Telehealth verdict: 'It's complicated'
Long-awaited results of one of the world's largest clinical studies of telehealth - the UK's "Whole Systems Demonstrator" (WSD) project - seem to raise more questions than they answer. Some apparently clear benefits are offset by puzzling findings in the control group and unclear levels of potential cost savings.
An international team led by researchers at the Nuffield Trust have pored over the data generated from the 2009-10 trials at three sites in Cornwall, Kent and the London Borough of Newham to assess the impact of telehealth on hospital use for 3,230 patients with long term conditions (diabetes, chronic obstructive pulmonary disease or heart failure).
Patients were randomly split into two groups, with half taught how to monitor their condition at home and transmit the data (for example on blood pressure or glucose levels) electronically to health care professionals and the other half receiving usual care.
The results, in a paper to the British Medical Journal published today on bmj.com, found telehealth can help patients with long-term conditions avoid emergency hospital care, and also reduce deaths. However, the estimated scale of hospital cost savings is modest and may not be sufficient to offset the cost of the technology, the report finds. Overall the evidence does not warrant full scale roll-out but more careful exploration, it says.
During the study period, significantly fewer (43%) of intervention patients were admitted to hospital compared with 48% of control patients. Even more strikingly, significantly fewer (4.6%) of intervention patients died compared with 8.3% of controls: a 45% reduction in the mortality rate.
There were also cuts in emergency hospital admissions per head (0.54 for intervention patients compared with 0.68 for controls) and the mean hospital stay per head (4.87 days for intervention patients compared with 5.68 days for controls). This may be because telehealth helps patients better manage their conditions, or that telehealth changes people's perception of when they need to seek additional support, the report finds. However, it says these effects appear to be linked with short term increases in hospital use among control patients, the reasons for which are not clear: a puzzling finding which clearly needs further research to bottom out.
Overall the estimated cost savings are modest as any benefits need to be balanced against the cost of the technology, and this latest evidence does not warrant full scale roll-out but more careful exploration, the reportfinds. "There is great potential but also still much to be done."
This is a setback for champions of telehealth, though the positive signs are also promising. If there are any savings to be made, clearly several new trials need to be launched as soon as possible to determine exactly how great these can be. Champions of telehealth will also point out that patient-centred care brings it own benefits and is hugely preferential to institutionalised care, even if cost savings are marginal. The cut in mortality will also be attractive to patients, if not bean counters.