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CCGs urged to be ‘cautious’ over nationwide telehealth rollout

GP commissioners should be cautious about rolling out telehealth initiatives too quickly as they may have ‘negative consequences’ for patients, the lead investigator of the Government’s flagship pilot has admitted.

The admission comes despite recent evidence from the Government’s Whole Systems Demonstrator (WSD) pilot showing telehealth programmes can reduce mortality and hospital admissions.

In an exclusive interview with Pulse, Adam Steventon, senior research analyst at the Nuffield Trust and project lead on the Whole Systems Demonstrator programme, said the evaluation was producing ‘interesting findings’.

But he admitted that even when the full results of the pilot are published it would be premature to expect the benefits seen in the trial to be reflected in routine practice.

In June this year, the first two of five academic papers were published detailing the results of the WSD trial, the largest randomised control trial of telehealth and telecare in the world.

Preliminary results released last year prompted the DH to launch a ‘3millionlives’ campaign to encourage GP commissioners to extend the use of telehealth and telecare technologies to three million people over the next five years.

But Mr Steventon said that conflicting results from different trials of telehealth meant any extension of its use should be tracked so its impact in different settings can be monitored.

In an exclusive interview, he said: ‘The [WSD] evaluation will produce a lot of very interesting findings. However, they will only relate to telehealth as implemented in this particular trial in these areas of England.’

‘We don’t know yet is what impact telehealth would have if implemented outside of a trial setting in other areas.’

‘A study done very recently which looked at patients with multiple chronic conditions that found that more deaths were associated with telehealth than the control group,’ he explained.

‘While the mortality finding is a strong incentive in itself to roll out telehealth, there must be some caution to try and understand why telehealth has this effect in this setting and the opposite in another setting – how can we avoid the negative consequences of rolling out telehealth nationally.’

A spokesperson for the DH said the WSD trial provided the evidence to support the 3millionlives initiative.

He said: ‘It shows that changes in utilisation are a reality and mortality can be significantly improved as well as care being better planned.

‘What it also shows is that to get the cost benefit return, costs need to be reduced and equipment integrated into services which are delivered at scale. This is what 3millionlives aims to achieve.’

Dr David Jenner, a GP in Cullompton, Devon, and senior policy adviser at the NHS Alliance, said that telehealth could have benefits, but commissioners had to find the ‘niche’ where it was cost-effective.

He said: ‘There’s always a danger with Government-funded trials that its policy based evidence rather than evidence-based policy.

‘Unless costs for primary care and other problems are tackled, widespread rollout may not produced the desired results.’

Dr Ian Greaves, a GP in Stafford, whose practice has used telemonitoring technology in a management scheme for patients with dementia said: ‘Telehealth has the potential to help a lot of people, but has to be incorporated into a safe structure. This will include people who are going to support it.’

‘Patients should be in charge to say if it has any value. If it works for them, they should have access to it. Patients should performance manage all input be it technological, social or clinical.’

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