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mHealth Myths and Reality continued

mHealth

I’m returning to my theme of ‘mHealth Myths and Realities’ to address another lazy generalisation that I hear too often – the myth that there’s ‘no evidence in favour of mHealth’.

 I think some of this is an unfortunate by-product of a piece of work done in the UK called the ‘Whole System Demonstrator’ (WSD) which was a randomised control trial for 3,230 COPD, diabetes and chronic heart failure patients that ran between 2008 and 2009 and was written up in the British Medical Journal between 2012 and 2013 (the reports are open access).  What the study actually found was:

       14% reduction in bed days

       20% reduction in emergency admissions

       45% reduction in mortality!

At the same time the study found no discernible difference in Quality of Life between the intervention and control groups (why should there be?), and found that costs were actually slightly higher with the telehealth group.  Unfortunately the positive findings were ignored and the last two findings were jumped on by some media and even professional commentators, suggesting ‘telehealth doesn’t work’.  And yet these findings are totally understandable when you consider the aged service design the study was working with and the fact that this study was bolted on top of usual care, whereas more successful implementations such as the Veteran’s Health Administration (see below) have re-structured organisationally to optimise roles in care delivery.   

So setting aside the questionable interpretation that has been put on the WSD, what do we have?  Let me give you a few examples:

       The Veteran’s Health Administration, one of the largest vertically integrated care organisations in the US, has been pioneering telehealth for over 10 years.  They now have more than 90,000 patients covered by remote telehealth monitoring (and that’s just one of their initiatives), claiming impressive resource savings – between 20-56% across a range of conditions such as Diabetes, Hypertension, Chronic Heart Failure, COPD and Depression.  You can read more about their leading work thanks to the folk at 2020health, or see Dr Adam Darkins who leads these programmes on video here.

       Johns Hopkins University has created the mHealth Evidence database, indexing almost 6,000 evidence sources in mHealh from around the world.  They’re not alone either – the Scottish Centre for Telehealth and Telecare recently launched a database of their own activity, listing over 50 projects in Scotland alone.  I predict many more will follow. 

So there’s ‘no evidence for mHealth’?  Really?  You only have to look for it.  However, I would agree with the doubters that we haven’t done a good enough job of communicating the evidence – and I don’t mean simply listing it in databases for experts, but in translating the benefits and telling human stories that are suitable for a much wider audience.  Equally some projects haven’t built in measurements from the outset, which is one of the essentials of good mHealth design.  More of that another day.  In the meantime, I’d love to hear your thoughts or feel free to contact me.

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