The Whole System Demonstrator RCT Evaluation of Telehealth

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Slides: 
Oplægsholder
Navn: 
Stanton Newman
Stilling: 
Professor
Firma/organisation: 
Centre for Health Services Research, City University London
Hovedbudskaber
Disse tre budskaber kan deltagerne forvente at få med hjem efter at have hørt indlægget.
1: 
Telehealth reduces mortality rates and the number of emergency admissions to hospital. However, the findings are complex & reductions in notional hospital costs are relatively small
2: 
TH would only become cost effective by a combination of reductions in the price of TH equipment and TH services operating at a higher capacity
3: 
Concerns about potentially deleterious effects of TH appear unfounded as no differences were found between the groups on quality if life

The Whole System Demonstrator (WSD) evaluations were randomised Controlled Trials which examined the benefits of integrated care supported by telehealth (TH) and telecare when delivered at scale. The TH study included people diagnosed with Chronic Obstructive Pulmonary Disease (COPD), heart failure or diabetes. TH was defined as a system that allows the remote exchange of data between patients and health care professionals to assist in the management of an existing long-term condition. The evaluation addressed a broad class of telehealth technologies. 

The study on costs and healthcare utilization examined administrative data on 3,154 patients. The findings indicated that TH reduces mortality rates and the number of emergency admissions to hospital.  However, the findings are complex & reductions in notional hospital costs are relatively small.

A nested Telehealth Questionnaire Study (n=1,573) examined health and social costs and outcomes after 12 months and indicated that the intervention in this study was not cost effective. TH would only become cost effective by a combination of reductions in the price of TH equipment and TH services operating at a higher capacity.  

The analysis of Patient Reported Outcomes (PROMs), over a 12 month period, indicated no differences between the control and TH group on generic Quality of Life, anxiety or depressive symptoms. Concerns about potentially deleterious effects of TH are largely unfounded.

A qualitative study on barriers to accepting TH identified a number of factors including loss to independence and threats to current services.

A quantitative study on those who asked for the equipment to be removed after having it installed found that people were more likely to reject TH if they felt it did not enhance care, decreased accessibility to healthcare, invaded privacy or was a substitute for current care.

The impact of these findings for TH roll out will be discussed.