Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial

Abstract

Objective: to assess the impact of telecare on the use of social and health care. Part of the evaluation of the Whole Systems Demonstrator trial.Participants and setting: a total of 2,600 people with social care needs were recruited from 217 general practices in three areas in England.Design: a cluster randomised trial comparing telecare with usual care, general practice being the unit of randomisation. Participants were followed up for 12 months and analyses were conducted as intention-to-treat.Data sources: trial data were linked at the person level to administrative data sets on care funded at least in part by local authorities or the National Health Service.Main outcome measures: the proportion of people admitted to hospital within 12 months. Secondary endpoints included mortality, rates of secondary care use (seven different metrics), contacts with general practitioners and practice nurses, proportion of people admitted to permanent residential or nursing care, weeks in domiciliary social care and notional costs.Results: 46.8% of intervention participants were admitted to hospital, compared with 49.2% of controls. Unadjusted differences were not statistically significant (odds ratio: 0.90, 95% CI: 0.75–1.07, P = 0.211). They reached statistical significance after adjusting for baseline covariates, but this was not replicated when adjusting for the predictive risk score. Secondary metrics including impacts on social care use were not statistically significant.Conclusions: telecare as implemented in the Whole Systems Demonstrator trial did not lead to significant reductions in service use, at least in terms of results assessed over 12 months.International Standard Randomised Controlled Trial Number Register ISRCTN43002091.

Telecare acceptance as sticky entrapment: A realist review

“…The results from telecare studies differ substantially as some reports that telecare appears to support older people to remain at home 2,3 , while others show opposite results 4 . Previous research raises several questions about the slow uptake and identifies users' acceptance of telecare to be a key issue [5][6][7][8] .…”

Experiences of front-line health professionals in the delivery of telehealth: a qualitative study

“…This article adds to the growing set of publications 12,[20][21][22][23][24] by the Whole System Demonstrator evaluation team and provides a unique insight into some of the challenges facing front-line professionals within the larger study. While the study was completed some time ago, it is unlikely that views will have fundamentally altered as little progress (in terms of large scale implementation) has been made and most healthcare staff will not have come across this technology.…”

Alarm pendants and the technological shaping of older people's care

“…While some research has illustrated how telecare can allow people to stay in their own homes for longer and forgo the immediacy of institutional care (Gordon, 1993;Mynatt et al, 2001) promote independence (Price, 2007) and reduce financial costs (Blythe et al, 2005;Meng & Lee, 2006), the empirical evidence is weak. Recent findings from the largest randomized control trial of telecare in the world, involving 2600 participants in 3 areas of England over a 12-month period found that it did not significantly alter rates of health and social care use or mortality (Stevenson et al, 2013).…”