A new US study published in the Archives of Internal Medicine this week shows remote telemonitoring is associated with increased mortality in vulnerable patients.
The study looked at 205 elderly patients who had a high risk of hospitalisation – it showed that there was a “significant increase” in the mortality rate over a year, with rates over 12 months for the telemonitoring group at 14.7%, compared with 3.9% for the usual care group.
It also found that telemonitoring made no difference in hospitalisation rates, with rates of 63.7% in this group, compared with 57.3% in the usual care group.
The researchers said that they were “unable to explain the differences”, but suggested it could be because an increased number of interventions and tests in the telemonitoring group.
Telehealth is backed by the UK government, which is investing billions to ensure it reaches three million patients by the end of the decade – the so-called 3millionlives project – and is being backed by doctors’ groups such as the Royal College of GPs.
Not all groups have backed the plans: In February the BMA’s GP committee said that whilst it shares the UK Government’s wish to cut patient waiting times and increase efficiency of care, it does not think, as the government does, that telehealth and remote monitoring schemes are necessarily the right way of doing this.
And this new study will only further add ambiguity to a system that has already seen a number of trials contend that it is both a positive and negative force for health.
A study in 2011 found that telehealth was unlikely to be cost-effective, with some analysts saying it would breach the upper limit of the NICE QALY formula.
However, results of a hub pilot in Yorkshire released in February found that telehealth can reduce hospital admissions, provide care at home and improve patient outcomes, and help produce savings.
The Department of Health recently confirmed that the full results of its Whole Systems Demonstrator Project on telehealth will be published “shortly” in the British Medical Journal.
Partial data released earlier this year showed a 45% reduction in mortality and a 20% fall in emergency admissions in patients with access to telemedicine – flatly contradicting the results from the Archives of Internal Medicine.
This will do little to sway the nay-sayers of telehealth, and paints a confusing picture for the NHS and for patients on whether it works and is not too costly.
Speaking to GP magazine Pulse, Dr Paul Cundy, chair of the GPC’s IT subcommittee and a GP in Wimbledon, south London, said: “This study tells us the current fashion for shoving it down everyone’s throats is not supported by evidence and if anything the evidence shouts loud and clear that this needs far greater scrutiny before it is embarked on wholesale.”
