Evidence based decisions.

Popular media is full of the newest medical app, telehealth is touted as a solution in popular media. However providers need to act on evidence based medicine not mainstream media. A recent study demonstrated that telehealth interventions decreased emergency admissions and mortality for individuals who need chronic care (e.g. diabetes, COPD). Additionally, the telethealth patients (intervention group) who were admitted had reduced hospital bed days. Providers exchanged information with the patients in the intervention group as part of diagnosis and disease management. This group also received usual care, which the control group also received. What makes this study so potent is that it used a randomized control paradigm, and had an enormous sample size, over 3,000 patients.

As this study demonstrates usual care visits will still be important. However their number may decrease with the increase of telehealth. Of course more research may be needed, but providers may see for themselves if a patient is experiencing improvement.

A similar study undertaken with veterans who had comorbidities of diabetes and hypertension and were primary care patients. The intervention group received nurse managed telehealth care. During the six months of the study the intervention patients had both decreased A1c and SBP relative to the control. Six months after the study was withdrawn A1c levels return to the pre-intervention levels, SBP saw the same process but in 12 months.

Is this a magic bullet to lower mortality and improve the lives of all patients?

Probably not all patients, since there are some outliers. Some are at very high risk may not necessarily benefit from the lower mortality rates that the data demonstrate. However, at the very least the provider can ensure that their patients are receiving the best care and are compliant. It may decrease the gaps of information between usual care visits. Additionally, patients can experience increased care at convenience of their own homes.

These results demonstrate that it telehealth is worth looking into for providers, at the very least to dig deeper to see how it can improve patient outcomes. Transmission of education and keeping an eye on clinical symptoms can detect problems early. Most of this work can be done by nurses will be relatively inexpensive. Most importantly, patients have better access to care, and better outcomes. Please let us know what you think or what your experience may be in telehealth below.

Works Cited in this blog:

Steventon, Adam, et al. “Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial.” Bmj 344 (2012).

http://www.bmj.com/content/344/bmj.e3874.abstract

Wakefield, Bonnie J., et al. “Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial.” Telemedicine and e-Health 17.4 (2011): 254-261.

http://online.liebertpub.com/doi/abs/10.1089/tmj.2010.0176