Telehealth

Researchers from West Virginia University have set out to determine the optimal frequency of telehealth appointments for patients with chronic conditions.   In a study published in E-Health Telecommunication Systems and Networks, the team reviewed other work concerning telehealth and chronic conditions. They found that virtual care services benefited patients more if they continued for about a year rather than ending after six months.   However, they said, more data is still needed.    "Developing clinical implementation knowledge for community dwelling individuals who experience [multiple chronic conditions] in relation to the effectiveness, cost, cost-effectiveness, and the patient experience will be crucial to realizing the promise and potential of telehealth," wrote researchers in the study.   WHY IT MATTERS   The systematic review of 47 articles included synchronous, asynchronous and remote patient monitoring services.    About half studied telehealth's effect for one chronic condition, and half examined its effectiveness for multiple conditions.   The team found that regardless of modality, longer duration of telehealth services (about a year) produced positive outcomes, compared with those with shorter durations (37 to 38 weeks).   That said, researchers explained that the optimal "dose" of telehealth services, meaning frequency and format, is still unknown – and that more data is needed.   In a follow-up program, lead study author Jennifer Mallow, an associate professor in the West Virginia University School of Nursing’s Adult Health Department, is delivering telehealth services to West Virginians and tracking the relevant metrics.   "We’re collecting information related to dose,” Mallow said in a press statement.  "How long do we spend with participants? What are the nurses doing, and how long does it take them? How long does it take us to review remote patient monitoring? Are we talking to patients on the phone? As we collect this information in a standard way, we can begin to make those links between dose and outcome."   The study also flagged the danger of telehealth worsening the digital divide, particularly if patient demographic data is not adequately collected. "Telehealth is often proposed as a solution to decrease health disparity such as a higher burden of illness, injury, disability, or mortality experienced by those with chronic conditions," according to the study. "However, healthcare disparity such as lack of insurance, access, and quality are rarely measured in telehealth research," researchers said.   "Understanding the results of telehealth trials in the context of the population will continue to be important as we attempt to diminish health disparity in the context of the determinants of health," they added.   THE LARGER TREND   The boost in telehealth use amidst the COVID-19 pandemic presents a rich opportunity for investigators to determine the effectiveness of virtual care, especially for patients who may not be able to access in-person care.   Perceived success has varied by specialty: In January 2021, a JAMA Network Open study found that medical oncologists were split on telehealth's clinical effectiveness, while psychiatrists have said they've been "pleasantly surprised" with the transition to telemedicine.   But more data is still needed. Major telehealth-focused legislation introduced in Congress would require a study to learn more about how telehealth has been used during the novel coronavirus crisis.   ON THE RECORD   "If you're going to use telehealth for chronic conditions, the various professional bodies need to come out with recommendations for when and how often," said Mallow in a press release.   "The American Diabetes Association might say you should see your patients in person at least once per year to do a foot exam but could use telehealth for other follow-up care, for example. But before they do that, we need rigorous research studies so that they can make those determinations," she added.   Kat Jercich is senior editor of Healthcare IT News. Twitter: @kjercich Email: kjercich@himss.org Healthcare IT News is a HIMSS Media publication.

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