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Telemedicine ‘potentially unsafe’ says major review



By Alisdair Stirling

Exclusive: Telemedicine is not cost-effective, potentially unsafe and needs closer clinical scrutiny before being used to shift more hospital activity into primary care, suggests a review by the RCGP and Royal College of Physicians.

Consultants are not comfortable with use of telemedicine in areas such as dermatology and often insist on seeing patients face-to-face anyway, according to interim results from a systematic review of published evidence on Care Closer to Home since 2000.

The review, carried out by researchers from the RCGP and Royal College of Physicians, also warned there was very little evidence to suggest Care Closer to Home overall was any more clinically effective or cheaper than conventional care.

The joint project, led by Dr Clare Gerada, chair-elect of the RCGP and Dr Mike Cheshire, clinical vice-president of the RCP, involved a Cochrane-style review of studies and so-called ‘grey’ literature – including press reports – of all care that did not involve hospitals.

Dr Gerada told Pulse they looked at five major categories of care including walk-in centres, hospital-at-home and telemedicine.

She said patients did tend to prefer being dealt with outside hospital, but that there was an ‘enormous gap’ in the evidence for clinical benefit or cheapness of delivery.

Interim findings due to be published this summer will show dermatologists were uncomfortable with use of telemedicine and not confident in GPs’ ability to use it safely.

Dr Gerada said it should not be depended on as part of the shift towards pushing hospital activity into the community: ‘I would want more information about clinical governance on telemedicine before it is adopted wide-scale in primary care.’

Dr Brian McKinstry, a GP in Edinburgh and senior research fellow in telemedicine at the University of Edinburgh, disputed the findings, saying telemedicine did have an important role to play.

‘The evidence for telemedicine in some conditions is absolutely concrete. Randomised controlled trials have shown if you provide patients with heart failure a telemedicine service they do better in terms of clinical outcomes.

‘There is also some evidence for diabetes and hypertension but fewer trials. It can also be useful for offering medication reviews.’

Dr Gerada said the study would challenge the view that shifting care into the community was automatically the best way forward.

‘The mantra is that care Closer to Home is the way forward but we’re going to say it doesn’t matter where care is carried out as long as services are integrated. That is the major contributary factor to quality of care.’

Telemedicine is ‘unsafe’ says Royal Colleges’ review