Nuffield Trust has published one of the long anticipated studies into the UK’s trial of telehealth and telecare technology, known as the Whole System Demonstrator, or WSD, trial. The studies have attracted interest around the world because the WSD trial was conducted on a larger scale involving several thousand participants compared to the typical 100 or less participants often found in other trials to date.
The study by the Nuffield Trust looked at telehealth’s impact on secondary healthcare and mortality. It found that among patients of COPD, diabetes or heart failure the use of a telehealth service was associated with lower rates of mortality and hospital admissions, although the latter might be explained by the recruitment processes used for the trial.
However the estimated scale of hospital cost savings is “modest” and the cost of implementing telehealth needs to be also taken into account, says the study.
The study is the first of five due to be published looking at different aspects of the WSD trial. The UK's Department of Health also published its own summary of findings at the end of last year. The other studies will focus on how telehealth impacted quality of life as well as looking at cost effectiveness. They will also pick up on what issues are raised for patients, health professionals and organisations. The Nuffield Trust study is published on the BMJ website here.
Among the principal findings of the Nuffield Trust study was that a smaller proportion of telehealth patients in the trial with COPD, diabetes or heart failure were admitted to hospital than in a control group during a 12-month period. However the study says “the magnitude of the group difference in admission proportion was relatively small”.
Another finding was that telehealth patients were significantly less likely to die within the 12-month period than those in the control group. The study also noted small differences in the mean number of emergency admissions between the two groups. The difference was particularly marked at the start of the trial period when emergency admissions were distincly higher. However the study says this might be explained by doctors identifying additional health problems among the control group during the recruitment process and deciding to intervene.
In a section of the study on what are implications for clinicians and policymakers, the Nuffield Trust says its study suggests that telehealth helped patients to avoid emergency admissions to hospital. But, it adds, “the mechanism for this is not yet clear”. One explanation is that telehealth might help patients better manage their conditions. It might also change patients’ perception of when they need to seek help, as well as professionals’ views of hospital admission.
Next the study says the reduced mortality rate among telehealth patients “will be an important motivator to invest in these interventions and similar technologies”. On reduced hospital admissions, the study says the findings “need to be tempered by the estimated scale of the difference in notional hospital cost savings for commissioners of care and the cost of the intervention”.
“For commissioners of care services, there are questions about whether any reduction in hospital use for patients receiving telehealth translates to an overall change at the organisational level,” the study says. It also makes the point that any hospital bed-days released as a result of telehealth could be filled by other patients rather than released as cost savings.
The effectiveness of telehealth might also vary between patients depending on their disease type, says the study.
It also made a subtle point about the how the effect of telehealth “could be intricately linked to wider issues about how health systems operate”. It is not clear whether effects are attributable to the technology itself or the way it is implemented, says the study which also points out its potential for disruption among professionals who have to adjust their working practices.