Mapping the Evidence Base as Telehealth's Popularity Soars
A Health Affairs rapid evidence review co-authored by University of Maryland School of Public Health Associate Professor Dr. Dylan Roby reveals that telehealth interventions are just as effective as in-person care for some conditions, but there is insufficient evidence showing how telehealth impacts the use of other services.
Telehealth is defined as the use of telecommunications and information technology to provide access to health care across distance. Medical providers can use telehealth technologies such as telephones, fax machines, email systems and remote patient monitoring devices to asses, diagnose, intervene, consult, supervise and provide information to patients.
Drawn to telehealth’s potential to lower costs and remove barriers to high-quality care, there is increased interest in expanding telehealth services despite concerns over blanket generalizations about telehealth’s efficacy across different applications and technologies. This rapid evidence review aims to provide policy makers with the time-sensitive information they need to inform decision-making on telehealth services. It is a part of the University of California, Berkeley’s California Health Benefit Review Program (CHBRP)’s work to score and analyze health insurance-related legislation in California on medical effectiveness, cost and public health impacts.
To assess whether health services delivered via telehealth are equivalent to in-person services and whether the use of telehealth services affects the use of other services, the research team reviewed twenty studies on the medical effectiveness of telehealth services delivered in seven clinical areas: telemental health, telerehabilitation, teledermatology, teleconsultation, oral anticoagulation management, nutrition management and diabetic foot ulcer treatment. The studies were conducted from January 2004–May 2018 with fourteen of the twenty published in the period between 2016–18. The studies included in the review included several telehealth technologies: live video conferencing, store and forward technology, telephone, email, text and chat.
For all clinical areas except teleconsultation, the studies examined found that outcomes of telehealth interventions did not differ significantly from in-person interventions. For teleconsultations, telehealth inventions were found to be a “potential alternative to in-person care, but equivalence is unclear as teleconsultation encompasses widely varied conditions.” The rapid evidence review concludes that “broadly, telehealth interventions appear generally equivalent to in-person care. However, telehealth’s impact on the use of other services is unclear.”
As telehealth’s popularity grows, the researchers highlight the need for decision makers to understand the impact of telehealth interventions on health outcomes and utilization. They maintain that a more robust systematic review of studies that assess the efficacy and impact of telehealth are needed to discern how telehealth can be used to replace or supplement in-person visits and whether those effects change as telehealth becomes more popular.
The review, “The Current State Of Telehealth Evidence: A Rapid Review” was published in the telehealth special issue of Health Affairs and co-authored by Erin Shigekawa, Margaret Fix, Garen Corbett, Dylan H. Roby, and Janet Coffman.