Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Abstract

BackgroundSelf-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions.ObjectiveThe objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support.MethodsWe performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots.ResultsWe included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma.ConclusionsWhile telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.

Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure – A randomized controlled trial

“…Still, factors contributing to building engagement are unknown [35] and patients with chronic conditions such as COPD are a particularly vulnerable and self-efficacy improvements are especially difficult to attain in such patients [34]. A similar pattern is seen in telehealth interventions where benefits have been reported in patients with CHF whereas they are rare in patients with COPD [26]. …”

eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project

“…Lastly, remote services in particular seems to empower patients by giving them tools to self-manage and live more autonomous in their home and enable them to keep living in deprived and rural communities, thus increasing their quality of life and possibility to access adequate care [15,25,57]. In particular telehealth seems to be a "safe option" for delivery of self-management support [58].…”

Strategies to promote adoption and usage of an application to support asthma self-management: a qualitative observational study

“…In the context of diabetes, patients stopped checking their blood glucose if professionals did not show interested in their logs 21. Tele-monitoring of diabetes encouraged home monitoring as a result of presumed professional surveillance22 and improved clinical outcomes were demonstrated in trials of telehealth in diabetes and heart failure which included monitoring and feedback 23. Tele-monitoring can thus support the motivation provided by on-going interest from professionals, though from a practical perspective this requires the professional to be able to seamlessly access their patients’ information during a consultation 24…”