Applying Research Evidence to Optimize Telehomecare

Abstract

Telemedicine is the use of technology to provide healthcare over a distance. Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. Most home care agencies are adopting telehomecare to assist with the care of the growing population of chronically ill adults. This article presents a summary and critique of the published empirical evidence about the effects of telehomecare on older adult patients with chronic illness. The knowledge gained will be applied in a discussion regarding telehomecare optimization and areas for future research. The referenced literature in PubMed, MEDLINE, CDSR, ACP Journal Club, DARE, CCTR, and CINAHL databases was searched for the years 1995-2005 using the keywords "telehomecare" and "telemedicine," and limited to primary research and studies in English. Approximately 40 articles were reviewed. Articles were selected if telehealth technology with peripheral medical devices was used to deliver home care for adult patients with chronic illness. Studies where the intervention consisted of only telephone calls or did not involve video or in-person nurse contact in the home were excluded. Nineteen studies described the effects of telehomecare on adult patients, chronic illness outcomes, providers, and costs of care. Patients and providers were accepting of the technology and it appears to have positive effects on chronic illness outcomes such as selfmanagement, rehospitalizations, and length of stay. Overall, due to savings from healthcare utilization and travel, telehomecare appears to reduce healthcare costs. Generally, studies have small sample sizes with diverse types and doses of telehomecare intervention for a select few chronic illnesses; most commonly heart failure. Very few published studies have explored the cost or quality implications since the change in home care reimbursement to prospective payment. Further research is needed to clarify how telehomecare can be used to maximize its benefits among diverse adult chronic illness populations. Keywords home care; telecommunications; telemedicineTelemedicine is defined as the use of technology to provide healthcare over a distance. 1 Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. 2 As noted in other articles in this issue, typical equipment can include a telephone line; simplified, regular computer, or wireless devices; videocamera; and physiologic monitoring equipment such as a blood glucose monitor, stethoscope, blood

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] These showed that evidence of effectiveness was stronger for some conditions (e.g. heart failure) than for others (e.g.…”

“…16,17,[69][70][71]73,77 Two reviews reported improved educational outcomes 11,73 and seven reported significant positive behavioural change, 11,17,20,68,71,73,75 particularly improved self-monitoring or management in patients with diabetes 17 and better treatment adherence. 17,20,68 There were few firm conclusions about the impact of telehealth on quality of life, although one meta-analysis reported improvements associated with computer-mediated support groups. 75 The three reviews which suggested that telehealth improved social support 11,73,75 were countered by three that reported inconsistent or insufficient evidence.…”

“…Telehealth was shown to reduce admissions for heart failure, heart disease, diabetes and hypertension 8,17,20,72 and reduce hospitalisations for elderly patients with LTCs. 70 However, other reviews showed limited impact on service utilisation 11,76 and meta-analyses reported that the evidence for a positive impact of telehealth on resource utilisation was questionable.…”

“…8,20,70,77 The use of mobile phones and text messaging appeared to be effective, 71,73 particularly for promoting behaviour change. Vital signs monitoring was reported as producing clinical benefits in approximately half of the trials in one review, 20 but other reviews suggested that this might be limited to particular conditions, such as hypertension, 69 diabetes, 17,68,69,77 heart failure 17,68 and respiratory conditions. 69 Vital signs monitoring was associated with increased mortality among COPD patients and appeared to offer no benefits for dementia, 70 obesity or blood glucose control in diabetes.…”

Business models for telehealth in the US: analyses and insights

“…58,73 While the many studies conducted show the potential cost savings due to telehealth and remote monitoring, both in the US and in other countries, the fact that most of these studies still involve small sample sizes with diverse types and doses for telehomecare intervention and for select chronic illnesses, such as heart failure and COPD presents a challenge to the revenue model. 27,[74][75][76][77][78] Also, other studies argue that the outcome of telemedicine in these areas is not conclusive due to definition and measurement issues. 79,80 A 1992 study by the Arthur D. Little Consulting Company which estimated then, that telemedicine would have resulted in savings of $36 billion annually, was perhaps the first, and one of the few, comprehensive studies that tried to estimate the potential savings from telemedicine.…”