The impact of telehealth support for patients with diabetes or chronic obstructive pulmonary disease on unscheduled secondary care utilisation: a service evaluation.

BACKGROUND Telehealth has been promoted as an adjunct to managing patients with long-term conditions. It has been used in various settings and for different disease groups. However, robust evidence for the efficacy of telehealth is currently lacking. OBJECTIVES To evaluate the impact of a telehealth service on emergency admissions and emergency department (ED) attendances. METHODS We evaluated a telehealth service providing supported self-management to patients that was implemented in Nottingham City. Two groups of patients ('graduates' of the Nottingham telehealth service and service 'decliners') were compared for two periods; 2009 (pre-service implementation) and 2011. Eighty-nine pairs of graduates and decliners were identified who were matched for age and sex. The number and cost of emergency admissions and ED attendances for these patients were then collated and analysed. RESULTS Graduates had significantly fewer emergency admissions and ED attendances compared with decliners in 2011. However, differences of a similar magnitude in emergency admissions and ED attendances were found in 2009. Telehealth service users were likely to be qualitatively different from decliners, reflecting a degree of self-selection. This suggests that decliners were more likely to have a confounding reason for not engaging with telehealth, such as greater disease severity. CONCLUSIONS This service review found no evidence that the Nottingham telehealth service has had a significant impact on secondary care utilisation in the short term. Longer term follow up is needed to establish conclusively whether telehealth initiatives like the Nottingham telehealth service does lead to tangible patient benefits and provide value for money.