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.
Highlights
The rising prevalence of long-term conditions is a major clinical and public health challenge [1]
While 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, in http://www.jmir.org/2017/5/e172/
The impact of telehealth-supported self-management on disease control and health care utilization was inconsistent, with positive outcomes more frequently identified in type 2 diabetes and heart failure and often no effect demonstrated in other conditions
Summary
The rising prevalence of long-term conditions is a major clinical and public health challenge [1]. Telehealth has attracted considerable interest as a means of delivering care to those with long-term conditions [2]. Definitions of telehealth are many and varied [3], and the technologies involved are novel and evolving [4]: in this paper we use the term to refer to any use of information and communication technology to facilitate communication or transfer of information between patient and health care provider over a distance [5]. Telehealth has been proposed as one mechanism by which self-management may be promoted and enabled [10], in contrast, it has been suggested that telehealth may sometimes increase dependence on health professionals rather than promoting self-management [11]. Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions
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