Journal_1_2014_final_WEB

Table 1. Survey on included studies referring to Whole System Demonstrator
Reference Effect measure N Follow-up, mdr. Recruitment
Steventon et al,
2012 [8]
Use of secondary care and mortality 3,230
individuals
12 Cluster-randomization
from 179
general practices in Newham,
Kent, and Cornwall
Cartwright et al,
2013 [9]
Quality-of-life (SF-36 and EQ-5D)
Fear (Brief STAI)
Depressive symptoms (CESD-10)
1,573
individuals
12 Randomized
subgroup from [8]
Henderson et al,
2013 [10]
Costs and cost-effectiveness 965
individuals
3 (9-12 months
of the trial)
Randomized
subgroup from [8]
Hendy et al,
2012 [11]
Challenges in implementation 115
Health care
professionals
Causes for not taking part in study 22 individuals
–
Health care professionals and
leaders in Health care
Sanders et al,
2012 [12]
–
Subgroup from [8]
CESD=Centre for Epidemiological Studies Depression Scale; CHF=Coronary Heart Failure; EQ-5D=EuroQoL-5 Dimensions;
COPD=Chronic Obstructive Pulmonary Disease; SF=Short Form; STAI=State-Trait Anxiety Inventory.
disease, and hypertension) found that in only 65 of the
studies a statistically significant effect was found on primary
outcomes 6 . A further 43 studies showed significant
effects on secondary outcomes. Very few studies have addressed
the issue of telemedicine cost-effectiveness. Thus,
evidence for using telemedicine to treat individuals with
chronic diseases is weak and contradictory. In response to
this scarce and scattered evidence on telemedicine effects,
the U.K. Department of Health launched a high-quality
study of telemedicine in 2008 – the Whole System Demonstrator
(WSD). This study was planned to include 6,000
individuals and has been called the world’s largest study
of telemedicine, 7 .
Due to the large sample size and high-quality study design,
the WSD results will most likely serve as the basis
for developing and assessing telemedicine use guidelines
in the coming years. It is therefore important to create an
overview of the many WSD publications and analyses to
create a solid basis for the discussing the results and the
implications of telemedicine in chronic disease management,
including wound care. Thus the aim of this article
is to summarize the results from the WSD and to assess
the study internal validity and the consequences for the
future development of telemedicine-based health care systems
worldwide.
In the WSD, researchers from six universities evaluated
the effects of telehealth and telecare. Telehealth involves
the remote exchange of data between patients and health
care professionals to assist in diagnosing and managing
diverse diseases. The term telecare is used to describe remote,
automatic, and passive monitoring of changes in an
individual’s condition or lifestyle (including emergencies)
in order to manage the risks of independent living. In this
article we focus on the study of telehealth. The internal
validity of the WSD was assessed by means of the Risk of
Bias-tool 8 . A level of significance of 5% was used.
Aim
The aim of the WSD was to evaluate whether telehealth
for people with chronic diseases can provide cost-effective
care to improve health outcomes, maintain independence,
achieve significant gains in quality-of-life, and reduce unnecessary
acute hospital use and costs. At the same time,
the goal was to carry out a large-scale, pragmatic assessment
of the impact of a broad range of telemonitoring
technologies in the context of routine delivery of NHS
care. Table 1 describes the studies in more detail.
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EWMA Journal 2014 vol 14 no 1