Re: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial
We welcome this high quality randomised control trial1 as it fulfils the need for more robust evaluation of telehealth interventions with evidence to inform our commissioning decisions.
The outcomes of the research reducing secondary care, reductions in mortality are pertinent to primary commissioning outcomes. However the evidence for actual clinical effect of the hospital day’s difference on its own is reported to be not significant enough. Also, the conclusion that the study is not generalisable puts a limitation on local use of the findings to transfer the knowledge directly into our telehealth work.
Two things we noted of relevance to our work locally are firstly, for pathway design that the mechanism for avoiding emergency admissions is not yet clear and there is no indication of which end of risk stratification yields the best outcomes. Secondly, the study is not powered to pick up anything meaningful regarding dementia and their specific carers. We know dementia is going to be one of the biggest Long Term Conditions we need to deal with in the coming years. Early indications from local evaluation work with service providers and patients using telehealth interventions shows benefits for people with long term conditions including dementia. The main problem is the need to have the findings from cost effectiveness and quality of life studies to give us evidence on the outcomes for patients receiving telehealth and whether the studies collectively strengthens the evidence; we need the complete picture.
1. Steventon et al, Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ, 2012. 344.
Competing interests:
No competing interests
30 July 2012
Susan Stokes
Locum consultant in public health
Sandwell PCT
Kingston House, High Street, West Bromwich B70 9LD
Rapid Response:
Re: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial
We welcome this high quality randomised control trial1 as it fulfils the need for more robust evaluation of telehealth interventions with evidence to inform our commissioning decisions.
The outcomes of the research reducing secondary care, reductions in mortality are pertinent to primary commissioning outcomes. However the evidence for actual clinical effect of the hospital day’s difference on its own is reported to be not significant enough. Also, the conclusion that the study is not generalisable puts a limitation on local use of the findings to transfer the knowledge directly into our telehealth work.
Two things we noted of relevance to our work locally are firstly, for pathway design that the mechanism for avoiding emergency admissions is not yet clear and there is no indication of which end of risk stratification yields the best outcomes. Secondly, the study is not powered to pick up anything meaningful regarding dementia and their specific carers. We know dementia is going to be one of the biggest Long Term Conditions we need to deal with in the coming years. Early indications from local evaluation work with service providers and patients using telehealth interventions shows benefits for people with long term conditions including dementia. The main problem is the need to have the findings from cost effectiveness and quality of life studies to give us evidence on the outcomes for patients receiving telehealth and whether the studies collectively strengthens the evidence; we need the complete picture.
1. Steventon et al, Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ, 2012. 344.
Competing interests: No competing interests