Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial

Sir,

I read the analysis of the findings from the WSD Study and was saddened to see the conclusions. I have witnessed first hand over many years the benefits for patients so was really disappointed in reading the article. Essentially I would argue that the findings need to be viewed with a few caveats below:

Firstly the cohort of patients included those that were known to Community Matrons and/or Specialist Nurses and patients that would usually be managed by General Practice/practice nurse and therefore as a result many of the patients who were included may not necessarily have been appropriate from a clinical perspective.

Secondly many of the cohort were managed by general practice and as a result were monitored by a monitoring centre, yet I cannot see that there was any differentiation in the final report, but it is likely that this could affect the results. Patients that were being managed by a health care professional within their own home will have different experiences than those that are registered with a general practice and continued to work for example.

Finally in light of the conclusions I would suggest that it should take into consideration the multmorbididty element. Essentially the study only looked at the 3 disease areas of COPD, Heart Failure and Type 2 Diabetes and therefore looked in isolation of the other Multi Morbididty and Co Morbidities. As we know from the Scottish Primary Care Data which reviewed over a million records Only a small percentage of patients just have one disease process and therefore one could argue that this could impact significantly on the patients QOL indicators also.