The first of five detailed papers from the Whole Systems Demonstrator (WSD) trial, published last month in the BMJ, found that, over the course of a year, patients provided with telehealth had 19% fewer emergency admissions than the control group, who were cared for ‘in the usual way'. More significantly, over the same 12-month period only 4.6% of those provided with telehealth died, compared with 8.3% of the control group.
Both these findings are statistically significant and are consistent with the results from a study my practice undertook two winters ago, when 100 patients with COPD were provided with telehealth monitoring and 11 hospital admissions were prevented in just three months.
The study in the BMJ, which covered 3,154 patients, also concluded that for those patients with telehealth the overall costs of hospital care were £188 per patient less than those for control patients (though this was not thought to be a statistically significant difference).
Telehealth is clearly good for patients: clinical outcomes are improved, lives saved and admissions prevented. But more detailed research needs to be done to prove the benefits to patients can be achieved at a lower cost.
My own experience of telehealth suggests that significant cost savings can only be generated by having nurse-led triage at the heart of the service.
Much of the WSD trial imposed technology on community and primary care staff with
no significant service redesign. Opportunities for economies of scale were lost – for example, one specialist nurse could cost-effectively monitor several hundred patients.
Too often telehealth became an additional cumbersome layer rather than a focused cost-effective improvement.
A wealth of overseas data exists that confirms the clinical and financial benefits of telehealth.
Reproducing these gains in the NHS will require more than just technology – sensitive patient selection and large-scale integrated implementations are essential prerequisites.
The Department of Health also needs to do its bit by providing incentives. A new ‘telehealth tariff' should encourage rollout of services to practices and CCGs, which in turn should drive down costs and encourage provision under any qualified provider.
It should also encourage the adoption of cheaper and smarter technological solutions, including mobile phone apps.
My own practice is currently four months into a two-year observational study of the effects of telehealth on hundreds of patients with COPD, chronic heart failure and diabetes.
As well as recording clinical outcomes and a large range of socioeconomic factors, we will analyse total NHS use for two years before and after deployment of telehealth.
The potential to reduce demand on both GPs and the out-of-hours services is enormous.
Dr Julian Neal is a GP in Portsmouth and clinical adviser to Telehealth Solutions