While there is a large evidence base supporting the efficacy of telemedicine in a number of clinical settings, more research is needed to make better informed policy and practice decisions regarding the overall value of telehealth.
That’s the conclusion of a draft technical brief from the Agency for Healthcare Research and Quality on telehealth, which was requested by Sens. John Thune (R-S.D.) and Bill Nelson (D-Fla.). AHRQ surveyed currently available research on the impact of telemedicine on health outcomes and healthcare utilization to evaluate the body of evidence supporting its use.
“Our searches confirmed that there is a large, broad evidence base about the effectiveness of telehealth, including over 200 systematic reviews and hundreds of primary studies published since 2006,” states the AHRQ draft report. “Although we found that many reviews are not structured or conducted in a way that would support current decisions related to telehealth, we did identify a substantial amount of evidence—44 systematic reviews that covered several important clinical focus areas and met our inclusion criteria.”
According to AHRQ, the largest volume of research demonstrated that telehealth interventions produce positive results when used in the clinical areas of chronic conditions and behavioral health, and when telehealth is used for providing communication/counseling and monitoring/management.
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Based on its analysis, the agency suggested a two-pronged approach going forward to advance telehealth. “In areas where we did not find sufficient synthesized research, such as telehealth for consultation in acute care and in maternal and child health, new systematic reviews may be able to organize primary research (some of which is new and some of which has been included in reviews in the past) into reviews that could address practice and policy considerations related to these issues,” according to AHRQ.
Further, the agency argues that for those clinical areas and roles for telehealth that do not yet have a sufficient evidence base to support important decisions about practice and policy, more primary research is needed rather than more systematic reviews. “We identified triage in urgent/primary care, management of serious pediatric conditions and the integration of behavioral and physical health as three potential topics for more primary research,” states the report.
In addition to considering future systematic reviews and promoting primary research in key areas, the agency recommended that telehealth research needs to expand its orientation to include new organizational and payment models. “Going forward, research should be conducted in emerging models of care, particularly value-based models where use of telehealth may improve the ability to share risk and attain quality and related outcomes,” states the report. “These studies of telehealth should consider combinations of applications of telehealth and outcomes that are important in these new models and evaluate the specific contribution telehealth can make in these contexts.”
Those wishing to comment on AHRQ’s draft technical brief have until Jan. 5, 2016, to do so here.
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