gms | German Medical Science

Background: The application of telemedicine solutions in health care has been rapidly increasing worldwide. Telemedicine services are said to facilitate access to relevant target groups and improve overall effectiveness of care. Due to the need for individualised and continuous monitoring and self-management support of patients, chronic diseases are the ideal setting for the development and implementation of telemedicine approaches.

However, to this day there is no clear understanding of the processes through which the applications work. The evidence evaluating the effectiveness of telemedicine solutions is still mixed. Findings from single studies also cannot be generalized due to a heterogeneous application of the term “telemedicine” and related terms such as eHealth and telehealth. Additionally, many studies suffer from methodological shortcomings and weaknesses of study designs. As reported by Neugebauer and colleagues, there are specific barriers to the conduct of RCTs on medical devices including matters of trial design, such as randomisation, acceptability, blinding, determining appropriate outcomes. Due to the heterogeneity of applied study designs and the increasingly differentiated phenotypes of applied telemedicine solutions, evidence-based guidance is challenging.

Objective: Therefore, the primary objective of this umbrella review is to identify and synthesise relevant international evidence on the effectiveness of telemedicine solutions and their components on the most common chronic diseases in Germany.

Methods: The study group carried out extensive automated and manual searches of Medline, Embase and Cochrane database to identify relevant evidence on the effectiveness of telemedicine interventions on the most common chronic diseases. Telemedicine was defined by the characteristics, namely using ICT, covering distance and involving professionals who deliver care directly to a patient or a group of patients. The search string was developed using the ten most common chronic diseases in Germany among older patients in general practices in Saxony as well as those chronic disease with the highest projected increase until 2030 in Saxony. Core outcome sets, including clinical outcomes as well as health-related and patient-reported outcomes, were used to clearly identify effectiveness studies.

Studies were included if they involved human populations, studied the effectiveness of telemedicine solutions and were systematic reviews of RCTs or meta-analyses. The search areas were ‘MeSH terms’ or ‘title, abstract and key words’. The search was limited to the time span between 1 January 2014 and 31 December 2017.

Two reviewers completed screening of studies, data extraction, and quality assessments. Quality assessment of studies was carried out using the Oxford Quality Assessment Questionnaire (OQAQ).

As a necessary first step, a descriptive summary of telemedicine applications used for each diagnosis will be delivered. It will show the number of telemedicine solutions employed for each chronic disease as well as the different phenotypes.

Based on these findings, each type of intervention will be studied in detail in order to determine which intervention component has proven to be effective based on pre-defined outcomes. Also, underlying concepts of the interventions, such as behaviour change theories or treatment guidelines will be determined.

Preliminary Results: A first search in pubmed yielded 940 results. A scan of the first 50 results based on title and abstracts resulted in nine studies considered to be relevant for the overall aim. The search string is considered as appropriate and will be applied in the named databases.

Discussion: This systematic review will summarize recent high quality systematic reviews and meta-analyses of studies evaluating telemedicine solutions. It therefore serves as a state of the art analysis of effective and non-effective components in telemedicine interventions. Due to the broad scope, it is expected to also uncover gaps in effectiveness research and inform the use of telemedicine in chronic care. The expected results may serve as a strong basis for disease- or application-specific meta-analysis.

Practical Implications: Overall, the umbrella review aims at providing guidance for the effective use of telemedicine in chronic care based on a methodologically sound research design