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      A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial

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          Abstract

          Background

          It is expected that increased demands on services will result from expanding numbers of older people with long-term conditions and social care needs. There is significant interest in the potential for technology to reduce utilisation of health services in these patient populations, including telecare (the remote, automatic and passive monitoring of changes in an individual's condition or lifestyle) and telehealth (the remote exchange of data between a patient and health care professional). The potential of telehealth and telecare technology to improve care and reduce costs is limited by a lack of rigorous evidence of actual impact.

          Methods/Design

          We are conducting a large scale, multi-site study of the implementation, impact and acceptability of these new technologies. A major part of the evaluation is a cluster-randomised controlled trial of telehealth and telecare versus usual care in patients with long-term conditions or social care needs. The trial involves a number of outcomes, including health care utilisation and quality of life. We describe the broad evaluation and the methods of the cluster randomised trial

          Discussion

          If telehealth and telecare technology proves effective, it will provide additional options for health services worldwide to deliver care for populations with high levels of need.

          Trial Registration

          Current Controlled Trials ISRCTN43002091

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          Most cited references22

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          What are pragmatic trials?

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            Explanatory and pragmatic attitudes in therapeutical trials.

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              A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions.

              We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.
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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2011
                5 August 2011
                : 11
                : 184
                Affiliations
                [1 ]Health Sciences Research Group, University of Manchester, Manchester, UK
                [2 ]School of Community and Health Sciences, City University, London, UK
                [3 ]Imperial College Business School, Imperial College London, London, UK
                [4 ]Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science, London, UK
                [5 ]Institute of Psychiatry, King's College London, London, UK
                [6 ]Nuffield Trust, London, UK
                [7 ]Department of Public Health, University of Oxford, Oxford, UK
                Article
                1472-6963-11-184
                10.1186/1472-6963-11-184
                3169462
                21819569
                e22e6821-81a8-4bbd-bdb5-b4a3595d5314
                Copyright ©2011 Bower et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 March 2011
                : 5 August 2011
                Categories
                Study Protocol

                Health & Social care
                Health & Social care

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