An evidence based approach to the use of telehealth in long-term health conditions:Development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Background Health services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term health conditions (LTCs). Aim To develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk. Methods Development: We synthesised quantitative and qualitative evidence on effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Findings are included in the full report. Based on these studies we developed a conceptual model (‘TECH’) as a framework for development and evaluation of the Healthlines Service for patients with LTCs. Implementation: The Healthlines Service comprised regular telephone calls from Health Information Advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence. Evaluation: Design: Linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care versus usual care alone, with nested process and economic evaluations. Participants: Adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. Primary outcome: Response to treatment. Secondary outcomes included: anxiety (depression trial); individual risk factors (CVD risk trial); efficiency; self-management skills; medication adherence; perceptions of support, access to healthcare, and satisfaction with treatment. Trial results Depression trial: 609 participants; 86% retention rate. Response to treatment (PHQ-9 reduction ≥ 5 points and score < 10 after four months) was higher in the intervention group (27% (68/255)) than the control group (19% (50/270)); odds ratio=1.7 (95% confidence interval 1.1, 2.5; p=0.02). Anxiety also improved. ...