Systematic review of patient and caregivers’ satisfaction with telehealth

videoconferencing as a mode of service delivery in managing patient’s health

By: Joseph F. Orlando, Matthew Beard and Saravana Kumar

2019

Reviewed by: Rodolfo B. Opido Jr.

Summary of purposes and objectives

The purpose of this study is to examine patients and caregivers’ level of

satisfaction on telehealth videoconferencing as a mode of delivery service in providing
patient’s care. Through systematic review, this paper tries to investigate the level of
patient and caregiver’s satisfaction by critically collecting, appraising, and synthesizing
existing studies. Moreover, the objective of this study is to generate outcome categories
that can contribute to the existing discipline in telehealth.

Methodologies

This study is tailored under PROSPERO international prospective register of

systematic review and aligned with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement. This ensured that the systematic
review is within the scope of organized and valid reports.

Using six electronic databases, the researcher’s laid down inclusion criteria that
emphasized on (1) patients and/or caregivers living in rural and remote areas who
accessed healthcare due to clinical condition; (2) interventions done and delivered
through video conferencing; and (3) telehealth intervention through video conferencing
as part of outpatient appointment. They also provided exclusion criteria that includes (1)
patients and/or caregivers living in metropolitan or urban areas who used telehealth
videoconferencing and (2) videoconferencing for consultation from inpatient or
emergency department, and management purposes.

These studies were extracted and put in Microsoft Excel spreadsheets. Extracted
data composed of study design, respondents’ demographic characteristics, sample size,
location, clinical services, outcome measures, and findings. They were classified and
compared based on their results.

Furthermore, a modified version of McMaster Critical Appraisal Tools for

Quantitative studies and Qualitative studies is employed to evaluate the methodological
quality of the selected studies. For quantitative studies, eight components are assessed
namely: study purpose, review of related literature, study design, sample, outcomes,
intervention, results, and conclusion. These components were scored by using “yes,”
“no,” “not addressed,” and “not applicable” with a total score of 14. Corresponding
scores were noted: a score of 1 is corresponded for “yes” answer, 0 for “no” and “not
addressed” and items were omitted for “not applicable” in the overall score.

Meanwhile, eight components of qualitative studies where also evaluated,

particularly: study purpose, literature review, study design, sampling, data collection,
data analysis, the rigor and conclusion of the study. These components were also
subjected in the same manner as the quantitative studies with a total score of 22.

For clarity and easy means of interpretation of findings and implication of the
study in the practice, five categories were created: system experience, information
sharing, consumer focus, and overall satisfaction. The synthesis and interpretation of
data results are done based on the adapted research model of Hsieh et al. (2015).

Summary of results

Initially, 535 studies were searched and collected. After thorough pooling and
screening of the studies, 64 studies were generated. These studies were undergone
another screening for in-depth detection of inclusion and exclusion criteria, leaving only
36 studies as eligible for the inclusion criteria.

Out of 36 studies, 19 were done in USA, seven in Canada and six in Australia. In
terms of respondents, there were 3,607 participants in all studies and 34 studies
included patients while four studies included pediatric and geriatric patients including
the caregivers. Additionally, the major clinical areas included medical specialties (11
studies), rehabilitation (5 studies), genetic counseling (5 studies), oncology (4 studies),
mental health (4 studies), primary care (2 studies), obstetrics and gynecology (2
studies), pharmacy (1 study), dermatology and general surgery (1 study), and
anesthetics (1 study). In addition, 28 studies used questionnaire as their instrument, 3
studies utilized numerical rating scale, 4 studies employed semi-structured interviews
while 1 study applied focus group discussion.

Results of methodological quality assessment showed that from 31 quantitative

studies, 15 scored above 70% while 16 scored below 70%. Those that scored lowered
than 70% found out that it was because of poor reliability and validity on outcome
measures, inadequate sample size and justification, and weak statistical treatment. Out
of five qualitative studies, 3 scored above 70% while 2 scored below 70%. Those
studies that scored below 70% were due to small sample size and poor generalizability,
insufficient and deficient information about data collection procedures, and
unsatisfactory and unsound rigor in the data analysis process.

Outcomes of satisfaction in telehealth video conferencing is categorized in four

groups. System experience was the major outcome of 29 studies with high levels of
satisfaction, specifically in good quality of videoconferencing, high quality of patient care
and comfort, and cost-efficiency and readily accessibility of health services.

Information sharing is the second outcome with 21 studies stating high levels of
satisfaction in good and effective communication quality between healthcare provider
(HCP) and patient, ensured data privacy and confidentiality, detailed health
assessment, comprehensive and useful data gathering and information and warranted
high patient comprehension.

Consumer focus placed third (17 studies), with still high levels of satisfaction in
complete adherence in patient-centered care, good empathy and rapport between
HCPs and patients, quality of care, professionalism, good cultural competence, and
satisfactory in emotional support.

Lastly, overall satisfaction placed fourth with 24 studies stating high levels of
satisfaction in various instruments. 3 studies that used numerical rating scale scored 45-
4.7 out of 5, studies with questionnaires scored above 80% for overall satisfaction, and
81% satisfied in the telehealth videoconferencing under semi-structured interviews.
Conclusion

The systematic review yielded high levels of satisfaction among patients and
caregivers when using telehealth videoconferencing as a mode of delivering health
services. With majority of the studies producing high results, there is high levels of
satisfaction among four categories and it is ensured that telehealth provides viable
source for flexible, accessible and cost-effective treatment while sustainably
incorporating the quality patient care, even in remote areas.

Establishing the Legal Framework of Telehealth in the Philippines

By: Ivy D. Patdu and Allan S. Tenorio

2016

Reviewed by: Graciela Placido

Telehealth medicine aims to improve the health outcomes in the country by

providing various advanced technology in the medical field when it comes to gathering
information and communication of patients and healthcare providers. Ethical
considerations from this telehealth medicine will always implemented especially in
obtaining the patient’s information while securing their privacy. Based from the study,
the number one problem of our country in terms of providing health is that the ratio of
patients are more than the number of doctors and healthcare providers due to the
reason of them leaving the country for better opportunities that’s why the National
Telehealth Center, National Institutes of Health and the University of the Philippines
came up to the idea of establishing the practice of using telehealth medicine which
somehow helps the hospital and other physicians to lessen the “Brain drain” from
numerous patients coming each day. According to the World Medical Association, “the
practice of medicine over a distance, in which interventions, diagnostic and treatment
decisions and recommendations are based on data, documents and other information
transmitted through telecommunication systems.” The National telehealth Center
visualizes that using eHealth and emphasizing the use of communication and gathering
information may improve the health outcomes in our country. The services provided
even from a distance that also associated with referral that helps you find the
appropriate healthcare that you need, to patient consultation, questions regarding the
consultation from patient and physician, as well as the evaluation of the process while
maintaining the data privacy, confidentiality and security of a patient. By implementing
the legal framework of eHealth, it should consist of accountability and liability and from
the law that needs to be considered, healthcare providers should not suppose that the
absence of requirement like physical examination is a practice medicine thus, telehealth
medicine limits the ability of practical relevance of this process. Another one is that a
person should not engage in this process if he/she does not a valid medical license so
that he/she will not be liable for illegal practice of medicine. Next is the physician-patient
relationship and duty of care, the existing relationship between the two might be the
cause of some other implications that should be prevented like having an informal
consultation that might lead to the physician not examining the patient anymore, no
direct communication and might not review the record of the patient. Breach of duty and
standard of care, under the current laws if patient need a medical assistance, the duty
of care automatically should exist and if the healthcare provider does not possess a
necessary skill as a respond of the patient’s needs, he/she will be liable especially if the
patient suffered from injury due to the treatment. Another legal framework of telehealth
medicine is the institutional liability, National Telehealth Center being the primary
institutions that provides services, it is a Governmental function that concerns the
health, safety and advance for the good of the publicity as a general regardless of their
socioeconomic status. As a Governmental functioning, their responsibility is also
providing an informed consent while securing the privacy of each individual especially
those who have an access to electronic data, having an unauthorized access to any
eHealth or computer systems might be punished under this law by a mandatory
imprisonment.

There might be no laws regarding the telehealth medicine, yet there are still
existing laws associated with these applications. As what we have observed, eHealth
has its own limitations to be considered. However, this should not be a barrier for
advancement and improvement of the technology in terms of medical health. This also
means that no matter how much improvement the medical health may allocate, it will
never affect the ethical considerations that the healthcare professionals provide.

The role of telehealth in disaster management: lessons for the Philippines

By: Kristine Mae P. Magtubo, Monica B. Sunga, Manuel O Gaspar and Portia Grace H.
Fernandez-Marcelo

2018

Reviewed by: Ellan Mariano

Summary of purposes and objectives

The purpose of the qualitative study is to create a telehealth implementation

model fit for the Philippines in which the telehealth will be able to expand its service in
order to improve the healthcare access without having a face to face interaction and to
establish a fastest and easiest way to seek information and help to the healthcare
providers.

Methodologies

There are many advantages that telehealth can do and not just in acute management.
Telehealth can either help in short term or long-term care. The study also aimed to
answer the following questions:

i) What are the characteristics of telehealth for disaster management projects in

LMIC’s?
ii) What are the limitations on the use of telehealth in disaster management in
LMIC’s?
iii) How can telehealth be integrated into mainstream disaster management in the
Philippines?

The researchers were able to generate the questions regarding telehealth or

telemedicine by having an online literature search in PubMed, PubMed Central, Google
Scholar and google with search terms of telemedicine or telehealth or anything that is
related to disaster management. The researchers also excluded blog posts and news
article when searching for their related study. The researchers also decided that their
subjective in nature will be Philippines.

Moreover, inclusion criteria included the studies that discussed about telehealth
in disaster management, conducted in middle and lower-income countries, referred
natural disasters which include but not limited to typhoons, floods, and earthquakes,
and studies must be readily available as open access and written in English.

Each study was analyzed according to the type, year of publication and location
of the study. Extracted data were ensured to generate themes needed for creation of
implementation model.

Summary of results

Out of 155 full studies initially searched, only 14 studies with descriptive study
design remained for eligibility of inclusion criteria. These studies include case reports
and case studies (7 studies) while others were narrative reviews collated from other
studies (7 studies). However, some of the studies included sensitive topic (human
emergencies due to disasters and attendant suffering), making it difficult to appraise.

The locale of 7 studies was Pakistan (3 studies), Philippines (2 studies), Sub-

Saharan Africa (1 study) and in India (1 study). Some studies had no specific locale but
still considered relevant due to LMICs. After clustering, reviewing, and categorizing the
extracted data, the studies were grouped for thematic areas of National Disaster Risk
Reduction and Management Plan (NDRRMP) 2011-2028 of the Philippines.

Conclusion

With 4 themes generated on the study, the study provided new insight on the
current problem of lacking implementation model for telehealth during disaster
management. Despite the lack of thorough integration, it still held a promise of having a
rigid model. While the role of telehealth in disaster management has been far-reaching
and well-established, there is a need for development of technology that will support the
health of every humans especially in health services for remote areas. Such
implementation model is ideal for LMICs like the Philippines who are in dire need for
health services in times of disaster.

Examining the role of Filipino elderly attitudes toward computer and internet on their
behavioral intention for telehealth participation

By: Allan B. de Guzman and Michael Joseph S. Diño

2020

Reviewed by: Glecel Andrea Pajarillo

Summary of purposes and objectives

The study aims to investigate the extent to which attitude toward technological
devices can be an effective predictor of telehealth program participation among the
selected group of Filipino elderly participants who subjected from training in basic
computer and internet utilization for Telehealth program. They also want to predict the
factors influencing among Filipino elderly in behavioral intentions to engage in
Telehealth using regression analysis. Hence, they want to inform and support the
development of training and implementation policies for a possible enhancement of
Telehealth initiatives specific for the elderly.

Methodologies

With descriptive-correlational design, the study was conducted in an urban

community from a local government in the Philippines approximately 10 kilometers from
the NCR. There are Eighty-two (82) seniors who are available and qualified to proceed
with the survey based on the their inclusion criteria that they set such as : (a) able to
use computer physically, (b) no cognitive conditions assessed using Mini-Mental State
Examination – Filipino Version (MMSE-F), Clock Drawing Test (CDT) and Geriatric
Depression Scale (GDS), (c) normal eye functioning and/or using corrective lenses, and
(d) willing to participate in the study provided with signed informed consent. The
respondents undergone basic training in computer and internet in a state college. The
instrument and data collection that they used is Web/internet attitude scale (WAS) or
attitude toward the internet scale (ATIS), Computer attitude scale (CAS) and survey
forms.

Summary of results

Study showed that elderly respondents had high favorable attitude toward
computers (x = 6.23) and internet (x = 6.40) among the elderly respondents after a
computer literacy training. After the training, it was found that respondents’ behavioral
intention to use telehealth was significantly impacted by ‘computer confidence’ (β =
0.24) and ‘web usefulness’ (β = 0.24).

Predictors of behavioral intentions to used computer and participate in Telehealth

consultations showed significant impact especially on the degree of confidence in using
computers and perceived usefulness of the internet influences, in some degree, to use
and participate in Telehealth.

Conclusion

In conclusion, Filipino elderly participants have high levels of positive attitude

toward computer and internet after the basic training. This is because confidence and
positive perceived usefulness significantly influenced the behavioral intention of the
respondents. Their findings have shown the importance of ‘computer and internet’
literacy session as an indispensable component of a successful Telehealth program.

Implications to nursing informatics practice

We all know that generation Z grew up in an advance technology than the other
past generations and as generation passes by and technology advances, the
implication of this study in nursing informatics practice revealed the importance of
computer and internet literacy session as an indispensable component of a successful
Telehealth program among elderly. Hence, older people who cannot visit a hospital or
clinic can access and knows what recommended treatment options and diagnose
ailments that nurses and doctors will provide to them.

Physician user perspectives in the practice of telemedicine in the Philippines

 By: Paulo Pasco

2016

Reviewed by: Reign Razalan

Summary of purposes and objectives

The purpose of this study is to evaluate the perceptions and attitudes of rural
physicians when using telemedicine. Furthermore, the objective of the study is the
performance expectancy, effort expectancy, social influence and facilitating conditions
that may impact the clinician’s expectations, perceptions, and attitudes towards
utilization of telemedicine.

Methodologies

Approval of IRB of the study was obtained. Aligned with the Unified Theory of
Acceptance and Use of Technology model of technology acceptance, the researchers
used adapted questionnaire from Vekantesh (2003) slightly modified it. This
questionnaire was used and forwarded to the rural physicians with 17 items, exploring
the significant domains of user acceptance in new technology including performance
expectancy, effort expectancy, social influence, attitude and facilitating conditions and
last three items exploring the behavioral intention to use telemedicine.

Thorough and extensive interviews were done with key informants including
officers and active members of the local medical associations. Nine key informants
include “Doctors to the Barrios,” training under DOH program. Training includes the
essence of telemedicine services, lectures and principles of telehealth, ethical and legal
aspect of telemedicine, and practical demonstrations using SMS and e-mail services for
future use.

Summary of results

For two-day training, 55 physicians were used as respondents and 37 of them

answered the questionnaire while 13 participated on the focus group discussion.
 Out of 37 participants, 56% were males with age mean of 28.3 years. The
questionnaire is Likert score with acceptable reliability and validity level of above 70%.
Regression analysis of behavioral intention on five constructs showed that social
influence has the highest correlation with behavioral intention to use telemedicine with a
score of 0.608. Moreover, five constructs scored 54.8% on the variability in intention to
use telemedicine.

Results from focus group discussion showed rural physicians referred their cases
to their peers or classmate in medical school regardless if this peer is starting to train.
Referral system is done through used of mobile phones (calling) but not text messaging.
Other forms of communication include Facebook and Viber but Internet connectivity is
still the persistent problem. Key informants saw telemedicine’s contribution to increase
the efficiency and easy access of data retrieval and giving medical opinion from experts.
Physicians are also aware on the ethical issues surrounding the telemedicine. While
first-timers voiced their enthusiasm, some who had used telemedicine voiced their
disappointment on their experiences. Others also voiced out that they will not used
telemedicine again because they forgot to save the email address and mobile phone
number needed for access and/or loss kits and materials for the said health services.
Hence, key informants said that what is needed is improvement of communication
infrastructure and consistent live services for the better quality of patient care. Internet
connectivity is also vital for open and effective referral system.

Conclusion

From the five constructs, social influence has the highest correlation with
behavioral intention to use telemedicine in the Philippines, with 54.8% variance.
Findings suggested in the focus group discussion is the insufficient and poor
telecommunication infrastructures, the need for readily available specialists during
referrals, and constant reminder for the passwords, mobile phone numbers, and e-mail
address. As such, these improvements will only happen if there is consistent support
and good recruitment of specialists when using telemedicine.
 Implementation of telemedicine services in lower-middle income countries: lessons for
the Philippines

By: Romeo Luis Macabasag, Kristine Mae Magtubo and Portia Grace Fernandez-
Marcelo

December 2016

Reviewed by: Shanniah Renn S. Macalos

Summary of Purpose and Objectives

The promising potential of telemedicine has been recognized to address health
care problems especially in Lower-Middle Income Countries (LMCI) such as the
Philippines. That is why the study’s purpose is to investigate, describe and review the
experience of Low-Middle Income Countries in implementing Telemedicine services
specifically in terms of the type of , modality, financing and the channel of
communication for enforcement of Telemedicine assistance. As mentioned by the
authors, the specific objective of this study was to develop recommendations for
implementing sustainable telemedicine services here in the Philippines, as the study
title suggest “Lessons for the Filipino”. Furthermore, the study emphasized on
education, financing options, policy, technology, governance, and partnership as an
important characteristic in the implementation of sustainable telemedicine
implementation among developing countries such as the Philippines.

Methodologies
The study utilized PRISMA Framework which is used as basis for reporting
systematic reviews of other types of research. In this study, the researcher utilized
search sites such as PubMed, EBSCOhost, Google Scholar and Google Search engine
in finding computerized literature related to Telemedicine. There authors were in
consensus in selecting article for the study. Therefore, to obtain relevant literature, the
researcher established inclusion criteria. The articles were verified for the second time
and scanned for the country of telemedicine implementation, the type of telemedicine,
modality, financing and the channel of communication. The researchers utilized
thematic analysis for thorough assessment. Thereafter, to establish commonalities the
text was organized on the excel sheet. Additionally, Jovell and Navarro-Rubio’s strength
of evidences classification was utilized in assessing the quality of the study.

Summary of Results
For this review, 342 total of articles were identified using the search strings, 159
duplicates and 183 were subjected for title and abstract review, and 50 articles were
reviewed against the inclusion criteria and 10 articles were considered for the final
review. The several studies included in this review were helpful but shows that there is
an obvious that there is an obvious lack of studies with high level of evidence that can
yield generalizable result.

Conclusion
In conclusion, the study review conducted by Macabasang et al. (2016) is helpful
but is still lacking in terms of the level of evidence in the implementation of
Telemedicine, particularly in LMCI country. The research also disclosed that through
making grassroots healthcare workers capable of adapting telemedicine implementation
and collaboration between multi sectors in implementation of telemedicine can
determine its success or failure.

Examining the use of telehealth in community nursing: identifying the factors affecting
frontline staff acceptance and telehealth adoption

By: Johanna Taylor, Elizabeth Coates, Liz Brewster, Gail Mountain, Bridgette Wessels,
and Mark Hawley

2014

Reviewed by: Jhoanne Pitogo

Summary of Purpose and Objectives

This study aims to identify and determine the frontline staff’s acceptance of
telehealth and determine any barriers of remote monitoring for patients with COPD and
Chronic Heart Failure in community nursing settings in England.
Methodologies

This is a qualitative case study of examining usage of telehealth in community

health nursing wherein there are eighty four participants, nurses and other frontline staff
and twenty managerial staffs interviewed by a set of questions to identify various factors
of acceptance and barriers of telehealth in their working place and changing
environment.

Summary of Results

Researchers found that there were five themes that influence the acceptance of
telehealth in their setting and these are - working in a changing environment,
introduction of telehealth to their staff, experiencing and understanding what telehealth
is, working out the technology and integrating telehealth into their routine care.
Researchers also found that their staff’s attitude reflects from resistive and enthusiastic
about investing in telehealth. Some of them were having opinions about having a
reliable and flexible technology for telehealth work. However, their acceptance of
telehealth is a slow process that can be hindered by negative perceptions. Early
success was also important for this encourages the staff to use telehealth and facilitates
clinical learning and adoption in this setting.

Conclusion

The use of telehealth in the United Kingdom has not developed at the pace and
scale anticipated despite policy support and industry efforts. Barriers in success of this
technology-based intervention exist where clinicians can lose faith in using technologies
to perform tasks than traditional delivered in person. Addressing their concerns in this
matter is vital if they are to adopt telehealth in routine practice.

Using Partial Least Square (PLS) in predicting behavioral intention for Telehealth use
among Filipino elderly

By: Michael Joseph Diño and Allan B. de Guzman

2016
 Reviewed by: Camille Jasmin Pagulayan

Summary of the purposes and objectives

The research study aims to foresee certain Unified Theory of Acceptance Use of
Technology (UTAUT) variables as great predictors of behavioral intention among the
elderly to utilize Telehealth with the use of Partial Least Squares (PLS) method of
Structural Equation Modeling (SEM). The conducted research study is essential to
internalize the technology adaptation at the sector of elderly user experience. The
outcomes of the research paper seek the goal to provide windows of opportunity in
improving Telehealth practices, which may direct policy development and supplement
knowledge frontiers on technology adoption among seniors’ citizens.

Methodologies

The research study employed Structural Equation Modeling (SEM) due to its
ability to analyze the relationship between latent variables resulting in precise
measurements with multiple indicators. Moreover, the SEM is capable of simultaneously
assessing the reliability and validity of theoretical constructs and estimating the
relationships among these constructs. The study uses a 12 items questionnaire to
measure constructs and relationships included in the research model.

Summary of Results

The results of the research study show that the Partial Least Squares (PLS)
regression provides a crucial substantiation on the significance of the model and its
measures. Moreover, the aforementioned latent variables showed to predict positively
the behavioral intention of the older adults to use Telehealth. The results showed two
noteworthy arguments which is first, the effort expectancy, performance expectancy,
and social influence can be shape positively in the behavioral intention among elderly to
use Telehealth regardless of their gender. Second, the Unified Theory of Acceptance
Use of Technology (UTAUT) model continues to reveal evidences of construct validity
through convergent and discriminant measures.

Conclusion
 The research study was able to provide a better understanding of the elderly and
their engagement to Telehealth technologies. The evidence gathered in the study
confirms that older adults have the potential for technology literacy and Telehealth
participation. However, the research findings remain relative in its context which could
be open as new challenges in building more patient-centered Telehealth programs.

Acceptance and usability of a web-based medication management system among

nurses n telehealth hospital

By: Hannah Monique Arinduque Floresca, Michael Joseph Diño, Christian Jay Orte, and
Michael Ignacio Aggari

2020

Reviewed by: Jessca Rebangcos

Summary of purpose and objectives

The study wants to determine if telehealth is going to be effective on nurses

working in a Pilot Telehealth Hospital in Bulacan, Philippines, especially the acceptance
and usability of a web-based medication management system.

Methodologies

This study used 3 designs:

1. Descriptive-evaluative
2. descriptive-comparative study
3. case study approach

The data was gathered through the use of a post study usability questionnaire
(PSSUQ) and a questionnaire adapted from the Unified Theory of Acceptance and Use
of Technology (UTAUT) model. The study applied purpose census sampling and
purposive sampling and includes Nurses in the E.R, OPD, general nursing unit and ICU.
Summary of Results
 The study shows that the usability and acceptance of web-based medication
management systems has no effect on the age, gender, and years of practice. At some
other range of age, the PUse tends to get lower as age increases. Whereas the model
that has emerged from the study showed that at some range of age, the PUse levels
tend to get higher as age increases. Furthermore, it also showed that at some range of
LoP, the PUse levels tend to get higher as LoP increases; then, at some other range of
LoP, the PUse tends to get lower as LoP increases. The data gathered from the
qualitative part of the study was analyzed and came up with three themes: Engaging,
Enabling and Exciting. However, it was found out that there is a significant difference
that lies in practice.
Conclusion
The web-based medication management system appeals to nurses regardless of
gender, age, and years of practice. Furthermore, to implement the Web-based
medication management system, additional modules or interfaces must be implemented
to be able to deliver safe medication administration to the patients. However, in the area
of practice, it is found out that the web-based medication management system is not
that much appealing specifically in terms of performance and effort expectancy,
facilitating conditions, and usability. Themes such as engaging, enabling, and exciting
were drawn from the study to describe the acceptance of technology among the nurses.
Furthermore, it also showed that at some range of length of practice, the higher the
length of practice is the lower the perceived usability of the technology may become.

Cost effectiveness of telehealth for patients with long-term conditions (Whole Systems
Demonstrator telehealth questionnaire study): nested economic evaluation in a
pragmatic, cluster randomized controlled trial
By: Catherine Henderson, Martin Knapp, Jose-Luis Fernandez, Jennifer Beecham,
Shashivadan Hirani, Martin Cartwright, Lorna Rixon, Michelle Beynon, Anne Rogers,
Peter Bower, Helen Doll, Ray Fitzpatrick, Adam Steventon, Martin Bardsley, Jane
Hendy, and Stanton Newman
2013
 Reviewed by: Ralph Obrado
Summary of purpose and objectives
The study aims to identify and examine what the costs and the factors affecting
the efficiency of telehealth are, in relation to the standardized support that is being given
as a treatment and as a backup.

Methodologies

The methodology of the research study implores the use of an evaluation tool
that involves data regarding the employed economic status that is nested in a clustered,
randomized and controlled trial. 
As for the locality of the research study, the research study is based on community that
involves the use of telehealth as part of an intervention, in three localities in the country
of England. 
The respondents that were considered as part of the research study consists of 3230
participants that have factors such as long-term diseases which consists of diabetes,
chronic obstructive pulmonary diseases, and heart failures. The participants were
recruited in the Whole Systems demonstrator within the dates of May 2008 and
December of 2009. The respondents were divided in which 845 were randomized to be
part of the telehealth group and 728 were part of the usual care.
Summary of results

As part of the study, the researchers undertook net benefit analyses of all of the
costs and the outcomes for a number of 965 patients, 534 of which are receiving
telehealth as an intervention, and 431 as the usual care. There was a significant change
in the number of respondents and a change in the mean number, from the past number
of respondents being added with a gain of respondents at the span of 12 months. The
total of the health and social care cost for the three months in which the study was
being conducted was 1390 EUROS and 1596 EUROS for the usual care and telehealth
groups. The efficiency acceptability of the cost generated curves in order to come up
with an analysis in regard to the value of the cost of the effectiveness threshold. With a
result being 92000 EUROS per QALY of the telehealth, the effectiveness cost
probability has resulted to a low probability. In terms of sensitivity analyses, the
intervention of telehealth costs has remained slightly pricier and higher than the usual
care that is being received, even after assuming that the equipment to be used in the
telehealth intervention would drop by 80% or if the equipment in the telehealth services
are operated at its maximum capacity.

Conclusion

The Quality-Adjusted life year that was gained by the patients in using telehealth
as an intervention in their healthcare in addition to their usual care was similar to the
intervention and quality of life of the respondents receiving the usual care solely. The
total costs that were associated with the addition of telehealth as health care
intervention were higher. Thus, telehealth does not seem to be a cost-effective addition
to the intervention of receiving the usual and standard care and treatment.

Implications to the nursing informatics practice