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Telehealth enables the remote exchange of data between a patient and healthcare professionals to facilitate diagnosis, monitoring, and management of long term conditions.8 9 Some telehealth systems incorporate an educational component aimed at improving patient knowledge10 and self care (for example, treatment adherence).11 12 Telehealth systems that send physiological or symptom data to a remote monitoring centre can alert healthcare professionals when disease specific clinical parameters are breached.
Collectively, the WSD Evaluation is the largest and most comprehensive investigation of telehealth and telecare so far.Results In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480≤P≤0.904) or available case (0.181≤P≤0.905) cohorts.The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months.Typically, the reviews are poorly reported (for example, they report how many studies found a significant association but not how many studies looked for an association and failed to find one35), combine outcomes comprising measures that are conceptually distinct (for example, health related Qo L combined with patient satisfaction and treatment adherence37), and fail to balance the evidence appropriately.39 In the two most transparent reviews, only one of three34 and three of seven36 studies that evaluated the monitoring of telehealth based vital signs reported any significant associations between telehealth and improvements in health related Qo L.In a recent randomised controlled trial of third generation telehealth40 that is not included in the cited reviews, researchers found no effect of telehealth on depression scores over 24 months, but found an overall benefit on one of eight SF-36 subscales.41 Overall, claims that telehealth improves health related Qo L for patients with heart failure are unsubstantiated.38Two systematic reviews have examined the effect of telehealth on health related Qo L for patients with chronic obstructive pulmonary disease.General practice was the unit of randomisation, and telehealth was compared with usual care.
Data were collected at baseline, four months (short term), and 12 months (long term).
Participants Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009.
Main outcome measures Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale).
The design, protocol, and objectives of the WSD Evaluation have been reported in detail elsewhere.18 Briefly, the evaluation comprises a pragmatic, cluster randomised controlled trial of telehealth for service users with long term conditions (chronic obstructive pulmonary disease, diabetes, heart failure; known as the WSD telehealth trial) and an equivalent trial of telecare for service users with social care needs (the WSD telecare trial).
These cluster randomised controlled trials evaluate a comprehensive range of healthcare utilisation outcomes and mortality.
This omission is important, given concerns about the potential detrimental effects of telehealth on patients.