BMJ.

The findings come from the UK Department of Health's whole system demonstrator (WSD) evaluation of telehealth and telecare, the largest trial of such technology to date. Earlier results showed great promise, with a 45% reduction in mortality rates as well as a 20% reduction in emergency admissions to hospital and a 15% reduction in emergency visits associated with telehealth, leading politicians to announce plans to roll it out nationally.

As such, the current study's disappointing results are seen as a significant blow to plans to expand the approach.

The study of 1573 patients found that those assigned to telehealth had similar outcomes at 12 months to those assigned to usual care in: HRQoL as measured by the physical and mental health components of the SF-12 and EQ-5D questionnaires; anxiety measured on the six-item Brief State-Trait Anxiety Inventory; and depressive symptoms measured by the 10-item Centre for Epidemiological Studies Depression Scale.

The authors note that per protocol analysis also yielded null findings for each outcome, thereby demonstrating that as well as being ineffective, the telehealth intervention "is not efficacious."

The telehealth intervention involves monitoring patients' vital signs, symptoms, and self-management behavior and providing them with general and disease-specific information, which is fed back to specialist nurses and other healthcare professionals for them to review.

The authors acknowledge that the system used in the current study represents a "second generation" version of the technology - later versions have incorporated immediate, real-time review of patients' data, and constant analytical and decision making support.

If telehealth delivers tailored healthcare that allows more responsive interventions from professionals, resulting in better disease control and fewer hospital admissions, corresponding improvements in HRQoL and psychologic wellbeing might be expected, Newman and team explain. Similarly, if it improves self-care behavior and efficacy, it should result in increases in HRQoL and reductions in negative affect.

On the other hand, the increased burden of self-monitoring and concerns about intrusive surveillance and the loss of the traditional face-to-face therapeutic relationship could reduce HRQoL and psychologic wellbeing.

Although no evidence of deleterious effects of telehealth were found here, the team concludes: "Our findings strongly suggest no net benefit from telehealth: therefore it should not be used as a tool to improve health related quality of life or psychological outcomes."

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