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TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation

Salisbury, Chris; Thomas, Clare; O'Cathain, Alicia; Rogers, Anne Elizabeth; Pope, Catherine; Yardley, Lucy; Hollinghurst, Sandra; Fahey, Tom; Lewis, Glyn; Large, Shirley; Edwards, Louisa; Rowsell, Alison; Segar, Julia; Brownsell, Simon; Montgomery, Alan A.

Authors

Chris Salisbury

Clare Thomas

Alicia O'Cathain

Anne Elizabeth Rogers

Catherine Pope

Lucy Yardley

Sandra Hollinghurst

Tom Fahey

Glyn Lewis

Shirley Large

Louisa Edwards

Alison Rowsell

Julia Segar

Simon Brownsell

Alan A. Montgomery



Abstract

Objective
To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression.

Design
The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients’ and health professionals’ experience of telehealth; a quantitative survey of patients’ interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention (‘Healthlines’) was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations.

Setting
Primary care.

Results
The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care.


Conclusions
A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions. It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to patients and providers, and cost-effective.

Journal Article Type Article
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 5
Issue 2
Article Number e006448
APA6 Citation Salisbury, C., Thomas, C., O'Cathain, A., Rogers, A. E., Pope, C., Yardley, L., …Montgomery, A. A. (in press). TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation. BMJ Open, 5(2), https://doi.org/10.1136/bmjopen-2014-006448
DOI https://doi.org/10.1136/bmjopen-2014-006448.
Publisher URL http://bmjopen.bmj.com/content/5/2/e006448
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Telehealth in chronic disease BMJ Open 2015 5 e006448.pdf (1.3 Mb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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