Telehealth and telecare are examples of assistive technologies that aim to improve outcomes for people with long-term health conditions or social care needs. They may also reduce use of hospitals and care homes. We are part of a major randomised controlled trial to assess the impact and effectiveness of these technologies.

Co-author Adam Steventon outlines the first findings of the Nuffield Trust’s analysis of the Whole System Demonstrator trial.

The Nuffield Trust is leading one aspect of a large-scale evaluation of telecare and telehealth:

  • Telehealth may help people with long-term health conditions such as diabetes, heart failure and chronic obstructive pulmonary disease. It refers to the remote exchange of data between an individual and a health care professional, and aims to assist in the diagnosis and management of conditions. Examples include blood pressure monitoring, blood glucose monitoring and medication reminders.
  • Telecare has been designed for people with social care needs and means the remote monitoring of an individual’s condition or lifestyle. It aims to manage the risks of independent living. Examples include automatic movement sensors, falls sensors, and bed occupancy sensors.

In 2006, the Department of Health announced the establishment of three pilots, known as the ‘Whole System Demonstrators’, to test the benefits of integrated health and social care supported by assistive technologies like telecare and telehealth.

We believe that with over 3,000 participants, this study is the largest randomised trial of telehealth in the world

In the trial – the largest of its kind to be conducted thus far – over 3,000 patients were recruited from three areas of England (Cornwall, Kent and Newham) to receive telehealth or to act as controls by receiving usual care.

The Nuffield Trust team led one strand of an evaluation concerning the impact of telehealth on use of hospitals and mortality. This is important because investment in telehealth has often been justified on the basis of cost savings through reduced hospital use.

Findings from this project are emerging in a series of papers. Our first findings were covered in the Nuffield Trust research summary: The impact of telehealth on use of hospital care and mortality (June 2012) and in an article in the British Medical Journal.

Our work used innovative data matching techniques to build up a picture of each participant’s health and social care use. We extracted over a billion records of administrative data from more than 250 health and social care organisations.

To protect data confidentiality, we used pseudonymisation, which involves replacing a patient identifier such as an NHS number with a code that cannot be traced back to an individual (see the diagram below).

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The WSD trial was a complex evaluation led by Professor Stan Newman at City University and included four other strands of work:

  • participant/carer reported outcomes and clinical effectiveness;
  • costs and cost effectiveness;
  • experiences of service users, informal carers and health and social care professionals;
  • organisational factors that help or hinder sustainable adoption of these technologies.

Published findings

Follow the links below to access some of the published findings from this programme of work.

  • Impact of telehealth on general practice contacts (BMC Health Services Research, October 2013)

    The WSD trial found no differences between telehealth and control users in terms of contacts with GPs or practice nurses as recorded on GP computer systems.

  • Effect of telecare on use of health and social care services (Age and Ageing, February 2013)

    Telecare as implemented in the WSD trial did not lead to significant reductions in service use, at least in terms of results assessed over 12 months.

  • Effect of telehealth on quality of life (British Medical Journal, February 2013)

    Home-based telehealth as implemented in the WSD evaluation did not improve quality of life or psychological outcomes for patients over 12 months. The findings suggest that concerns about potentially deleterious effects of telehealth are unfounded for most patients.

  • Organisational impact of WSD trial (BMC Health Services Research, November 2012)

    The implementation of a complex innovation such as remote care has to be responsive and adaptable to the local health and social care system.

  • Effect of telehealth on use of secondary care and mortality (British Medical Journal, June 2012)

    Telehealth is associated with lower mortality and emergency admission rates. The reasons for the short-term increases in admissions for the control group are not clear, but the trial recruitment processes could have had an effect.

  • Barriers to participation and adoption of telehealth and telecare within the WSD trial (BMC Health Services Research, July 2012)

    These findings, regarding perceptions of potential disruption of interventions to identity and services, go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.

Project outputs

Articles

  1. Effect of a telephonic alert system (Healthy outlook) for patients with chronic obstructive pulmonary disease: a cohort study with matched controls

    10 Jul 2014
    Journal of Public Health Advance Access
  2. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study

    30 Jun 2014
    British Journal of General Practice
  3. Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial

    8 Oct 2013
    BMC Health Services Research
  4. Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial

    22 Mar 2013
    British Medical Journal
  5. Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial

    26 Feb 2013
    British Medical Journal
  6. Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial

    25 Feb 2013
    Age and Ageing
  7. An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator

    15 Nov 2012
    BMC Health Services Research
  8. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study

    26 Jul 2012
    BMC Health Services Research
  9. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

    22 Jun 2012
    British Medical Journal
  10. A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial

    5 Aug 2011
    BMC Health Services Research

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