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2nd Concertation Meeting

2nd Concertation Meeting. Evidence in telemedicine: a literature review. Brussels, September 8, 2011 Reinhard Prior, Scientific Coordinator, HIM. Telemedicine vs eHealth. Telemedicine "Medicine at a Distance". 1892.

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2nd Concertation Meeting

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  1. 2nd Concertation Meeting Evidence in telemedicine: a literature review Brussels, September 8, 2011 Reinhard Prior, Scientific Coordinator, HIM

  2. Telemedicine vseHealth

  3. Telemedicine "Medicine at a Distance"

  4. 1892 Alexander Graham Bell inaugurating the first telephone line from New York to Chicago, 1892

  5. RCT ! How are you doing? 1911 The MAST domains • Safety? • Clinical effectiveness? • Patient perspectives? • Economic aspects? • Organisational aspects? • Socio-cultural,ethical and legal aspects?

  6. You must be crazy ! RCT? HTA? MAST?

  7. IT Body sensors Mobile health Video 2011

  8. 2011 Health care changes • More chronic disease • Sophisticated medical protocols • Clinical guidelines to be followed • Budget restrictions

  9. What ist the evidence? 2011 • Evidenced based medicine • HTA • MAST et al.

  10. What is the current evidence?

  11. Cochrane reviews Levels of Evidence

  12. TM+ Cochrane review: 4 TM + Meta-Analysis: 50 TM + Systematic review: 110 TM + Randomized controlled trial: 756 TM + Trial: 1269 Total number of publications: 13504 Evidence by numbers Medline Search for "Telemedicine or Telemonitoring" (5.9.11)

  13. TM+ Cochrane review: 4 TM + Meta-Analysis: 50 TM + Systematic review: 110 TM + Randomized controlled trial: 756 TM + Trial: 1269 Total number of publications: 13504 Evidence by numbers Medline Search for "Telemedicine or Telemonitoring" (5.9.11)

  14. Consolidated standards of reporting trials • 25 item checklist • Flow diagram www.consort-statement.org

  15. J Am Med Inform Assoc, July 29, 2011

  16. 32 / 3784 papers analyzed 43 % : Objectives not clearly defined 34%: Sample size calculation missing 29%: Outcomes not clearly identified 62%: Adverse events not reported 80%: Information on long-term implementation missing Only 40% were of superior quality (> 3 Jadad points) Augestad et al, 2011

  17. TM+ Cochrane review: 4 TM + Meta-Analysis: 50 TM + Systematic review: 110 TM + Randomized controlled trial: 756 TM + Trial: 1269 Total number of publications: 13504 Evidence by numbers Medline Search for "Telemedicine or Telemonitoring" (5.9.11)

  18. 1972 Archibald Leman Cochrane (1909-1988)

  19. "28000 health care professionals from over 100 countries work together to help health care providers, policy makers, patients and carers to make well informed decisions based on the best available research evidence by systematic reviews of RCTs"

  20. 2000: General review on telemedicine versus face to face patient care "Establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research and the fact that it is feasible to carry out randomised trials of telemedicine applications. Policy makers should be cautious about recommending increased use and investment in unevaluated technologies".

  21. 2010: Asthma (21 RCTs analyzed) "Telehealthcare interventions are unlikely to result in clinically relevant improvements in health outcomes in those with relatively mild asthma, but they may have a role in those with more severe disease who are at high risk of hospital admission. Further trials evaluating the effectiveness and cost-effectiveness of a range of telehealthcare interventions are needed."

  22. July 2011: COPD (10 RCTs analyzed) • 70% reduction in ermergency room visits • 54% reduction in hospital admissions • No difference in death rate "Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages."

  23. August 2010: CHF (25 RCTs analyzed, 16 telephone support, 9 telemonitoring) 34 % mortality reduction for telemonitoring (!) Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.

  24. November 2010

  25. November 2010

  26. Single, but large studies may be more appropriate to avoid invalid conclusions even from high quality meta-analyses

  27. Current directions in CHF: 1: Still more studies (TIM-HF II) 2: Subgroup analysis Which patients do benefit? Which components of the interventions are most effective? Which level of technology is appropriate?

  28. Lancet, Feb 10, 2011

  29. Single blinded 270 treated 270 control 40% reduction in hospitalisation

  30. Thank you!

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