What impact does telehealth have on long-term conditions management?

I thought your use of Prezi was a good example of using the new tool to liven up a traditional type of presentation. You might be interested in thecourse.webicina.com/for a good example of the use of video clips in Prezi. Apart from the presentation, the actual information on the impact of telehealth is very welcome and I thought your coverage of the studies was suitably balanced. Are you planning to have another look at the cost-effectiveness (or otherwise) of intermediate care or CATS services for musculo-skeletal conditions? Assumptions are being made that redesign of services can be brought in anywhere without establishing the correct network of skill sets.

Philip
Many thanks for your comments. We are developing a peer-reviewed article based on this work and also writing a King's Fund paper about the issues involved in successful telehealth adoption. We are not specifically planning any work on MSK conditions, but a key issue generically is about having the necessary capability and skills as you point out.
Best wishes
Nick

I enjoyed your Prezi. I have a few comments and questions-
1. In weighing up the balance of evidence, how can you avoid ascertainment bias and include some measures of pilots/studies that did not make it into print? We all know that it is usally the positive studies that get printed :)
2. Can we put a definition on 'telehealth/telecare'? We usually mean it as a complex intervention, maybe understanding which components help/work would be a good way forward.
3. We need to be clear on the comparitor intervention- 'usual care' isn't what it used to be! If the studies are more than a few years old, it is likely that 'usual care' now may be superior to what happened in the study.

Thanks!

Dear Pete
Thanks for your comments
1. Yes, there is a bias in studies since they seek to demonstrate positive benefits and there is a problem in the number of studies that don't get to print because (a) the work is not of high quality; (b) they were not able to demonstrate impact, either positive or negative, because data collection was too problematic; (c) they did not achieve the results being looked for. I noted this in my talk at the conference discussing the nature of this evidence-base and its problems, and I will return to these problems in a paper due out later this year
2. We have a definition on the website of both telehealth and telecare (see evidence database background) but you are right to point out that, like integrated care, telehealth and telecare are complex and multi-faceted 'interventions' that are not just about the technology. I have always argued that the technology is but a tool to support better care and that 90% of the issue (at least) is one of system change and service innovation
3. Yes - and this is particularly unclear in most studies what 'usual' care means. One clear issue for me is that some studies are looking at telehealth enabled case management vs. traditional primary care - where positive effects are found, its probably the case management system that has worked with its focus on managing chronic illness through population management, supported self-care, early discharge to multi-disciplinary service teams and care co-ordination. The value of the technology component in this approach needs to be examined closely as it may not be the main driver of results.
There are many problematic questions with the evidence base and its variability, which is why we developed the 'clapometer' version of the evidence to give a general 'feel' for the balance of evidence. If you dug into each study more deeply then I think you would have few truly comparable sets of studies
Best wishes
Nick

Nick,

This study was very helpful. I was wondering if you could provide definitions for the six areas that you reviewed telehealth studies across (service utilization, clinical effectiveness, etc.) Some of these metics, such as utilization and cost effectiveness, can be interpreted in a couple different ways when evaluating an effectiveness study.

Thanks,
Peter

Hi Nick,
Hope you are well ( hi to you as well Pete).
Just enquiring as to how to get hold of the PREZI presentation, it only seems to download in low res, so images are all blurred. Is it possible to access a copy another way
J

Can u post more like this?

I found the prezi presentation nauseating as the slides changed and therefore not watchable.

Is there a PDF version of this?...it may look nice but for studying purpose it's not so usable.
Thank you

Hi Federico,
No, there isn't. You can share it by email / social media or embed it on another website but there isn't a PDF.