Ambivalence over end of life decisions (Europe)

Not telehealth or telecare directly, but relevant to many TTA readers, a new Europe-wide research findings from the King’s College London’s Cicely Saunders Institute and Project BuildCARE explores people’s preferences when it comes to decision-making at the end of life. Dr Daveson, lead author of the paper, said that when thinking about scenarios of lost capacity, for example, most people in Europe do not want to make decisions about their healthcare in advance. Some people decide not to make end of life decisions about their care before they absolutely have to because:

  1. They believe that they will not know what they will want to choose until they are in the situation
  2. It is easier not to think about it
  3. They think that avoiding making decisions beforehand will avoid burdening family members

However, 53% of survey respondents wanted their partner or spouse to be involved in helping them make their decision and 40% also wanted other relatives to be involved. This means that for many people these will be family decisions. Preferences for self-involvement in decision-making – new research findings from across Europe: What would you choose? KCL main site. Infographic (PDF download)

Wales: telehealth research participants sought

The Institute of Rural Health and Aberdeen University are to research the effect of technology on patients interactions with their home carers, and are seeking input from patients using telehealth in the Powys and Betsi Cadwaladr health board areas. Recruitment is open until the end of June and seeks patients aged 60-79 years, who are visited by a nurse or other professional carer at least once a week and are using some sort of telehealth technology to help them to manage chronic pain or another medical condition. ‘Technology’ might include the use of internet forums, phone ‘apps’, or Skype links to carers. For further information please contact Sophie Corbett at the IRH on 01686 629480. (Info via Dispensing Doctors’ Association)

Free whitepaper about the current smartphone app market

research2guidance is offering a free 27-page report on the current smartphone app market (the ninth edition). Entitled Building And Marketing A Mobile App Will Have Bigger Impact Than Commercialization Of Internet it highlights how:

  • App publishers and companies will be forced to keep track of at least the most important distribution channels for their most important target groups. Building and marketing an app is therefore becoming an important part of businesses. It will even have a bigger impact than the commercialization of the internet economy at the beginning of the century.
  • Diversity of mobile operating systems will increase, offering new opportunities, especially for 2nd tier device manufacturers.
  • App development will become more complex. For developers the pressure to reach out to new target groups who are demanding innovation is rising.

WSD QALY paper published – cost worse than expected (UK)

Since one of the Whole Systems Demonstrator (WSD) let drop at the King’s Fund conference last March that the telehealth Quality Adjusted Life Years (QALY) cost calculation was coming out at £80,000 the actual paper has been ‘eagerly’ awaited, with speculation and concern that the calculation included management and other study-related costs that would not apply in a normal service setting. The paper is published by the BMJ today and a) such costs were excluded and b) the QALY figure is actually £92,000. Well, that’s the headline figure that is already being headlined by Pulse but, of course, the calculations are more nuanced. Foe example:

Whether telehealth is considered to be cost effective will depend on the willingness to pay for the outcomes generated. Figure 1 presents the probability that telehealth would be seen as cost effective as an addition to usual care, using an acceptability curve for different values of willingness to pay. At the £30,000 threshold (associated with NICE recommendations), the probability of cost effectiveness was 11%. Figure 1 also shows the probability of cost effectiveness if costs related to project management were excluded: at the £30,000 threshold, the probability of cost effectiveness was 17%. Indeed, this probability including management costs only exceeded 50% at threshold values of willingness to pay above £90,000. Excluding project management costs, the probability exceeded 50% only at values above about £79,000.

The discussion is also worth reading carefully, as is the final conclusion:

A community based, telehealth intervention is unlikely to be cost effective, based on health and social care costs and outcomes after 12 months and the willingness to pay threshold of £30,000 per QALY recommended by NICE. A reduced cost of telehealth per QALY may be possible by combining the effects of equipment price reductions and increased working capacity of services; On the assumption of reduced equipment costs and increased working capacity, the probability that telehealth is cost effective would be about 61%, assuming a willingness to pay threshold of £30,000 per QALY.

BMJ paper: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial BMJ 2013;346:f1035

Related items
Mike Clark’s Updated list of WSD results papers.
Interview with Professor Martin Knapp As “telehealth” grows, experts question cost benefits Reuters.
David Brindle, in The Guardian anticipated these results last month and, in a follow up article commented “Fourteen months on from its launch, 3millionlives seems to be going nowhere. Intuitively, telecare/telehealth feels like a key pillar of the future care system. To be that, however, it does need a credible evidence base.”
3millionlives press release: 3millionlives – enabling change to benefit patients and carers. (PDF)
GP Online Telehealth ‘not good use of NHS money’, finds DH-backed study.
NHS Choices Are benefits of telehealth care worth the cost?

Effect of telehealth on quality of life: Another WSD research publication (UK)

Quick on the heels of the telecare study from the Whole Systems Demonstrator (WSD) Programme reported here today, comes another research report, this time from the BMJ: Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial.

Here are a few quotes from the abstract:

Objective: To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.

Conclusions: Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients.

So can we now not even say ‘Never mind the business case, that can be improved – it’s very good for patients’ sense of well being’? Heads-up thanks again to Mike Clark who is keeping an updated list of the reports as they are published.

UPDATE Thurs 28 Feb: Pulse does its usual thing with this study, but note the comment from the GP at the end: DH-commissioned report finds telehealth fails to improve quality of life.

The Elderly Always Sleep Worse, and Other Myths of Aging

New sleep research blows away the idea that the quality of sleep declines with age. It relates to physical health and well being and more older people have problems with those. This strengthens the argument made by the Vivatec company (see useful sites page), whose Wristcare product monitors activity levels throughout the day and night, that disturbances recorded in someone’s sleep pattern is indicative of a problem which may be developing. Research reported in the New York Times.

Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis

This review of 14 studies found that remote monitoring programmes for patients with chronic heart failure living in the community reduced admissions to hospital and all cause mortality by nearly one fifth while improving health related quality of life, but had no significant effect on all cause admission to hospital. Detailed article from the BMJ about telephone support v telemonitoring has an interesting discussion section. My thanks to David Bergman from Medic4all for the note of this article.

What does Archimedes say?

Fascinating article for those of us who sense that reluctance to embrace telehealth and telecare technology is more than just a ‘rational’ plea for more evidence. Long but interesting item on Dr David Eddy, who has spent much of his life exposing the ‘irrationality’ underpinning most medical practice. Read it here.

PSA target on homecare, and European statistics on aging

1) Health and Social Care Information Centre publication provides information about the Public Service Agreement (PSA) on home care 2004/05. Data is provided at local authority level, to asses the progress being made towards the target. (The past three years have seen a steady increase in the proportion of older people receiving intensive help to live independently at home rather than in residential care.) More…

2) The trend toward ageing is most pronounced in Europe, which by 2025 will have eight of the 10 “oldest” populations—that is, percentage of people above age 60—among countries worldwide with at least 10 million people. Report on the statistics.

This is reportedly from a press release by the Alliance for Health and the Future although we cannot find it on its site. However, it’s a site that many of our readers will be interested to explore.