Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator Telehealth Questionnaire Study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial

Article (PDF Available)inBMJ (online) 346(feb26 2):f653 · February 2013with192 Reads
DOI: 10.1136/bmj.f653 · Source: PubMed
Abstract
Objective:- To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. Design:- A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively. Setting:- Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems. Participants:- Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009. Main outcome measures:- Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale). Results:- In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480≤P≤0.904) or available case (0.181≤P≤0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth v usual care) was non-significant for any outcome (complete case cohort 0.273≤P≤0.761; available case cohort 0.145≤P≤0.696). Conclusions:- Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients. Trial Registration: ISRCTN43002091.

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    • "Ramtohul [14] did a comprehensive analysis of the adoption setting of eHealth from the user's perspective and found that the user's readiness and health literacy influenced future adoption decisions. Several reviews describing evaluations of e-health services from the patients' perspectives using self-reported measures show a low effect on psychosocial outcomes [15]. Contextual factors, beyond psychosocial factors, steer the level of technology use among older persons ageing in place [16]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Relevant determinants of adoption of eHealth are needed in order to understand future usage. Aim: To investigate the anticipated psychosocial impact of present and future eHealth services and discuss how psychosocial factors can impact the readiness for eHealth services among older Swedes and reflect upon instruments for measuring eHealth acceptance. Method: The Psychosocial Impact of Assistive Device Scale (PIADS) measured the psychosocial impact of eHealth services as illustrated in pictures of a set of events of eHealth services that may reasonably occur in the present and the future. The PIADS scale and the scenarios were administered via a randomly selected sample from the Swedish population aged 55–105. Results and Discussion: Older Swedes have, from a psychosocial perspective, positive expectations regarding eHealth services. The PIADS scale could be a useful supplement to acceptance measurements in the context of eHealth. Using animated illustrations to depict eHealth services, together with the PIADS scale, can generate findings that are generalizable across technologies. The dimensions adaptability, competence and self-esteem could be relevant determinants of adoption of eHealth.
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    • "In terms of self-rated health, Brownsell et al. (2008) and Hirani et al. (2014) reported no significant improvements for older people using telecare over a year. Similarly, Bowes et al. (2009) and Cartwright et al. (2013) did not find significant effects on self-rated health for people using telehealth services. The MonAMI evaluation showed that significantly more participants found the telecare services to be " unhelpful " than " helpful " in terms of feeling energetic, managing their medication and memory. "
    [Show abstract] [Hide abstract] ABSTRACT: It is often asserted that older people's quality of life (QOL) is improved when they adopt information and communication technology (ICT) such as the Internet, mobile phones and computers. Similar assumptions are made about older people's use of ICT-based care such as telecare and telehealth. To examine the evidence around these claims, we conducted a scoping review of the academic and grey literature, coving the period between January 2007 and August 2014. A framework analysis approach, based on six domains of QOL derived from the ASCOT and WHOQOL models, was adopted to deductively code and analyse relevant literature. The review revealed mixed results. Older people's use of ICT in both mainstream and care contexts has been shown to have both positive and negative impacts on several aspects of QOL. Studies which have rigorously assessed the impact of older people's use of ICT on their QOL mostly demonstrate little effect. A number of qualitative studies have reported on the positive effects for older people who use ICT such as email or Skype to keep in touch with family and friends. Overall, the review unearthed several inconsistencies around the effects of older people's ICT use on their QOL, suggesting that implicit agreement is needed on the best research methods and instrumentation to adequately describe older people's experiences in today's digital age. Moreover, the available evidence does not consider the large number of older people who do not use ICT and how non-use affects QOL.
    Full-text · Article · Feb 2016
    • "The Whole System Demonstrator (WSD) programme was a cluster randomised controlled trial of telehealth and telecare provision for people (n ¼ approximately 3,000) living with COPD, diabetes, chronic heart disease and social care needs. Overall the findings were mixed, especially in relation to telehealth (Bower et al., 2011; Cartwright et al., 2013; Doll et al., 2013;). Despite some evidence of use of telehealth being associated with lower mortality and fewer hospital admissions, WSD evaluation results also suggested that telehealth was probably not cost effective at usual thresholds (). "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose - The purpose of this paper is to report on a small telehealth pilot in local authority sheltered housing in NE England. This explored the training and capacity building needed to develop a workforce/older person, telehealth partnership and service that is integrated within existing health, social care and housing services. Design/methodology/approach - A qualitative case study approach on the implementation and deployment of a pilot telehealth service, supporting sheltered housing tenants with Chronic obstructive pulmonary disease (n=4). Findings - Telehealth training and capacity building, needs to develop from within the workforce/older person partnership, if a usable and acceptable telehealth service is to be developed and integrated within existing health, care and housing services. To be adaptable to changing circumstances and individual need, flexible monitoring is also required. Practical implications - Service users and workforces, need to work together to provide flexible telehealth monitoring, that in the longer term, may improve service user, quality of life. Originality/value - The pilot explored a workforce/older person partnership to consider how to add and implement telehealth services, into existing health and housing services.
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