Twenty years of telemedicine in chronic disease management – an evidence synthesis

Abstract

A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory.

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…Despite these encouraging results, the penetration of these technological advances in the clinical practice is still slow, especially when compared with other respiratory chronic diseases or others pathologies [98,99,[101][102][103]. Furthermore recently published results questioned the validity of this technology as a method to delivery healthcare for all populations [104].…”

Stakeholder Contradictions in Early Stages of eHealth Efforts

“…Terms like telecare, telehealth, telemedicine, eHealth and mHealth are used interchangeably, and various definitions of these concepts exists [17,34,44].…”

Video-based telehealth in Australian primary health care: current use and future potential

“…One review of telehealth-assisted chronic disease management (Wootton 2012) identified three diabetes trials in which patients whose management included videoconferencing had significantly better blood glucose levels. The results for heart failure were less conclusive; several studies found fewer hospitalisations and higher quality of life, but the differences were not always significant.…”

“…The results for heart failure were less conclusive; several studies found fewer hospitalisations and higher quality of life, but the differences were not always significant. Wootton (2012) concluded that 'the evidence base for telemedicine in managing chronic diseases is on the whole weak and contradictory'. Overall, the available evidence indicates that outcomes of video consultations are not significantly different from outcomes of FTF consultations for most conditions and specialties.…”