What question did this study set out to answer?

To assess the effectiveness, acceptability, and healthcare costs of interactive telemedicine when delivered as an alternative or supplement to usual face-to-face or telephone care.

September 7, 2015Cochrane libraryOpen Access

Interactive telemedicine: effects on professional practice and health care outcomes

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Why the study?

Does interactive telemedicine improve health care outcomes compared to usual care in patients with various clinical conditions?

Population

22,047 participants from 93 randomized controlled trials with various clinical conditions, including…

Comparison

Interactive telemedicine involving direct… vs Usual care alone.

Design

Meta-analysis, Randomized controlled trials included

Follow-up

Median 6 to 9 months (varies by condition and outcome)

Authors

GFGerd FlodgrenNorwegian Institute of Public Health ARAntoine RachasConservatoire National des Arts et Métiers MIMarco InzitariUniversitat Oberta de Catalunya

Discussion

Member takes

Implication

Telemedicine may aid glycemic control in diabetes without reducing heart failure mortality; confirms condition-specific effects in Level 1 evidence.

Key Points

To assess the effectiveness, acceptability, and healthcare costs of interactive telemedicine when delivered as an alternative or supplement to usual face-to-face or telephone care.
Searched the EPOC register, CENTRAL, MEDLINE, EMBASE, five other databases, and two trial registries up to June 2013.
Identified 93 randomized controlled trials encompassing 22,047 participants evaluating interactive telemedicine delivered via remote monitoring (55 studies) or real-time video-conferencing (38 studies).
Conducted fixed-effect meta-analyses pooling risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes across clinical conditions.
In heart failure, telemedicine showed no significant effect on all-cause mortality compared with usual care (16 trials, N = 5,239; RR 0.89, 95% CI 0.76 to 1.03; P = 0.12), but demonstrated improved quality of life (5 trials, N = 482; MD -4.39, 95% CI -7.94 to -0.83; P < 0.02).
In diabetes, telemedicine significantly reduced glycated hemoglobin levels (16 trials, N = 2,768; MD -0.31%, 95% CI -0.37 to -0.24; P < 0.00001), LDL cholesterol (4 trials, N = 1,692; MD -12.45 mg/dL, 95% CI -14.23 to -10.68; P < 0.00001), and systolic blood pressure (4 trials, N = 1,770; MD -4.33 mmHg, 95% CI -5.30 to -3.35; P < 0.00001).
Seven trials evaluating video-conferencing for mental health and substance abuse found no difference in therapeutic outcomes compared with face-to-face therapy, while hospital admissions across conditions showed inconsistent effects.

Structured PICO

Does interactive telemedicine improve health care outcomes compared to usual care in patients with various clinical conditions?

Population

22,047 participants from 93 randomized controlled trials with various clinical conditions, including cardiovascular disease (36 trials), diabetes (21), respiratory conditions (9), mental health or substance abuse (7), and others.

Intervention

Interactive telemedicine involving direct patient-provider interaction (remote monitoring or real-time video-conferencing), delivered in addition to, or substituting for, usual care.

Comparator

Usual care alone (face-to-face care or telephone consultation).

Outcome

All-cause mortality, hospital admissions, quality of life, and clinical biomarkers (HbA1c, LDL, blood pressure).hard clinical

Interactive telemedicine provides similar health outcomes to usual care for heart failure and improves glycemic control in diabetes, though cost-effectiveness remains unclear.

Limitations

Limited data reported for cost to health services and acceptability by patients and healthcare professionals

Cite This Study

Flodgren et al. (2015) studied this question.

synapsesocial.com/papers/6a7ccd88c08a1eaeb68ce185 https://doi.org/10.1002/14651858.cd002098.pub2

Topics

HFrEF treatment Heart failure

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Implication

Telemedicine may aid glycemic control in diabetes without reducing heart failure mortality; confirms condition-specific effects in Level 1 evidence.

Interactive telemedicine: effects on professional practice and health care outcomes

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Interactive telemedicine: effects on professional practice and health care outcomes

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider