Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Jun;18(4):211-20.
doi: 10.1258/jtt.2012.120219.

Twenty years of telemedicine in chronic disease management--an evidence synthesis

Richard Wootton  1
Affiliations
Review

Twenty years of telemedicine in chronic disease management--an evidence synthesis

Richard Wootton. J Telemed Telecare. 2012 Jun.

Abstract

A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Medline publications on telemedicine and five chronic diseases. There were 1324 publications between 1990 and 2011.
Figure 2
Figure 2
Size of the trials. The solid line shows the linear regression
Figure 3
Figure 3
Funnel plot
Figure 4
Figure 4
Duration of interventions
Figure 5
Figure 5
Disease type. The boundaries of the boxes indicate the 25th and 75th percentiles, and a line within the box marks the median. The whiskers (error bars) above and below the boxes indicate the 90th and 10th percentiles. Potential outliers are shown individually
Figure 6
Figure 6
Telemonitoring. Box plot attributes as for Figure 5
Figure 7
Figure 7
Routine voice contact. Box plot attributes as for Figure 5
Figure 8
Figure 8
Videoconferencing. Box plot attributes as for Figure 5
Figure 9
Figure 9
Number of subjects
Figure 10
Figure 10
Year of publication
See this image and copyright information in PMC

References

    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747–57 - PubMed
    1. Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff (Millwood) 2001;20:233–41 - PubMed
    1. Sutherland D, Hayter M. Structured review: evaluating the effectiveness of nurse case managers in improving health outcomes in three major chronic diseases. J Clin Nurs 2009;18:2978–92 - PubMed
    1. Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care 2005;17:141–6 - PubMed
    1. Wootton R. Chronic disease management telemedicine pp 1–20 in Best Practices in the Behavioral Management of Chronic Disease. Vol II Other Medical Disorders. Trafton JA, Gordon WP (eds). Los Altos, CA, USA: Institute for Brain Potential, 2003.