The latest journal article containing results of the Whole System Demonstrator (WSD) programme has just been published and the conclusion is “Telecare as implemented in the Whole Systems Demonstrator trial did not lead to significant reductions in service use, at least in terms of results assessed over 12 months.” We note the “as implemented” caveat. Article, from where it can also be downloaded as a PDF: Effect of telecare on use of health and social care services. Age and Ageing. Heads up thanks to Mike Clark.
UPDATE: 6 March 2013. The GP paper Pulse’s take on the study: No evidence telecare can cut costs, says DH-funded study.
‘Although the multisite nature of the trial adds to generalisability, telecare might have different effects in other settings or when implemented differently.’
The above taken from this latest result flash is the telecare version of the telehealth statement…….
‘They show that, if delivered properly, telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E.’
So the rule is that if you want to deliver a successful Telehealth or Telecare service, don’t replicate anything that the pilot sites in the WSD did. Simple.
Disappointing results, even within the constraints of the trial, I would have hoped and expected something more positive. I think there are a range of issues that concern me.
1) They separate out Basic Telecare (button and box) from Advanced Telecare (sensors over and above a smoke detector) I think this is wrong to do. Effectively people in the control were receiving basic Telecare.
2) From my experience there is one key group that benefit from the provision of Advanced Telecare and that is those with cognitive impairments (be it intellectually disabled of those with dementia). The automated nature of Advanced Telecare means risk can be managed without the user having to consciously raise an alert. The fact that the trial did not focus on this group (and potentially didn’t involve them at all) means the real benefits of Telecare are not going to be evidenced.
3) This trial was trying to evidence what most of us would have thought were fanciful. I would never have expected Telecare to reduce hospitalization, length of hospital stays, visits to primary care or death rates.
4) The number of people entering residential care for both the advanced Telecare and control groups was very low (3.1 and 3.2% respectively) indicating that the people in the trial were not generally at risk of going into residential care or nursing care. Effectively with no targeting at those at risk of going into care you were not likely to show any impact of advanced Telecare on this entry into care.
I fear (without evidence and happy to be disproved) that what happened in the WSD trial is the same as what happened in many councils following the Preventative Technology Grant and Advanced Telecare was thrown at people who generally didn’t need it. There was little or no rigorous assessment process in many councils under the PTG to determine who needed what, meaning many sensors were given to people with little follow up. Just because someone falls doesn’t mean they need a fall detector (especially the tilt and impact ones used in the UK at the time of the trial). Just because you have epilepsy doesn’t mean to need an under bed epilepsy detector. There needs to be an assessment of the nature of the risks presented to the individual by their condition to see if Advanced Telecare could help to address or mitigate those risks and support independence. Effectively I am asking who determined what was needed in the trial?
To get the right advanced Telecare solution to the right people takes a great deal of understanding around the needs of the user and the way the technology could help them and their carers. Critically it is not right for everyone.