Journal_1_2014_final_WEB

Scientific Communication
Results from the world’s
largest telemedicine project
– the Whole System Demonstrator
Summary
Telemedicine is highlighted as a solution to future healthcare challenges, but
currently extant research is criticized for not being sufficient and of poor quality
The Whole System Demonstrator (WSD) is the largest and most comprehensive
research project performed to date, that evaluated telemedicine effectiveness
and costs in patients with chronic diseases including lung disease, heart disease,
and diabetes. The trial was initiated in 2008 as a cluster randomized study
including 3,230 patients from 179 general practices from three regions in the
UK. The objective of the present review is to summarize the results from the
WSD based on study data published to date. Results from five publications
show that telehealth reduces mortality (odds ratio 0.54), the number of hospital
admissions during a 12-month observation period, and patient use of secondary
care. However, it is not yet clearly established which specific patient groups will
realize these benefits, nor is it known what the underlying mechanisms of these
advantageous effects are. The savings achieved by reducing hospital costs are,
at least for now, less than the extra costs incurred by using telehealth, which
increased overall net healthcare costs by 15%. There remains a strong need
to expand focused research into telemedicine technology and applications to
enhance the well-being, health outcomes, and quality-of-life of individuals in
our rapidly ageing population.
INTRODUCTION
Telemedicine is applied to a number of patient groups on a global level and,
among other applications, is used in diagnosing and treating wounds 1 . Politicians
and policy makers generally welcome telemedicine as one solution to
the challenges imposed by the changing demographics in the western world.
However, evidence regarding the clinical outcomes is scarce and more knowledge
on patient perception and the organizational and economic consequences of
telemedicine is needed.
One systematic review showed that clinical outcomes have been included in less
than 5% of over 1,300 trials studying telemedicine 2 . Another review also states
that there is a severe lack of randomized controlled studies that have focused
on telemedicine 3 . Further, it has been demonstrated that studies on telemedicine
use in general do not follow recognized standards for reporting scientific
results 4 . A Danish review comprising individuals suffering from chronic lung
disease that are treated via telemedicine underlines the need for larger studies
of higher quality 5 . Another recent review of 141 randomized studies using
tele medicine across several specialties (i.e., asthma, chronic lung disease, heart
Kristian Kidholm 1 Birthe Dinesen 2
Anne-Kirstine Dyrvig 3 Benjamin Schnack
Rasmussen 4
Knud B. Yderstraede 4
Conflict of interest:
None declared.
ICMJE formulars
from the authors are
available on request.
The article was
originally published
in Danish.
For the publication in
EWMA, journal-specific
references to
wound care have
been included.
Orig. publ; Ugeskr
Læger 2014;176:
V05130299
1 Center for Innovative
Medical Technology,
Odense University Hospital,
Odense, Denmark
2 Integrative Neuroscience
Research Group, Centre for
Senses and Motor interaction,
Institute of Medical
and Health Technology,
Faculty of Health,
Aalborg University,
Aalborg, Denmark
3 Institute of Health
Research, University of
Southern Denmark,
Odense, Denmark.
4 Department of Medical
Endocrinology and
University Centre for
Wound Healing,
Odense University Hospital
and University of Southern
Denmark, Odense,
Denmark
Correspondence:
kristian.kidholm@rsyd.dk
EWMA Journal 2014 vol 14 no 1 43