Gaps in the systematic reviews of the telemedicine field

Bahaadinbeigy, Kambiz; Kanagasingam, Yogesan; Wootton, Richard

doi:10.1258/jtt.2010.100505

Cited by 7 publications

(8 citation statements)

References 50 publications

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“…However, experiences of telemonitoring were not measured in the study of Chang et al Although the evidence for the use of telemonitoring in heart failure patients is still growing [5-8], gaps in knowledge about the use of telemonitoring in heart failure remain [3,20,21]. These gaps in knowledge are mainly caused by the absence of data on adequate patient profiling and the overall cost-effectiveness of telemonitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Telemonitoring is considered a promising new intervention for heart failure patients, and a study on the use, perceptions, and experiences has been published recently [1,2]. However, current evidence regarding the effectiveness of telemonitoring in the care of heart failure patients is conflicting [3]. There are many definitions used for telemonitoring, but the core principle does not generally differ.…”

Section: Introductionmentioning

confidence: 99%

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Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

Vries¹,

Wal²,

Nieuwenhuis³

et al. 2013

J Med Internet Res

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BackgroundAlthough telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined.ObjectiveTo assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands.MethodsIn collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics.ResultsOf the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are “monitoring physical condition”, “monitoring signs of deterioration” (n=39, 91%), “monitoring treatment” (n=32, 74%), “adjusting medication” (n=24, 56%), and “educating patients” (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system “as long as needed” or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (P<.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to “keeping up with current development” (before 7.2, after 6.8, P=.15), “being innovative” (before 7.0, after 6.1, P=.003), and “better guideline adherence” (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time.ConclusionsOne third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

Vries¹,

Wal²,

Nieuwenhuis³

et al. 2013

J Med Internet Res

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“…Hospital level data was used to estimate costs in one study [7] and acquisition costs for the technology (with these costs based upon the retail price where equipment was donated) in one [9]. The source of cost data was not stated in the remaining two studies [11], [12]. The consequence of this is that it is not possible to translate the findings of these studies into the current time period.…”

Section: Search Resultsmentioning

confidence: 99%

“…One reason for this may be the lack of studies proving the economic viability of ALTs [30]–[32]. Clearly there is a need for further economic evaluation of the ALTs that enable aging in place for older people [12]. This systematic review highlights a number of important issues.…”

Section: Discussionmentioning

confidence: 99%

“…Even if the effectiveness of ALTs for older people is proven to be universally accepted, as with any new health technology, it is important that the costs and benefits of widespread adoption are measured so decision makers in publically and privately funded healthcare systems can make evidence based decisions [11]. The lack of such research was evident in a recent overview [12] of systematic reviews that highlighted several important gaps in the telecare literature, one being economic analysis.…”

Section: Introductionmentioning

confidence: 99%

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Can Aging in Place Be Cost Effective? A Systematic Review

2014

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Purpose of the StudyTo systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to ‘age in place’ and highlight what further research is needed to inform decisions regarding aging in place.DesignPeople aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement.MethodsStudies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style.ResultsEight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered.ImplicationsThe studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.

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Critical Appraisal of Published Systematic Reviews Assessing the Cost-Effectiveness of Telemedicine Studies

Mistry

Garnvwa

Oppong

2014

Telemedicine and e-Health

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Even though the general quality of reporting of the reviews was fine, we have found that conclusions cannot be drawn on the cost-effectiveness of telemedicine applications based on the methodological flaws in the economic analysis of the studies included in the reviews. Over time, reporting of cost-effectiveness has generally improved; however, there is still room for improvement, and authors need to use the recommended checklists for economic evaluations.

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Gaps in the systematic reviews of the telemedicine field

Cited by 7 publications

References 50 publications

Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

Can Aging in Place Be Cost Effective? A Systematic Review

Critical Appraisal of Published Systematic Reviews Assessing the Cost-Effectiveness of Telemedicine Studies

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