The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
A Cochrane review [Abstract] 1 on telehealthcare for COPD included 10 studies with a total of 1 307 subjects. Three studies used the telephone system, three used the Internet, one used a specialist independent network with video and three used videoconferencing. Telehealthcare was associated with a clinically significant increase in quality of life (mean difference -6.57, 95% CI -13.62 to 0.48; 2 trials, n=253). Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months (OR 0.27, 95% CI 0.11 to 0.66; 3 trials, n= 449). OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65; 6 trials, n=604). There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group (OR 1.05, 95% CI 0.63 to 1.75; 3 trials, n=503).
Most telehealthcare interventions for COPD have been introduced as part of a complex package of enhanced care. More research is needed to help to determine the precise contribution of telehealthcare to the package. Substantial aspects of the technology are inconclusive.
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