Wednesday, March 27, 2013

It Looks Like Telehealth In Chronic Disease May Not Be All That Useful.

This appeared a few days ago.

As "telehealth" grows, experts question cost benefits

Thu, Mar 21 2013
LONDON (Reuters) - Monitoring patients at home using modern technology, so-called 'telehealth', is tipped as the next big thing in healthcare, but a new study by British researchers suggests it may not be worth the extra expense.
The findings will fuel controversy over the economic case for telehealth, which many information technology and telecoms companies are betting on as a multibillion-dollar market opportunity.
Martin Knapp, professor of social policy at the London School of Economics, one of the leaders of the study, said the disappointing results did not mean telehealth was a waste of time but did suggest it needed to be better targeted.
In some cases, smarter technology and a scaling up of programs might help improve the outcome, he added.
"We have got to find ways of better adjusting the equipment to suit the circumstances of the individual patient," he said in an interview. "Just at the moment we don't find the advantage that people had hoped for."
Knapp and colleagues tested the cost-effectiveness of telehealth compared with standard care over 12 months in 965 patients with three long-term conditions: heart failure, chronic obstructive pulmonary disease or diabetes.
Just over half the patients received equipment to allow them to measure things like blood pressure and blood glucose levels at home. They then transmitted their readings electronically to a healthcare professional.
The pay-off, however, was marginal. The researchers found that the cost per quality adjusted life year (QALY) - a standard measure of quantity and quality of life - of telehealth when added to usual care was 92,000 pounds ($139,200).
That is well above the 30,000 pounds that Britain's National Institute for Health and Clinical Excellence (NICE) uses as a benchmark for assessing if medical interventions are worth using on the state-run health service.
Lots more here:
There is also coverage here:

Study: Telehealth not cost effective for chronic patients

March 22, 2013 | By Susan D. Hall
Telehealth failed to produce gains more cost effectively than standard care alone in a new study published at BMJ. That work comes on the heels of previous research in the journal that found telehealth produced  no significant improvements in reported quality of life or anxiety or depression symptoms.
Both studies were part of the British government's Whole System Demonstrator Evaluation of telehealth. The latest study tracked 534 patients with heart failure, chronic obstructive pulmonary disease or diabetes who received telehealth services for 12 months along with usual care, and 431 who received usual care alone.
In the telehealth program, patients received equipment that enabled them to take measurements like blood pressure and blood glucose level at home and transmit readings electronically to a healthcare professional, according to Reuters.
Lots more with links and references here:
On a different tack - slightly different technology seems to be useful with early stroke treatment.

Telestroke programs significantly boost care access for rural patients

March 18, 2013 | By Ashley Gold
Researchers from the University of Pennsylvania School of Medicine have found that a telestroke program based in Oregon was able to increase access to stroke care by 40 percent in regions of the Beaver State. Their findings are being presented this week at the American Academy of Neurology's 65th annual meeting in San Diego.
According to an announcement touting the presentation, telemedicine programs in rural parts of Oregon upped the percentage of residents with access to stroke care within one hour from 54.5 percent to 80 percent. The researchers noted that in-person stoke care was crowded in urban areas, and while telestroke care was available in urban centers, it didn't reach less populated, uninsured areas quite as well.
Previous work by the same researchers published in February 2010 found that half of Americans live more than an hour away from lifesaving stroke care.
"Telestroke programs can reach patients in smaller communities and provide time-critical treatment to previously unreached people," senior study author Brendan Carr, an assistant professor of emergency medicine, surgery, & epidemiology at UPenn said. "Increasing telestroke networks gives everyone a better chance of surviving a stroke, the fourth leading cause of death in the United States."
More with links here:
All in all some useful perspectives again on what works and what doesn’t.

1 comment:

Anonymous said...

The simple commercial paradigm for deployment of TeleHealth or any other remote online health monitoring technology line to people-at-home is that the ROI must be measurable and clear and sufficient to underpin the costs involved in employing the humans who are needed to provide the support services to the people-at-home. All the TeleHealth services do is to make it easier and faster to MONITOR and RECORD the data but without the corresponding SUPPORT SERVICES in place to act upon the data when required the service will be of not benefit to anyone.

So Hospital-in-the-Home, Out-of-Hospital-Care (eg. Royal District Nursing type services) with teams of mobile carers will benefit most from deployment of TeleHealth facilities.