Authors' objectives: "Aimed to conduct a systematic review of existing systematic reviews (i.e., a meta-review) assessing the impact of real-time telehealth on health outcomes, process of care, resource utilization, and user satisfaction. This report addresses four questions: 1) What evidence exists in the peer-reviewed literature to support the use of real-time telehealth modalities to improve health outcomes? 2) What effect does the use of real-time telehealth have on access to health delivery services? 3) What impact, if any, does real-time telehealth have on health care resource utilization? 4) What is the level of user satisfaction for health services delivered through telehealth modalities?" (executive summary)

Authors' results and conclusions: Of the 3,120 citations yielded from all databases in the literature search, 24 met the inclusion criteria. Another seven articles were identified through a manual review of the references of eligible publications and submissions from external reviewers. Of the 31 publications that were included in the final review, 11 were judged to be of high methodological quality. All the reviews but one were published after 2000, and most originated from the US and the UK. One review identified details of the underlying technology used. Two-thirds of the reviews did not restrict their inclusion criteria to a specific disease or condition. High quality reviews indicated that real-time telehealth could improve communication with health care providers and quality of disease monitoring when used for home care or to support the self-care of patients with chronic conditions. In home-based care involving congestive heart failure, telehealth could contribute to a reduction in patient mortality. Real-time telehealth seems to be as effective as in-person care to support health professionals and patients facing psychiatric and neurological problems in remote, under-served communities.

Authors' recommendations: Most systematic reviews addressing the impact of real-time telehealth, just as the original studies that they reviewed, had low methodological quality. This absence of evidence of effect does not mean that telehealth is ineffective. It may illustrate that many researchers and policy makers lack the methodological support and resources needed to design and conduct valid, precise, and relevant studies. Despite its weaknesses, the evidence available from high quality reviews provides an indication of the benefits of real-time telehealth. In terms of health outcomes, there is support for the use of homebased telemedicine for patients' self-care or the management of chronic disease, to improve communication between patient and provider, to contribute to closer monitoring of chronic conditions, or to enhance the quality of life in elder care. In cases such as congestive heart failure, the use of home-based telehealth as part of a multidisciplinary interventional program could result in reduced mortality. Real-time telehealth could provide an effective way to meet the needs of health professionals and patients with psychiatric and neurological conditions in remote, under-served communities. In these areas, real-time telehealth leads to health outcomes that are equivalent to those obtained through inperson interactions. There is weaker, but favourable, support for real-time telehealth to affect process-of-care outcomes (i.e., increased access to services). In terms of user satisfaction and resource utilization, there was no consistent message across all high quality systematic reviews. There is weak evidence from low quality reviews to support both these outcomes. The data reveal that there is growth in real-time telehealth services throughout Canada. There remains, however, continued independent evolution of programs and limited collaborative work across provinces. With its aging population, vast geographic area, limited health care workforce, and rapidly developing telehealth programs, Canada is in a unique position to pave the way for effective and efficient health services that result in equitable, fair, and sustainable health care delivery for its citizens. Although weak, the evidence gathered suggests that telehealth could play a role in this process.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://cadth.ca/index.php/en/hta/reports-publications/search/publication /788

Year Published: 2008

URL for published report: https://cadth.ca/contact-us

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)