A Department of Health-commissioned report has found that telehealth failed to help patients with COPD, diabetes or heart failure, striking a blow to the Government’s drive towards a mass expansion of its use.
The researchers, carrying out the latest Whole Systems Demonstrators trial, concluded that ‘second generation’ home-based telehealth brought no significant improvements in health-related quality of life, anxiety level and depression symptoms for these conditions.
GP leaders said the study should cause the DH to ‘pause and think again’ about its move to expand the use of telehealth.
Health secretary Jeremy Hunt said in November he wants three million people in England to have access to it by 2017. Seven pathfinder sites, including CCGs, are piloting telehealth this year for 100,000 patients.
Previous findings from the Whole Systems Demonstrator programme show that telehealth can cut mortality rates by 45% and emergency admission rates by 25%, he said last year.
The Government has also proposed a national roll-out of a telehealth DES in April 2013 with a single disease area, such as hypothyroidism, with a further locally agreed priority area to be established for the second year.
However, the researchers from City University London concluded: ‘Although enthusiasts have written much about the promise of telehealth, most studies do not meet orthodox quality standards.’
The study of 150 GP practices in London, Cornwall and Kent involved patients from an initial cohort of 3,230 being split into two roughly equal groups; one using telehealth and the other given ‘usual’ treatment.
The telehealth group patients had their vital signs, symptoms, and self-management behaviour monitored. Patients were also given educational aids such as short films about lifestyle and their specific illnesses, and had condition reviews with nurses.
All patients filled in questionnaires at the start of the study, and again at four and 12 months about their quality of life, anxiety and depressive symptoms. Researchers then used recognised scoring scales – including the SF-12, Brief State-Trait Anxiety Inventory and the Centre of Epidemiological Studies Depression Scale – to analyse the results.
The report concluded: ‘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.’
Research lead Professor Stanton Newman, dean of the school of health sciences at City University London, said: ‘Telehealth… should not be used as a tool to try to improve these outcomes. More research is required to understand the many potential and harmful mechanisms by which telehealth could affect patient reported outcomes.’
He added: ‘Notwithstanding steady growth in telehealth studies over the past 20 years, robust evidence to inform policy decisions is lacking. Systematic reviews show that although enthusiasts have written much about the promise of telehealth, most studies do not meet orthodox quality standards.’
GPC negotiator Dr Chaand Nagpaul said: ‘The new findings show that the Government should pause and think again about its blanket, target-based approach to promoting all forms of telehealth. I’m not saying that telehealth won’t work for some patients, but we need a much more measured, questioning approach.’
The researchers cautioned that their study relates to second generation telehealth systems, which have non-immediate analytical or decision making properties.
Dr Will Haynes, a GP in Gloucestershire and telehealth lead for NHS Gloucestershire, said: ‘I’m not surprised about these results for patients with diabetes. They tend to know already how to manage their own care pathways. If they are vomiting repeatedly for example they already know about getting in touch with a health professional.’
‘Talking to patients in Gloucestershire who have used telehealth, we think it has great potential regarding heart failure and COPD. We did a survey and 90% said they would recommend these services to their friends and families.’
Pulse Live: 30 April – 1 May, Birmingham
The COPD Update session at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers, will cover the latest developments in telehealth.
Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.
To find out more and book your place, please click here.
The research is published in the British Medical Journal, BMJ 2013;346:f653 doi: 10.1136/bmj.f653