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Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review.
Lewinski, Allison A; Walsh, Conor; Rushton, Sharron; Soliman, Diana; Carlson, Scott M; Luedke, Matthew W; Halpern, David J; Crowley, Matthew J; Shaw, Ryan J; Sharpe, Jason A; Alexopoulos, Anastasia-Stefania; Tabriz, Amir Alishahi; Dietch, Jessica R; Uthappa, Diya M; Hwang, Soohyun; Ball Ricks, Katharine A; Cantrell, Sarah; Kosinski, Andrzej S; Ear, Belinda; Gordon, Adelaide M; Gierisch, Jennifer M; Williams, John W; Goldstein, Karen M.
  • Lewinski AA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
  • Walsh C; School of Nursing, Duke University, Durham, NC, United States.
  • Rushton S; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
  • Soliman D; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
  • Carlson SM; School of Nursing, Duke University, Durham, NC, United States.
  • Luedke MW; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
  • Halpern DJ; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
  • Crowley MJ; Department of Neurology, Duke University Medical Center, Durham, NC, United States.
  • Shaw RJ; Neurodiagnostic Center, Durham Veterans Affairs Medical Center, Durham, NC, United States.
  • Sharpe JA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
  • Alexopoulos AS; Duke Primary Care, Duke University Medical Center, Durham, NC, United States.
  • Tabriz AA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
  • Dietch JR; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
  • Uthappa DM; School of Nursing, Duke University, Durham, NC, United States.
  • Hwang S; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
  • Ball Ricks KA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
  • Cantrell S; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
  • Kosinski AS; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States.
  • Ear B; School of Psychological Science, Oregon State University, Corvallis, OR, United States.
  • Gordon AM; Doctor of Medicine Program, Duke University School of Medicine, Durham, NC, United States.
  • Gierisch JM; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.
  • Williams JW; Cecil G Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, United States.
  • Goldstein KM; Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, United States.
J Med Internet Res ; 24(8): e37100, 2022 08 26.
Article in English | MEDLINE | ID: covidwho-2022362
ABSTRACT

BACKGROUND:

Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects.

OBJECTIVE:

We conducted a systematic review to address the following question among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use?

METHODS:

We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions.

RESULTS:

We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease.

CONCLUSIONS:

This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / Pulmonary Disease, Chronic Obstructive / Diabetes Mellitus, Type 2 / Text Messaging / Heart Failure Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2022 Document Type: Article Affiliation country: 37100

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / Pulmonary Disease, Chronic Obstructive / Diabetes Mellitus, Type 2 / Text Messaging / Heart Failure Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2022 Document Type: Article Affiliation country: 37100