Does Telecare Work? – a randomised control trial

23 08 2013

 

It’s a slightly misleading title for this post which I only partially apologise for but I wanted to look at an article I found from ‘Age and Ageing’ (Vol 42 No 4 Feb 2013) called “Effect of telecare on the use of health and social care services : Findings from the Whole Systems Demonstrator cluster randomised trial”.

The project was undertaken to ascertain whether the provision of ‘telecare’ had any significant difference to people in terms of hospital admissions/use of social care (namely admissions or care in residential settings, contacts with GPs or practice nurses and weeks of domiciliary home care provided.

The trial involved a group of 2600 people from 217 GP surgeries who already had identified social care needs and resident in three areas within England (Cornwall, Kent and Newham).

I’ve been involved, personally, in a number of ‘telecare’ trials (not this one!) over the years as I’ve seen the technology change over the years I’ve been working in adult social care. From the simple, button alarm call type system which has been around for a long time – to increasingly sophisticated electronic monitoring devices which were able to monitor if someone has moved (or not moved) for certain periods, if someone has fallen and which rooms they would be going into and when. Monitors for gas, fire, smoke, CO2, floods – they are all common now. Increasingly, we are moving to more motion sensor type telecare and remote monitoring – most recently we used a system which can allow families (um, and social workers) to access a remote website to get an idea of where someone is in their property – this can sound a bit ‘big brother’ – and it is – and has to be carefully risk-assessed vis a vis the potential wrench of residential care but it has also put long distance families’ minds at rest.

Anyway, so telecare is constantly evolving and while I don’t think there’s any doubt that it can be useful all round, the argument for cost reduction by limiting reliance on social care services, that’s less clear in  my mind – I see it as an addition rather than a replacement but here’s a study so let’s turn back to that.

The study says

The three sites were left to design and procure their own telecare systems but all intervention participants were given a Tunstall Lifeline Connect or Connect+ base unit together with a pendant alarm and up to 27 peripheral devices, assigned by local teams. These covered [9]:

  • Functional monitoring, including the ‘Lifeline’ base units and pendants, bed and chair occupancy sensors, enuresis sensors, epilepsy sensors, fall detectors and medication dispensers.
  • Security monitoring, including bogus caller buttons, infrared movement sensors and property exit sensors.
  • Environmental monitoring, including gas, monoxide and smoke detectors, heat sensors, temperature extremes sensors and flood detectors.
  • Standalone devices not linked to a monitoring centre, such as big button phones, key safes for carers and memo minders.

Data from the peripheral devices were sent to a monitoring centre via a telephone line and alerts were monitored continuously.

My local authority used the Tunstall systems so I’m fairly familiar with the systems that were available. The study ran over 12 months.  People were excluded from the trial if they were already receiving telecare services (apart from a pendant alarm/smoke alarm).  The main goal of the study was to see if there was any change between the control group and the group with the provision of extensive telecare services in the hospital admission rates over the year but other factors were monitored such as inpatient days, admission to residential or nursing care, domiciliary care provided, visits to GPs and nurses.

There were 1324 ‘control group’ participants and 1276 ‘intervention group’ participants across the GP practices which were involved in the study. It took place between 2008 and 2009 (which, in itself, shows one of the problems with assessing ‘telecare’ because things have moved on in terms of provision enormously since 2009).

While there’s a lot of statistical analysis in the original paper – much of it which is beyond me as a fluffy humanities/social science graduate (!) – there were no significant differences in the areas being compared between the two groups on any of the levels measured. In terms of hospital admissions, 46.8% of the intervention group were admitted to hospital as opposed to 49.2% of the control group. There were no significant differences in access to health and social care services between the two groups and no differences in mortality rates. The usage of GPs was higher in the intervention group but when this had been adjusted on the basis of prior use, it levelled out.

As the paper says

No impacts were indicated in rates of hospital use, length of inpatient hospital stay or admissions to residential or nursing care. Higher levels of general practitioner contacts were detected among intervention than control participants, but differences appeared to exist before the trial and adjusting for prior use removed the significance of results.

So does this mean that telecare doesn’t ‘make a difference’?

The study was the first large scale randomised trial of telecare interventions – however, the authors say that ‘making a difference’ is relative. This, very  much, relied on quantitive data which is easy to analyse.

There are gains, certainly, (well, this is where I veer into the anecdote but bear with me) in terms of peace of mind, particularly for family carers and for ‘services’ which can sometimes be too risk averse. My own experiences of using telecare is that they could augment rather than replace traditional services and could act to minimise risk levels rather than eliminate them. Someone may be able to stay at home for a few more months, but a monitor can’t stop someone falling. It can make the service more aware when they do though.

It’s useful to see some data about the use of telecare as often it is seen as a cheaper ‘cure-all’ and this study allows greater perspective on that. It can’t replace but it can augment – that would be what I would take from this.

It all comes back to what does ‘work’ mean? Does it mean reducing costs to a stretched health and social care system? Or does it mean improving the quality of life of people and their families who need social care and want to add additional factors which can help ease some of the worry and strain that is otherwise present in these situations.

Telecare, quite rightly, isn’t going away, but its useful that we don’t perceive of it as a replacement and rationalise – with the evidence – some of the perceptions that technology alone can be a cure-all.

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