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Whole System Demonstrator studies show not enough evidence for telehealth rollout

Whole System Demonstrator studies show not enough evidence for telehealth rollout

[London, UK/ Medicine] - The first evaluations of the Whole System Demonstrator telehealth trials show there were reductions in mortality, but no significant cost savings and not enough evidence to justify full-scale rollout in the government′s 3millionlives campaign. The government launched the campaign in December 2011 on the back of some selected early headline findings from the trials, and before detailed results were known.

Launched in 2008 with over 3,000 patients, the trials were the largest evaluations of telehealth in the world. They were set up to study in a formal trial the wide-ranging impact of telehealth on people with long-term conditions, following mixed evidence from several small-scale studies.

Five themes were studied and in this analysis an international team, led by researchers at the Nuffield Trust, set out to assess the impact of telehealth on hospital use and mortality for 3,230 patients with long-term conditions (diabetes, chronic obstructive pulmonary disease or heart failure) over one year. Other themes studied cover the impact of telehealth on quality of life; the cost-effectiveness of telehealth; and patient, professional and carer views, and results will be published later.

Results

During the study period, 43% of intervention patients were admitted to hospital compared with significantly more (48%) of control patients and significantly fewer (4.6%) of intervention patients died compared with 8.3% of controls. This equates to about 60 lives over a 12-month period.

There were also statistically significant differences in the mean number of 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), although the authors say these findings should be interpreted with caution. These differences remained significant after adjusting for several factors that could have influenced the results.

Caution required

The authors point out that these effects appear to be linked with short term increases in hospital use among the control group of patients at the start of the trial, the reasons for which are not clear. If the early increases are excluded then the differences in hospital admissions between the control and intervention group were not significant.
In an accompanying editorial in the BMJ, Josip Car, Director of the Global eHealth Unit at Imperial College London and colleagues say this latest evidence doesn′t warrant full scale roll-out but more careful exploration. They say “the evidence base is essentially unchanged and uncertainties remain. … Policy makers, commissioners, and guideline developers should help ensure that the research agenda focuses on areas where telehealth shows most promise,” and conclude, “there is great potential but also still much to be done”. [hw]

[Related information]

Steventon, A et al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012;344:e3874.

Editorial. Telehealth for long term conditions. BMJ 2012;344:e4201.

The UK government′s 3millionlives campaign website

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