There is an increasing national and international evidence base to support the use of telecare to replace, as well as supplement, traditional care methods.  This is in stark contrast to earlier studies (e.g. Whitten et al., 2002) which found no, or limited, evidence of the effectiveness of telemedicine. 

 

Although the research literature on telecare is vast and varied, consisting of various systematic reviews of reviews (e.g. Ekeland, 2010), hundreds of individual systematic reviews and economic evaluations (e.g. Wade et al., 2010) and thousands of studies of use across various clinical conditions and care functions, there is now sufficient evidence to support the effectiveness of telehealth for specific uses with some types of people, including (AHRQ, 2016):

  • Remote patient monitoring for people with chronic conditions
  • Communication and counselling for patients with chronic conditions
  • Psychotherapy as part of behavioural health

 

The Whole System Demonstrator (WSD) programme, which reported its findings in 2011, was the largest randomised control trial of telehealth and telecare in the world, involving 6,191 patients, 238 GP practices across three sites, and was set up to look at the cost effectiveness, clinical effectiveness, organisational issues, effect on carers and workforce issues.  It focused on three long term conditions: diabetes, Chronic Obstructive Pulmonary Disease (COPD) and coronary heart disease.  The headline findings for the telehealth element of the trial showed that, if delivered properly, telehealth can (Department of Health, 2011):

  • substantially reduce mortality,
  • reduce the need for admissions to hospitals,
  • lower the number of bed days spent in hospital, and
  • reduce the time spent in A&E.

 

Although promising results have been reported with other applications, such as video and telephone consultations, and telecare applications within a social care setting (e.g. Davies et al., 2013), these primary studies have generally been of poor quality, have not been synthesised and/ or have not fully considered the cost-effectiveness of such approaches.  Elsewhere (e.g. triage for urgent care) there is currently insufficient primary evidence to demonstrate effectiveness and more studies are needed in this field (AHRQ, 2016).  The research to date has also failed to adequately address the promotion of broader implementation of telecare and how barriers to implementation can be overcome (AHRQ, 2016).

 

Key references

  • Agency for Healthcare Research and Quality (2016).  Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews.  Technical Brief Number 26, Rochville: AHRQ.  Available: https://www.effectivehealthcare.ahrq.gov/ehc/products/624/2254/telehealth-report-160630.pdf [Accessed 02/02/17].
  • Davies, A., Rixon, L. & Newman, S. (2013).  Systematic review of the effects of telecare provided for a person with social care needs on outcomes for their informal carers, Health & Social Care in the Community, 21(6): 582-597. 
  • Department of Health (2011).  Whole System Demonstrator Programme:  Headline Findings December 2011, Available: https://www.gov.uk/government/publications/whole-system-demonstrator-programme-headline-findings-december-2011 [Accessed: 02/02/17].
  • Dullett, N.W., Geraghty, E.M., Kaufman, T. et al. (2017).  Impact of a university-based outpatient telemedicine program on time savings, travel costs, and environmental pollutants, Value in Health, Available: http://www.valueinhealthjournal.com/article/S1098-3015(17)30083-9/fulltext [Accessed 27/03/2017].
  • Ekeland, A. (2010).  Effectiveness of telemedicine: A systematic review of reviews, International Journal of Medical Informatics, 79(11): 736-771.
  • Wade, V.A., Karnon, J., Elshaug, A.G. & Hiller, J.E. (2010).  A systematic review of economic analyses of telehealth services using real time video communication, BMC Health Services Research, 10: 233. 
  • Whitten, P.S., Mair, F.S., Haycox, A., May, C.R., Williams, T.L. & Hellmich, S. (2002).  Systematic review of cost effectiveness studies of telemedicine interventions, British Medical Journal, 324: 1434.