Who could forget the Department of Health’s claim that three million lives were going to be saved by telehealth? Let me remind you of their press release, earlier this year, in which they claimed that it would create ‘45% reduction in mortality, 21% reduction in emergency admissions, 24% reduction in elective admissions, 15% reduction in A&E visits, and 8% reduction in tariff costs.’
You may also remember that the DH stated that industry would be ‘bringing the benefits’ of telehealth to the masses, as well as admonishing us for having only a ‘slow’ uptake of telehealth. All this on a background of trials, some of which show benefit, and some of which show harm.
It comes down to one thing – show us the evidence. Extraordinary claims demand it. So now we have the set of results from the Whole System Demonstrator Trial published last week in the British Medical Journal.
Have the results provided us with the same certainty expressed by ministers? Not a bit of it. The patients were randomised by practice, not individually; the telehealth intervention was variable, though had some common denominators; it also included educational messages.
So what was actually being tested – and was it very different from the cheap and widely used telephone? I’m not clear that this was a clear test of telehealth, but of a variety of interventions.
So what are we to make of the mortality rate of 8% in the control group, and 5% in the intervention group? There was an initial rise in admissions in the intervention group followed by a statistically significant fall; 48% of the control group, versus 43% in the intervention group, had been admitted to hospital over the course of a year.
The study failed to demonstrate that telehealth could reduce costs to secondary care; or reduce A&E or elective admissions as the DH claimed.
We need to ask more questions about if or how telehealth could be used; we also need to know where the DH is getting it’s data from.
Dr Margaret McCartney is a GP in Glasgow