Telehealth, the delivery of health-related services and information via telecommunications technologies, is a promising new heart disease cure designed for the care of people at an increased risk of cardiovascular diseases. On 1st June, 2016, British Medical Journal (BMJ) published the results of a controlled trial where the use of digital health technologies by non-clinical staff showed positive clinical benefits. Groups at high risk of cardiovascular diseases were provided better care and support with the use of the Healthline services, which is an established telehealth company. The approach was successful in lowering the blood pressure and weight of study subjects, reducing the risk of stroke by 23% and heart attack by 15%.
Although there was no general improvement or reduction in the overall average risk of preventing cardiovascular diseases, some progress was seen for a few risk behaviors in the study. Similarly, Telehealth interventions improved behavioral aspects such as diet, physical activity and proper administration of medication.
Telehealth is a new technology intensive approach in which health info and services are exchanged between health professionals using telecommunication devices such as telephone, fax, computer etc. This may also include techniques that seem like something out of science fiction e.g., two doctors sharing medical advice or supervising robotic operations across continents over a computer, all fall under the branch of Telehealth. Currently the National Institute of Health (NIH) is supporting eight projects which use technological approaches for the collection and analysis of biomedical data used for development of telehealth technologies.
Telehealth may not sound like a dependable approach, but optimism regarding telehealth is already rising. Telehealth is poised to improve the ease of access, convenience, and productivity of healthcare services. Previously, all beneficial assumptions were rhetorical but the research now being discussed provides facts when talking about the benefits of healthcare delivery systems.
Professor Chris Salisbury, MD, a Professor in Primary Health Care at the University of Bristol, is the lead author of the study.
“Our hypothesis was that the Healthline service for patients with high cardiovascular risk would be more clinically effective and cost-effective than usual care, while also improving participant’s quality of life, risk behaviors, and experience of care,” said Salisbury.
The study was carried out from 2012-2013 at 42 general practices in three different areas of England, on 642 adults between the ages of 40-70 years. All of the recruited participants had a ‘10-year cardiovascular disease risk of 20% or more’. The systolic blood pressure of all the subjects was above ≥140 mm Hg and the body mass index (BMI) was recorded ≥30. The subjects were also current smokers and all of them had access to the internet, emails and telephones.
Along with normal care, the Healthline service was applied to the test subjects, while only simple care was applied to the control group. Trained health advisors made calls to the test group to advise them on proper drug use and the maintenance of a healthier lifestyle.
A total of 148 participants out of 295 in the test groups showed improvement, which was greater compared to the control group which showed only 43% improvement. There was substantial reduction in systolic blood pressure and BMI of the test group.
The new research shows evidence on the potential of telehealth approaches, which have improved clinical services to a substantial degree. Furthermore, for the first time, the feasibility of telehealth interventions on a large scale has been exhibited. Telehealth was used on a wide scale to share valuable information at a low cost.
Another encouraging point is the use of ‘non-clinically trained health advisors’ in trials for handling the computerized algorithms i.e., collection of medical data. It shows that only medically trained staff is not required for sharing valuable information between different clinical settings and that anyone with an expertise in computer sciences can handle such a project.
If the claims can be confirmed by another independent group then it would mean Telehealth can be adopted by a large number of clinical settings all over the globe. Such telehealth service based practices would also ensure improved quality of care for the masses anywhere in the connected world.
Before we get our hopes up and believe telehealth is a sure winner, there are several weaknesses inherent to the concept. Researchers have admitted their study only shows ‘modest benefit from the Healthline service in terms of the proportion of people reducing or maintaining their cardiovascular disease risk over 12 months.’
In the same way the outcomes were not ‘statistically significant’ when a complete analysis was carried out. Despite the large sample size, the results further showed inconsistency in terms of ‘confidence intervals’ meaning there could be a 90% chance of success or failure for reducing risk of cardiovascular diseases in the subjects. Although blood pressure and weight were lowered, there was no improvement in cholesterol levels or the behavioral factor of smoking.
The first limitation mentioned by the researchers was about the disinterest about telehealth in the primary care setting. Only 16% of the people who were sent info on the study sent back positive responses.
Secondly, towards the end of the trial the approach was disturbed and not all participants received full information.
Thirdly, the analysis of so many secondary outcomes implied that there could be differences in the results.
Furthermore, the trial was carried out with a practical approach, the results exceeded expectations. Only 35% of the subjects were expected to show promising results but 50% of them showed the desired results, which ‘reduced the power of the study to detect differences between the intervention and control groups.’
Lastly, the age group of the subjects was cut off at 75 years but it was believed that Telehealth could also help older populations. Similarly people or settings without internet were obviously excluded but such populations have an increased need for medical guidance.