The impact of telehealth support for patients with diabetes or chronic obstructive pulmonary disease on unscheduled secondary care utilisation: a service evaluation

Andrew Ck Lee,Kate Fletcher,Jean Robinson,Simon Oliver

doi:10.14236/jhi.v20i4.16

Abstract

Telehealth has been promoted as an adjunct to managing patients with long-term conditions. It has been used in various settings and for different disease groups. However, robust evidence for the efficacy of telehealth is currently lacking. To evaluate the impact of a telehealth service on emergency admissions and emergency department (ED) attendances. We evaluated a telehealth service providing supported self-management to patients that was implemented in Nottingham City. Two groups of patients ('graduates' of the Nottingham telehealth service and service 'decliners') were compared for two periods; 2009 (pre-service implementation) and 2011. Eighty-nine pairs of graduates and decliners were identified who were matched for age and sex. The number and cost of emergency admissions and ED attendances for these patients were then collated and analysed. Graduates had significantly fewer emergency admissions and ED attendances compared with decliners in 2011. However, differences of a similar magnitude in emergency admissions and ED attendances were found in 2009. Telehealth service users were likely to be qualitatively different from decliners, reflecting a degree of self-selection. This suggests that decliners were more likely to have a confounding reason for not engaging with telehealth, such as greater disease severity. This service review found no evidence that the Nottingham telehealth service has had a significant impact on secondary care utilisation in the short term. Longer term follow up is needed to establish conclusively whether telehealth initiatives like the Nottingham telehealth service does lead to tangible patient benefits and provide value for money.

Highlights

Telehealth has been promoted as an adjunct to managing patients with long-term conditions
This service review found no evidence that the Nottingham telehealth service has had a significant impact on secondary care utilisation in the short term
Longer term follow up is needed to establish conclusively whether telehealth initiatives like the Nottingham telehealth service does lead to tangible patient benefits and provide value for money

Summary

Introduction

Telehealth has been promoted as an adjunct to managing patients with long-term conditions. Health services in England face a challenging task of meeting the needs of a growing aged population, with their attendant burden of ill health, against a backdrop of funding and resource constraints in the decade.[1] It is estimated that the number of people over the age of 65 years will increase by 28% between 2010 and 2035.2 The size of the burden of chronic ill health, including diseases such as diabetes mellitus, chronic obstructive pulmonary disease (COPD) and heart failure, is on the increase Many of these longterm conditions feature more prominently in this age group, and older patients are more likely to suffer multiple morbidities.[3,4] Telehealth and its associated technologies have been touted as one of the solutions to deal with this problem.[5,6,7] Telehealth refers to an array of communications technology used by health staff to deliver health and social care support to individual patients.[8] It has been tried for the management of a range of long-term conditions that include diabetes, mental health, cardiac disease, monitoring of high-risk pregnancies and frail elderly, and palliative care.[9,10,11,12,13,14] It has been implemented in different settings and could be especially useful for the delivery of chronic disease care for more remote and rural areas.[15]

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