30 Sep 2019

Telehealth for Chronic Disease Management

In the age of smartphones, Internet and wearable technological devices, the ability to provide health care has been changing rapidly. One example of contemporary health care is telehealth, or “the delivery and facilitation of health and health-related services… via telecommunications and digital communication technologies.”1 Telehealth solutions—usually targeting chronic diseases—include video conferencing, remote collection of patient data and use of mobile health applications, as well as telemedicine, through which clinicians use telecommunication to remotely diagnose and treat patients.1 While telehealth is a relatively new phenomenon,2 many studies have already approached the potential pros and cons of integrating technology and health care.

Research shows that telehealth can have economic benefits. For one, a systematic review by Polisena et al. found that home telehealth for chronic diseases saved costs for the health care system and insurance providers.3 Another study showed that the “Health Buddy” telehealth program for Medicare beneficiaries with chronic disease reduced patients’ spending by up to 13.3 percent.4 Darkins et al. also found that home telehealth for veterans with chronic diseases was notably less expensive than other noninstitutional or nursing home care programs.5 According to these data, telehealth can reduce costs for individual patients and the health care in general.

Aside from alleviating expenses, telehealth can affect patients’ quality of health care and health outcomes. Studies show that telehealth solutions lead to improved diet quality6 and health behaviors in remote communities,7 and can be useful for self-management in chronic diseases such as heart failure and adult onset diabetes.8 Darkins et al.’s study showed a reduction in bed days and hospital admissions,5 while a review by Tran et al. found such reductions along with lower numbers of emergency department visits and primary care visits.9 Finally, some researchers conclude that telehealth can decrease mortality as compared to care as usual.9,10 Thus, telehealth may allow patients to improve their behaviors and health, avoid hospitalization and delay mortality.

That said, data on telehealth solutions are mixed. Researchers note the limited evidence on telehealth solutions9 given the lack of statistically powerful studies8 and studies in vulnerable populations.11 Others point to low study quality3 and incomplete reporting of data,12 as well as publication bias for successful studies.13 Furthermore, some researchers are skeptical of the obscure mechanisms of telehealth interventions themselves.11 Lastly, one meta-analysis on telehealth for chronic obstructive pulmonary disease (COPD) showed that while home telehealth (i.e., home telemonitoring and telephone support) reduced hospitalization and emergency department visits, the mortality rate among the telephone support group was elevated as compared to controls.14 In sum, data on telehealth solutions indicate that lack of research and unclear intervention processes do not allow for conclusions about their efficacy.

While they appear to have various economic and care-based advantages, telehealth programs remain under-researched. In order to build a stronger evidence base, future studies should focus on the psychological and physical mechanisms of telehealth interventions, as well as their longitudinal and widespread effects across patients.

1.         What Is Telehealth? NEJM Catalyst. Web: The New England Journal of Medicine; Feb 1, 2018.

2.         Lehoux P, Battista RN, Lance JM. Telehealth: Passing Fad or Lasting Benefits? Canadian Journal of Public Health. 2000;91(4):277–280.

3.         Polisena J, Coyle D, Coyle K, McGill S. Home telehealth for chronic disease management: A systematic review and an analysis of economic evaluations. International Journal of Technology Assessment in Health Care. 2009;25(3):339–349.

4.         Baker LC, Johnson SJ, Macaulay D, Birnbaum H. Integrated Telehealth And Care Management Program For Medicare Beneficiaries With Chronic Disease Linked To Savings. Health Affairs. 2011;30(9):1689–1697.

5.         Darkins A, Ryan P, Kobb R, et al. Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions. Telemedicine and e-Health. 2008;14(10):1118–1126.

6.         Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Telehealth methods to deliver dietary interventions in adults with chronic disease: A systematic review and meta-analysis. The American Journal of Clinical Nutrition. 2016;104(6):1693–1702.

7.         Jaglal SB, Haroun VA, Salbach NM, et al. Increasing access to chronic disease self-management programs in rural and remote communities using telehealth. Telemedicine and e-Health. 2013;19(6):467–473.

8.         Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. Journal of Medical Internet Research. 2017;19(5):e172.

9.         Tran K, Polisena J, Coyle D, et al. Home telehealth for chronic disease management. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]: Centre for Reviews and Dissemination (UK); 2008.

10.       Hung CS, Yu JY, Lin YH, et al. Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study. Journal of Medical Internet Research. 2016;18(5):e102.

11.       Parker S, Prince A, Thomas L, Song H, Milosevic D, Harris MF. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: A systematic review and realist synthesis. BMJ Open. 2018;8(8):e019192.

12.       Warner MM, Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Reporting of telehealth-delivered dietary intervention trials in chronic disease: Systematic review. Journal of Medical Internet Research. 2017;19(12):e410.

13.       Wootton R. Twenty years of telemedicine in chronic disease management – an evidence synthesis. Journal of Telemedicine and Telecare. 2012;18(4):211–220.

14.       Polisena J, Tran K, Cimon K, et al. Home telehealth for chronic obstructive pulmonary disease: A systematic review and meta-analysis. Journal of Telemedicine and Telecare. 2010;16(3):120–127.

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