Health professionals' responses to the introduction of a home telehealth service

Hibbert, Derek; Mair, Frances S; May, Carl; Boland, Angela; O'Connor, Jane; Capewell, Simon; Angus, Robert

doi:10.1258/1357633041424386

Cited by 52 publications

(81 citation statements)

References 13 publications

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“…110 Therapists, nurses and doctors were all less enthusiastic than patients about telehealth. 81,115 Improved self-management through monitoring in diabetes was noted, 106,109,114,116 as was increased symptom awareness 112,117 and better self-management for LTCs generally. 103 For example, middle-aged men with diabetes reported improved knowledge and management of symptoms linked to a diabetes decision support system, but the system was reported as not working for patients engaging in sport.…”

Section: Care and Symptom Managementmentioning

confidence: 99%

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

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Care and Symptom Managementmentioning

confidence: 99%

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

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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“…A semi-structured interview guide was developed following a review of literature [13][14][15][16][17] and discussions between the authors, both health services researchers. The main interview topic areas covered implementation of telehealth at local level, impact on practice, on professional-patient relationships and on interprofessional communication and relationships.…”

Section: Data Generationmentioning

confidence: 99%

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

et al. 2014

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BackgroundTelehealth is an emerging field of clinical practice but current UK health policy has not taken account of the perceptions of frontline healthcare professionals expected to implement it. AimTo investigate telehealth care for people with long-term conditions from the perspective of the front-line health professional. Design and settingA qualitative study in three sites within the UK (Kent, Cornwall, and the London Borough of Newham) and embedded in the Whole Systems Demonstrator evaluation, a large cluster randomised controlled trial of telehealth and telecare for patients with long-term and complex conditions. MethodSemi-structured qualitative interviews with 32 front-line health professionals (13 community matrons, 10 telehealth monitoring nurses and 9 GPs) involved in the delivery of telehealth. Data were analysed using a modified grounded theory approach. ResultsMixed views were expressed by front-line professionals, which seem to reflect their levels of engagement. It was broadly welcomed by nursing staff as long as it supplemented rather than substituted their role in traditional patient care. GPs held mixed views; some gave a cautious welcome but most saw telehealth as increasing their work burden and potentially undermining their professional autonomy. ConclusionHealth care professionals will need to develop a shared understanding of patient self-management through telehealth. This may require a renegotiation of their roles and responsibilities. Key wordsprimary care; qualitative; telehealth, Whole System Demonstrator.

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“…It is argued that the demand of IS innovation is mainly dominated by users experience and perception; and the sense of efficacy mainly originates from the scientific evidence provided to back up the IS innovation deployment and evaluation through strategies as RCT (McGrath et al, 2008;Clark & Goodwin, 2010;Cornford et al, 1994;Hibbert et al, 2004;Finch et al, 2008).…”

Section: Acceptabilitymentioning

confidence: 99%

Understanding Innovation Deployment and Evaluation in Healthcare: The Triality Framework

Sharma¹,

Barnett²,

Clarke³

2012

Management of Technological Innovation in Developing and Developed Countries

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Health professionals' responses to the introduction of a home telehealth service

Cited by 52 publications

References 13 publications

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

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

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

Understanding Innovation Deployment and Evaluation in Healthcare: The Triality Framework

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