New research suggests no benefit to quality of life or psychological outcomes
The Government could be forced to rethink its plan to roll out telehealth to at least three million patients with long-term conditions after independent research questioned the effectiveness of the technology.
A study of the findings of the Department of Health’s Whole System Demonstrator (WSD) project, the largest randomised controlled trial of telehealth in the world, suggests no net benefit from telehealth and rules that it should not be used as a tool to improve health-related quality of life or psychological outcomes.
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This is a bitter blow for politicians, who were expecting the rollout of assistive technologies to save millions of pounds through a reduction in hospital admissions and improved patient outcomes. The Department of Health has already announced its 3millionlives project, which will fund the deployment of telehealth to three million patients with long-term conditions.
With no real evidence base to prove the positive impact of the technology, they had been pinning their hopes on the findings of the WSD to convince commissioners to support the programme. This week’s report by Stanton Newman and colleagues, published in the British Medical Journal , will therefore come as a disappointment.
The study of 1,573 patients found that those assigned telehealth had similar outcomes after 12 months to those assigned to usual care when comparing depression and anxiety symptoms.
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
It concludes: “More research is required to understand the many potential beneficial and harmful mechanisms by which telehealth could affect patient reported outcomes. However, 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.”
The assessment is based on the use of telehealth to monitor patients' vital signs up to five days a week. Individuals measured their own blood pressure, blood glucose levels or other indicators and transmitted the results to health professionals via a remote data monitoring centre.
The researchers, drawn from a group of UK universities led by City University's school of health sciences, acknowledge that their analysis ended in December 2010 and did not embrace later development of telehealth techniques, including real-time analysis of data by doctors or nurse specialists.
The study team also admits that its work did not assess any potential benefits specific to individual long-term conditions, as opposed to general wellbeing.
The findings suggest that claims for potentially salutary or deleterious effects of telehealth are unfounded for most patients
The report states: “Effects of telehealth might not be uniform across all patients, and analyses may suggest sub groups of patients for whom telehealth is either particularly beneficial or harmful.
“However, the findings suggest that claims for potentially salutary or deleterious effects of telehealth are unfounded for most patients. Telehealth should not be introduced with the aim of improving quality of life or psychological outcomes.”
This review of WSD comes after the Government itself published the results of the trial. It claimed telehealth helped to reduce A&E visits among those with long-term conditions by 15%, reduced emergency hospital admissions by 20% and reduced elective admissions by 14%. More importantly, the trial, which involved 6,000 people over three UK sites, recorded a 45% drop in mortality rates, and constituted an 8% reduction in tariff cost. The new research questions the effect on patient wellbeing and quality of life as a result of deployment.
When the earlier results were unveiled, a Department of Health spokesperson said: "We funded a three-year randomised control trial involving more than 6,000 people, which clearly demonstrated that if implemented appropriately, telehealth can reduce emergency admissions by 20%, A&E attendance by 15% and mortality rates by 45%.
"This trial has been used to help inform the3millionlives initiative, which aims to help improve lives through better integrated telehealth and telecare services in the next five years."
The Government has not yet commented on this latest report.
Click here for the BMJ report.