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Review
. 2013 Aug 19;8(8):e71238.
doi: 10.1371/journal.pone.0071238. eCollection 2013.

The impact of telehealthcare on the quality and safety of care: a systematic overview

Susannah McLean  1 , Aziz Sheikh, Kathrin Cresswell, Ulugbek Nurmatov, Mome Mukherjee, Akiko Hemmi, Claudia Pagliari
Affiliations
Review

The impact of telehealthcare on the quality and safety of care: a systematic overview

Susannah McLean et al. PLoS One. .

Abstract

Background: Telehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare.

Methods and findings: Two reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (<12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of many studies to adequately describe the intervention makes it difficult to disentangle the contributions of technological and human/organisational factors on the outcomes reported. Evidence on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent from the evaluative telehealthcare literature.

Conclusions: Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.

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Conflict of interest statement

Competing Interests: Members of the team have co-authored three of the included Cochrane reviews, [60,80,118] and also some of the trials included in these reviews, but they were not involved in the quality assessment of these studies. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

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Grants and funding

This work was funded by the NHS connecting for health programme, grant 001 extension, and an NHS Academic General Practice fellowship for Susannah McLean. The funders had no role in study design data collection and analysis, decision to publish or preparation of the manuscript.