AIM: With underwhelming benefits, telehealth merits cautious approach
 |
In response to a study published online April 16 by Paul Y. Takahashi, MD, MPH, from the department of internal medicine at Mayo Clinic, Rochester, Minn., and colleagues, Scott Wilson, DO, and Peter Cram, MD, MBA, both from the division of general internal medicine, department of internal medicine, University of Iowa Carver College of Medicine, Iowa City, wrote that the Takahashi study provides “further evidence that home telehealth programs do not reduce ED visits or hospital readmissions.”
Takahashi and colleagues, via a randomized controlled trial to assess telemonitoring in relation to rehospitalization, reported, “Among older patients, telemonitoring did not result in fewer hospitalizations or ED visits. Secondary outcomes demonstrated no significant differences between the telemonitoring group and the usual care group.”
Cram and Wilson described the results of the study as “sobering and warrant careful consideration.
“We would caution against such discounting of this study and its negative findings. In contrast, we would argue that this study joins a growing body of literature suggesting that home telehealth does not reduce readmissions or ED visits,” they wrote. “The somewhat underwhelming results aside, the accumulating evidence should not necessarily be taken as a blanket indictment of a potentially useful technology. In particular, it is likely that telehealth may be effective at influencing the right outcomes in the right context.”
Cram and Wilson paid particular attention to the metrics used in the Takahashi study, which focuses specifically on ED visits and inpatient hospitalizations as the relevant outcomes and did not examine an array of other outcomes, including healthcare spending, outpatient clinic visits, patient satisfaction, quality of life or anxiety. “In actuality, there is a growing array of studies whose results suggest that home telehealth may help in many of these areas.
“We believe there are two principal lessons to be drawn from this well-performed study,” they concluded. “First, we need a better understanding of the critical patient, physician, health system and telehealth program factors that predict success and that would allow us to target these interventions to patients who are most likely to see benefit. Second, there should be careful thought given to the appropriate outcomes that telehealth programs aim to effect. While awaiting the answers to these questions, we would advise payors and physicians to move slowly in implementing telehealth programs on a wide scale.”