Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial

Abstract

BackgroundTelehealth is increasingly used in the care of people with long term conditions. Whilst many studies look at the impacts of the technology on hospital use, few look at how it changes contacts with primary care professionals. The aim of this paper was to assess the impacts of home-based telehealth interventions on general practice contacts.MethodSecondary analysis of data from a Department of Health funded cluster-randomised trial with 179 general practices in three areas of England randomly assigned to offer telehealth or usual care to eligible patients. Telehealth included remote exchange of vitals signs and symptoms data between patients and healthcare professionals as part of the continuing management of patients. Usual care reflected the range of services otherwise available in the sites, excluding telehealth. Anonymised data from GP systems were used to construct person level histories for control and intervention patients. We tested for differences in numbers of general practitioner and practice nurse contacts over twelve months and in the number of clinical readings recorded on general practice systems over twelve months.Results3,230 people with diabetes, chronic obstructive pulmonary disease or heart failure were recruited in 2008 and 2009. 1219 intervention and 1098 control cases were available for analysis. No statistically significant differences were detected in the numbers of general practitioner or practice nurse contacts between intervention and control groups during the trial, or in the numbers of clinical readings recorded on the general practice systems.ConclusionsTelehealth did not appear associated with different levels of contact with general practitioners and practice nurses. We note that the way that telehealth impacts on primary care roles may be influenced by a number of other features in the health system. The challenge is to ensure that these systems lead to better integration of care than fragmentation.Trial registration numberInternational Standard Randomised Controlled Trial Number Register ISRCTN43002091.

Raising the standard of applied dementia care research: addressing the implementation error

“…However, many studies fail to report positive outcomes (Olazaran et al, 2010). For example, recent pragmatic trials of support programmes (Kurz et al, 2012;Low et al, 2013;Van de Ven et al, 2013;Waldorff et al, 2012), telecare (Bardsley, Steventon, & Doll, 2013), training interventions (Beer et al, 2011;Spijker et al, 2011) and system enhancements or novel methods of delivering services (Goldberg et al, 2013;Meeuwsen et al, 2012;Nourhashemi et al, 2010;Van Houdt & De Lepeleire, 2010) all report no positive effects compared with the control 'usual care' condition. One study nonetheless demonstrated improvements in the patient experience and family carer satisfaction (Goldberg et al, 2013) whilst others point to problems with delivery of the intervention by practitioners such as poor adherence and variation in practice (Low et al, 2013;Spijker et al, 2013;Wenborn et al, 2013).…”

Experiences of front-line health professionals in the delivery of telehealth: a qualitative study

“…9 Pinnock and colleagues report that the introduction of telehealth has resulted in increasing contact between patients and GPs, 10 although this was contradicted in another study on GP and practice nurse contacts with patients which showed no change. 11 The qualitative study reported here is a component of the Whole System Demonstrator evaluation, a large cluster randomised controlled trial of telehealth and telecare for patients with long-term and complex conditions (chronic heart disease, chronic obstructive pulmonary disease [COPD] and diabetes) and those with social care needs. Details of the trial design are reported elsewhere 12 but are summarised here in Box 1 and Box 2.…”

Heart failure in primary care with special emphasis on costs and benefits of a disease management programme

“…However, a German PHC-based study showed that a patient with HF had six visits to their GP. Meanwhile, in an English study, there were nine visits to the GP (95,117). These divergent findings possibly illustrate that PHC differs in European countries and that these studies had somewhat different populations.…”