Can telehealth reduce demand on GPs?

After several years in gestation, the Whole Systems Demonstrator (WSD) trial of telehealth is now producing a steady stream of outputs – most recently in the form of a paper looking at whether telehealth changed the frequency with which people used GPs and practice nurses.

The WSD, one of the largest trials of its type in the world, focussed on one use of telehealth as a form of remote monitoring and support to help people better manage their chronic health conditions – which in this study meant either chronic obstructive pulmonary disease, heart failure or diabetes.

Many people believe that telehealth can radically change the way we use health services, and it is often given the tag of a disruptive technology – something that doesn’t necessarily fit with our traditional ways of doing things. Yet the evidence of the benefits of these technologies on the management of chronic disease is irritatingly ambiguous.

The impacts of telehealth are often assessed in terms of reduction in hospital admissions and few studies look at the changes in use of GPs that arises from home based monitoring. Yet GPs should be an important group in promoting and exploiting the use of these technologies. We considered that telehealth could impact on GPs in two ways.

The results should reassure those GPs who fear telehealth may lead to greater demands on their time

On the one hand, telehealth may lead to fewer contacts with the GPs as patient health is better controlled and there is less need for checking and monitoring – a reduction in demands on GPs. Conversely there could be a problem that more monitoring may lead to greater anxiety in patients, coupled with some ‘false alarms’ that increases the number of times they call upon their GP.

In this study we looked at the frequency with which over 2,300 patients contacted their GPs, or practice nurses, according to whether they had the telehealth kit for the 12 months of trial, or whether they were in the control group. We used anonymised records extracted from the GP information-systems – which aren’t perfect but give us some idea.

We actually found no differences between intervention and control during the course of the trial – patterns of GP contacts appeared unaltered – so not disruptive at all. We also noted that the technology used in this trial did not allow routine sharing of information between the telehealth technology and GP records – something that should probably happen in an ideal world of integrated information systems.

The results should reassure those GPs who fear telehealth may lead to greater demands on their time – yet it is disappointing that we could not detect a significant reduction in the use of GPs.

As with all the elements of the WSD trial it is important to add the caveat that there is more to telehealth than the box on top of the telly. The results are the product of certain forms of technology used in a certain way across the three pilot sites in the study.

Since the start of WSD, the technologies have changed, for example in the way the kit can be used and also the people it targets.

As an academic colleague said recently, we have to avoid throwing the baby out with the bathwater. Instead, I think we have to continue to work on understanding which types of patients get the most benefits – and what needs to be around the technology to make this happen.