Home Telehealth for Chronic Disease Management: A Systematic Review and an Analysis of Economic Evaluations

Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada.
International Journal of Technology Assessment in Health Care (Impact Factor: 1.31). 08/2009; 25(3):339-49. DOI: 10.1017/S0266462309990201
Source: PubMed


The research objectives were two-fold: first, to systematically review the literature on the cost-effectiveness of home telehealth for chronic diseases, and second to develop a framework for the conduct of economic evaluation of home telehealth projects for patients with chronic diseases.
A comprehensive literature search identified twenty-two studies (n = 4,871 patients) on home telehealth for chronic diseases published between 1998 and 2008. Studies were reviewed in terms of their methodological quality and their conclusions.
Home telehealth was found to be cost saving from the healthcare system and insurance provider perspectives in all but two studies, but the quality of the studies was generally low. An evaluative framework was developed which provides a basis to improve the quality of future studies to facilitate improved healthcare decision making, and an application of the framework is illustrated using data from an existing program evaluation of a home telehealth program.
Current evidence suggests that home telehealth has the potential to reduce costs, but its impact from a societal perspective remains uncertain until higher quality studies become available.

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    • "All studies that matched the key words were included in the review. We chose to examine articles that addressed the management of the chronic diseases of heart failure (HF), hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD) in older adults age 65 years or above, because those diagnoses and that population are common for tele-homecare services (Polisena et al. 2009). Studies that were not based in home health agencies or that did not explore tele-homecare usage were excluded. "
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    ABSTRACT: To identify the barriers and facilitators for sustainability of tele-homecare programs implemented by home health nursing agencies for chronic disease management. English-language articles on home telehealth in the CINAHL, PubMed/MEDLINE, PsychInfo, Web of Science, and Cochrane Reviews databases published from January 1996 to December 2013. We performed a systematic literature review. Data extraction using PRISMA guidelines and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) were conducted on relevant empirical studies. Thematic analysis across the studies and narrative summaries were used to synthesize the findings from the included studies. Of the initial 3,920 citations, we identified 16 articles of moderate quality meeting our inclusion criteria. Perceptions on effectiveness of tele-homecare programs for achieving intended outcomes; tailoring of tele-homecare programs to patient characteristics and needs; relationship and communication between patient, nurse, and other health care professional users of tele-homecare; home health organizational process and culture; and technology quality, capability, and usability impacted the sustainability of tele-homecare programs. The findings of this systematic review provide implications for sustained usage of tele-homecare programs by home health nursing agencies and can help such programs realize their potential for chronic disease management. © Health Research and Educational Trust.
    Health Services Research 06/2015; DOI:10.1111/1475-6773.12327 · 2.78 Impact Factor
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    • "However, the potential of using technology to assist patient self-management is currently underexploited (Broderick & Lindeman 2013). While demographic predictions and the scarcity of resources have underpinned the drive to mainstream telehealth , there are still questions about its clinical and costeffectiveness (Polisena et al. 2009). Accordingly, these uncertainties have meant that telehealth is yet to be embraced by services. "
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    ABSTRACT: To synthesize qualitative and quantitative evidence of front-line staff acceptance of the use of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. The implementation of telehealth at scale is a governmental priority in countries including the UK, USA and Canada, but little research has been conducted to analyse the impact of implementation on front-line nursing staff. Six relevant data bases were searched between 2000-2012. Mixed-method systematic review including all study designs. Centre for Reviews and Dissemination approach with thematic analysis and narrative synthesis of results. Fourteen studies met the review inclusion criteria; 2 quantitative surveys, 2 mixed-method studies and 10 using qualitative methods, including focus groups, interviews, document analysis and observations. Identified factors affecting staff acceptance centred on the negative impact of service change, staff-patient interaction, credibility and autonomy, and technical issues. Studies often contrasted staff and patient perspectives, and data about staff acceptance were collected as part of a wider study, rather than being the focus of data collection, meaning data about staff acceptance were limited. If telehealth is to be implemented, studies indicate that the lack of acceptance of this new way of working may be a key barrier. However, recommendations have not moved beyond barrier identification to recognizing solutions that might be implemented by front-line staff. Such solutions are imperative if future roll-out of telehealth technologies is to be successfully achieved.
    Journal of Advanced Nursing 06/2013; 70(1). DOI:10.1111/jan.12196 · 1.74 Impact Factor
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    ABSTRACT: Health Economics Papers 2011: 2 1 Preface This report is a research paper commissioned by the Copenhagen Consensus Center, CCC. On request we undertook to write a report to CCC and in return received an honorarium. We have had entirely free hands during the writing process apart from CCC's usual requirement to apply cost-benefit analysis – rather loosely defined –to the proposed solutions. We have, partly, complied with this, but only carried out very rough cost-benefit calculations, in part because the data only allowed this, in part because we as health economists would have preferred to use cost per QALY (quality adjusted life years). Another 'limitation' was a request to limit the number of 'solutions' to 10. Hence, the analytic framework – SWOT analysis – the analysis and the proposed solutions have been decided by us and are our responsibility entirely. The background for the report is that CCC was contacted by DR (Danmarks Radio, the national radio and TV channels) some time during the autumn of 2010 because DR wanted to focus on the Danish health care system for a two week period late February and early March 2011 in a multi-media approach using the internet ( , radio, and TV. As background DR wanted a report with a limited number of solutions, and possibly a priority setting exercise using the CCC approach to this.
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