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 finding seems to have taken the usual commentators by surprise and knocked them into a stunned silence!
Of course, as the GP in the item Pulse published on this points out, the non-difference may be more relevant for people with diabetes than people with heart problems. The other explanation we will no doubt hear (but is on rather dodgy grounds as you would not hear that if the result were positive) is that the WSD ‘didn’t do it right’. However, this is definitely not going to be helpful to the 3ML pathfinders as people with diabetes are considered some of the ‘low hanging fruit’.
The Telehealth prescription needs to be very specific and personal. One box that does a multitude of ‘things’ does not fit all.
It could be an app for self management; a text to an endocrinologist, a phone call from a community matron, a technically monitored system via a private company, a clinically monitored system through your local NHS Trust, a family/friend monitored system sharing information for peer to peer support etc etc.
Telehealth is not the name of one specific product from one company – it is going to be a branch of medicine that provides tailor made solutions for people with a specific set of symptoms, conditions and presentations.
I’m curious. I’m not an expert in this field but have been researching solutions for my father, who has diabetes.
It would seem to me that the non-difference is non-news. If quality of life wasn’t affected, but overall health outcomes have been shown to improve, the I would actually think the study is good news, in that fears about patient resistance are somewhat unfounded.
No?
If there’s any clear outcome of the WSD it must be that telehealth is NOT a standard box of tricks that is offered to anyone who is identified as being likely to use NHS resources. Rather, it is a service that can include none, one or many technologies that are selected (prescribed) after fully assessing an individual’s condition, attitude, family support, acceptance of technology, and psychological makeup. When people see that solutions are personalised then they will feel better about themselves – and clinical outcomes will be better too and for lower cost. True, the WSD programme designers made some serious mistakes but this was a long time ago, and you can bet that the new services that are being planned and delivered today bear little resemblance to the big programmes that have been rolled out in the past. Unfortunately, some of the recommendations from the industry members of 3ML campaign do not recognise this.