Monday, 26 May 2014

Telehealth, only expectations for now








The technology of data transmission is experiencing an explosion in all areas of social and professional activities and, of course, the specialised industry can see a big opportunity for introducing it as a tool for improving life quality of chronic patients. Doubts, however, appear in the minds of the funders of health services as they see themselves forced to adopt new investments in electronics, which have not yet been able to demonstrate good enough clinical results to compensate the effort.

Seen this way, it seemed to me that in this article about telehealth, it is appropriate to discuss two papers, one English and one Catalan, which aim to answer the question of whether the investment is worthwhile.


This article about findings from the Whole System Demonstrator, project led by Nuffield Trust researchers which sought to evaluate the clinical effect of home interventions with remote data exchange between patients and professionals (telehealth). The project was carried out with the collaboration of 3,230 patients with diabetes, COPD or heart failure from three geographical areas (Cornwall, Kent and Newham) over a 12 month period between 2008 and 2009.

The intervention consisted of a telehealth service that included at least a pulse-oximeter for respiratory patients, a glucometer for diabetics and weight scales for cardiac patients. The control group continued with standard health care without any remote technology support.

The results were positive in the sense that a significant reduction in the number of hospitalisations and mortality of the group involved with telehealth was observed, but instead failed to demonstrate the cost-effectiveness of the program because decreasing hospitalisation costs still could not compensate for the investment required.


This PowerPoint cover is for the presentation of the interim results of a clinical trial (iCOR) from the Cardiology Service of the Hospital del Mar de Barcelona. This project evaluates the clinical outcomes in a group of patients with a high risk of heart failure through a combined program: a home telemonitoring service (remote data) and the telecare of a nurse. The Hospital del Mar’s trial  is more specific than the Nuffield Trust’s one and is based on more intense medical support, but I think it's worthwhile seeing them in the same post because both seek the same outcome, which is nothing more than to prove the effectiveness of information technology support for chronic patients.

So far I have only had access to some interim results (78 patients) that Dr. Comín, the project's IP, has facilitated in the aforementioned presentation, where a significant reduction in hospitalisations and costs are shown, although, as the trial authors warn, we’ll have to wait for the final results in order to draw a conclusion.


Discussion

The investments in telehealth applied to chronic patients, urgently need to demonstrate how they are able to reduce hospitalisation costs, at least to a comparable level to the required investment. But even assuming that this can be demonstrated, the followers of this blog already know how difficult it is to apply Sutton’s law (moving resources from wherever they exceed to seemingly better targeted programs).

But if we want to really see better clinical outcomes we mustn’t forget that even more important than the electronic gadgets are the organisational models aimed at continuous care of chronic disease, the professionals involved and the patients put in charge of their self-care and when targeting these issues, then yes, I can foresee that the telehealth application is bound to be a very useful support instrument.

And let’s not forget that we must encourage locally evaluated research, which is more conclusive to our environment than any evaluation conducted outside of it. 




Jordi Varela
Editor

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