Pragmatic randomized controlled trial comparing a complex telemedicine-based intervention with usual care in patients with chronic conditions

Abstract

This study evaluates a complex telemedicine-based intervention targeting patients with chronic health problems. Computer tablets and home telemonitoring devices are used by patients to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to answer health-related questions at a follow-up center. We designed a pragmatic randomized controlled trial to compare the telemedicine-based intervention with usual care in six local centers in Norway. The study outcomes included health-related quality of life (HRQoL) based on the EuroQol questionnaire (EQ-5D-5L), patient experiences, and utilization of healthcare. We also conducted a cost–benefit analysis to inform policy implementation, as well as a process evaluation (reported elsewhere). We used mixed methods to analyze data collected during the trial (health data, survey data and interviews with patients and health personnel) as well as data from national health registers. 735 patients were included during the period from February 2019 to June 2020. One year after inclusion, the effects on the use of healthcare services were mixed. The proportion of patients receiving home-based care services declined, but the number of GP contacts increased in the intervention group compared to the control group. Participants in the intervention group experienced improved HRQoL compared to the control group and were more satisfied with the follow-up of their health. The cost–benefit of the intervention depends largely on the design of the service and the value society places on improved safety and self-efficacy.

Kan friskere aldring og økt familieomsorg veie opp for lavere tilgang på offentlige helse- og omsorgstjenester?

“…Helsepersonellkommisjonen skriver at «velferdsteknologiske hjelpemidler og digitale verktøy … kan styrke både den enkelte og deres omgivelser til å kunne utføre oppgaver som bidrar til å senke etterspørselen etter helse-og omsorgstjenester fra kommunene og sykehus» (2, s. 279). Selv om dette ofte vil stemme, og saerlig i omsorgstjenestene, kan det stilles spørsmål ved den samlede gevinsten gitt at det vrir forbruket over mot andre deler av helsetjenesten (22). De mer pessimistiske påpeker også økt ensomhet som en mulig negativ konsekvens av velferdsteknologi (23).…”