No evidence for 3millionlives roll-out

The 3millionlives campaign is not justified by the results of the whole systems demonstrator trials, experts say.

The first paper on the WSD trial, looking at the effect of telehealth on use of secondary care and mortality, has been published by the British Medical Journal.

The trial showed patients using telehealth had lower mortality and fewer hospital admissions, but failed to identify any cost savings.

The 3millionlives scheme aims to bring telehealth and telecare to three million people with long term conditions. It has been championed on the premise that it will reduce flow-on costs to secondary care because people’s conditions are better managed at home.

In an editorial accompanying the report, Josip Car, director of Imperial College London’s global eHealth Unit, and colleagues say this latest evidence does not warrant full scale roll-out of telehealth or the 3millionlives campaign.

They instead urge more careful exploration. “The evidence base is essentially unchanged and uncertainties remain,” the editorial says.

“If it is politically expedient and makes sense in terms of how commissioners wish to innovate to meet patient needs then perhaps that is justification enough for the 3millionlives project. But we’re not sure.”

The editorial says there are uncertainties about the cost, quality, and safety of telehealth interventions, their effects on patient-clinician relationships, and their scalability and sustainability.

“Although frustrating for patients and industry advocates, evidence based policy making is particularly needed when health systems are facing unprecedented resource pressures,” it adds.

“Policy makers, commissioners, and guideline developers should help ensure that the research agenda focuses on areas where telehealth shows most promise. There is great potential but also still much to be done.”

The WSD project is the largest and most complex telehealth study ever conducted.

A team led by researchers at the Nuffield Trust assessed the impact of telehealth on hospital use for 3,230 patients with diabetes, chronic obstructive pulmonary disease or heart failure, over one year.

Half were given devices and taught how to monitor their condition at home and transmit the data to health care professionals while the other half received usual care.

During the study period, significantly fewer (43%) of intervention patients were admitted to hospital compared with 48% of control patients.

However, this was due to the number of admissions amongst the control group rising rather than the number dropping for those on telehealth

Also, significantly fewer (4.6%) of intervention patients died compared with 8.3% of controls. This equates to about 60 lives over a 12 month period.

Adam Steventon, senior research analyst at the Nuffield Trust, told eHealth Insider that the reasons behind the reduction in mortality are not yet known, but it could be due to the increased monitoring or changing behaviour amongst telehealth patients

He commented that while the study has produced some very important messages, it will not answer everything people want to know.

“The choice about whether to roll out telehealth is not a clear choice in this trial, but there are a lot of other factors such as impact on quality of life,” he explained.

Further research looking at the impact on quality of life for patients is due to be published soon.

Steventon said the analysis of cost impact had only looked at hospital costs so far, but papers looking at the effect on primary care, community care and social care providers will come in a “steady stream” over the next 12 months.

Any cost analysis has to take the cost of intervention into account. The investment in the WSD trial has not been revealed, but Steventon said similar trials in the past had “cost quite substantial amounts of money”.

Reports on the telecare part of the trials should also be published “towards the end of the year”.

A number of much smaller studies have yielded mixed results on the impact of telehealth.

The WSD findings are therefore being closely watched by commissioners of care in the UK and other countries that are grappling with the increased prevalence of chronic disease.

“This has been a very high profile trial,” Steventon said. “A lot of money and effort went into it over six years.

"Although we had a very large number of patients we were still only looking at particular instances of telehealth deployment and only followed them for a year when there might have been longer term impacts.”

Care services minister Paul Burstow said telehealth can help deliver the change needed to tranform services for patients with long-term conditions. 

“We are working closely with industry, the NHS and social care organisations to make progress through the 3millionlives initiative to develop flexible funding models with a reduced price point, which will achieve the economies of scale needed to make telehealth a success,” he said. 

An analysis of the results from the Nuffield Trust can be found here.