Telehealth keeps asthmatics out of hospitals

Health care delivered via telephone or Internet might not improve the quality of life for people with mild asthma, but it could keep those with severe asthma out of the hospital, a new evidence review finds.

“Telehealth care” could be one way to treat growing ranks of asthma sufferers worldwide, reducing the time and cost of care for these patients and perhaps making treatment more accessible to a wider number of people, said University of Edinburgh researcher Susannah McLean and colleagues.

The researchers examined 21 studies in which asthma patients interacted with health care workers via telephone, videoconferencing, the Internet, text messages or a combination of technologies. In most cases, the patients began their care with a face-to-face visit.

It can be “very hard to pinpoint the ‘active ingredients’ of a telehealth care intervention,” said McLean, making it difficult to determine why telehealth care benefits some patients and not others.

In all, more than 10,000 adults and children participated, from the United Kingdom, Portugal, the Netherlands, Brazil, Australia, Croatia, Japan, Taiwan and the United States.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

McLean said that there is “always a risk” that patients diagnosed incorrectly through telehealth care could “receive insufficient support for their needs and their safety will be compromised.” However, the Cochrane authors found no evidence that telehealth patients received worse care than those who received face-to-face care.

McLean suggested that patients and health care workers might also be using the Internet-calling software Skype and Web 2.0 applications like Facebook, but these technologies “have not yet made it into the asthma literature,” she said.

More research is needed, the Cochrane experts said, to determine whether telehealth care for asthma is cost-effective, and whether different forms of telehealth care are more effective than others.