Article

Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 344:e3874

The Nuffield Trust, London W1G 7LP, UK.
BMJ (online) (Impact Factor: 17.45). 06/2012; 344(jun21 3):e3874. DOI: 10.1136/bmj.e3874
Source: PubMed

ABSTRACT

Objective: To assess the effect of home based telehealth interventions on the use of secondary healthcare and mortality. Design: Pragmatic, multisite, cluster randomised trial comparing telehealth with usual care, using data from routine administrative datasets. General practice was the unit of randomisation. We allocated practices using a minimisation algorithm, and did analyses by intention to treat. Setting: 179 general practices in three areas in England. Participants: 3230 people with diabetes, chronic obstructive pulmonary disease, or heart failure recruited from practices between May 2008 and November 2009. Interventions: Telehealth involved remote exchange of data between patients and healthcare professionals as part of patients' diagnosis and management. Usual care reflected the range of services available in the trial sites, excluding telehealth. Main outcome measure: Proportion of patients admitted to hospital during 12 month trial period. Results: Patient characteristics were similar at baseline. Compared with controls, the intervention group had a lower admission proportion within 12 month follow-up (odds ratio 0.82, 95% confidence interval 0.70 to 0.97, P=0.017). Mortality at 12 months was also lower for intervention patients than for controls (4.6% v 8.3%; odds ratio 0.54, 0.39 to 0.75, P

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    • "According to recent systematic reviews, emergency admissions due to AECOPD could be reduced through home telemonitoring [21]. Furthermore, telehealth interventions have proven to reduce mortality [22]. However, more evidence on the benefits of telehealth strategies is required [23]. "
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    • "Furthermore, although general practices in the intervention and control arms typically provided similar numbers of patients for the current study (median 3 patients in each arm), some intervention practices supplied up to 38 patients, compared with up to 16 for control practices. This pattern was also not systematic across the wider trial, and indeed the primary study found differences in cluster sizes in the opposite direction [19]. "
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    • "However, a debate on the validity of the conclusions in the Whole System Demonstrator Project study is ongoing in Denmark for at least two reasons. First, the conclusion of the UK study might be biased since trial recruiters had foreknowledge of the allocation groups in many cases [16]. Second, its transferability to a Danish context is an issue since the trial did not consider all community and healthcare resources [15]. "
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