Page 1 - Effect of telehealth on quality of life and psychological out comes over 12 months

BMJ 2013;346:f653 doi: 10.1136/bmj.f653 (Published 26 February 2013) Page 1 of 20

Research

RESEARCH

Effect of telehealth on quality of life and psychological
outcomes over 12 months (Whole Systems

Demonstrator telehealth questionnaire study): nested
study of patient reported outcomes in a pragmatic,

cluster randomised controlled trial

OPEN ACCESS

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Martin Cartwright research associate in health services research , Shashivadan P Hirani senior
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lecturer in health services research , Lorna Rixon research associate in health services research ,
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Michelle Beynon research assistant in health services research , Helen Doll senior research
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associate , Peter Bower professor of health services research , Martin Bardsley head of research ,
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Adam Steventon senior research analyst , Martin Knapp professor of social policy , Catherine
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Henderson research officer , Anne Rogers professor of health systems implementation , Caroline
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Sanders lecturer in medical sociology , Ray Fitzpatrick professor of public health and primary care ,
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James Barlow professor of technology and innovation management (healthcare) , Stanton P Newman
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principal investigator, professor, dean , for the Whole Systems Demonstrator evaluation team
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School of Health Sciences, City University London, London EC1A 7QN, UK ; University of East Anglia, Norwich, UK; The Nuffield Trust, London,
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UK; London School of Economics and Political Science, London, UK; University of Southampton, Southampton, UK; University of Manchester,
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Manchester, UK; University of Oxford, Oxford, UK; Imperial College Business School, London, UK
Abstract (long term). Primary intention to treat analyses tested treatment
Objective To assess the effect of second generation, home based effectiveness; multilevel models controlled for clustering by general
telehealth on health related quality of life, anxiety, and depressive practice and a range of covariates. Analyses were conducted for 759
symptoms over 12 months in patients with long term conditions. participants who completed questionnaire measures at all three time
points (complete case cohort) and 1201 who completed the baseline
Design A study of patient reported outcomes (the Whole Systems
Demonstrator telehealth questionnaire study; baseline n=1573) was assessment plus at least one other assessment (available case cohort).
nested in a pragmatic, cluster randomised trial of telehealth (the Whole Secondary per protocol analyses tested treatment efficacy and included
Systems Demonstrator telehealth trial, n=3230). General practice was 633 and 1108 participants in the complete case and available case
the unit of randomisation, and telehealth was compared with usual care. cohorts, respectively.
Data were collected at baseline, four months (short term), and 12 months
Correspondence to: S P Newman stanton.newman.1@city.ac.uk
Extra material supplied by the author (see http://www.bmj.com/content/346/bmj.f653?tab=related#webextra)
Web appendix 1: Whole Systems Demonstrator (WSD) terminology
Web appendix 2: Description of the telehealth intervention
Web appendix 3: Per protocol criteria
Web figure 1: Provision of peripheral telehealth devices to intervention participants in the WSD Telehealth Questionnaire Study
Web figure 2: Early removal of telehealth for reasons other than death across the 12 month trial period
Web table 1: Unadjusted mean change scores (Complete Case Cohort)
Web table 2: Unadjusted mean change scores (Available Case Cohort)
Web table 3: Means and estimated marginal means at each assessment point (intention-to-treat)
Web table 4: Means and estimated marginal means at each assessment point (per protocol)
Web appendix 4: Comparison of characteristics of participating and non-participating practices

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