Table 4

eHealth and telehealth studies

Study, countryVulnerability/chronic diseaseIntervention descriptionComponents and delivery of the interventionOutcomes assessedRigour/relevance
Cardoza and Steinberg53 2010,
Elderly patients following discharge from an inpatient setting with a diagnosis of HF, COPD, DM or HTN.Case managed telemedicine.
No comparison group.
Condition-based instruments including a scale, digital BP, heart rate monitor, pulse oximeter, glucometer and ‘healthy buddy’—a telephone modem for information transmission monitored daily by a nurse. Failure to transmit data instigated an FU PC or home visit. Home visits averaging 1–3 a week for 60 days including review of condition, compliance, patient education.
Disease management software programme tracked patients over time, and symptom assessment was performed through patient care management system that recorded nine quality of care indicators (pain, dyspnoea, urinary incontinence, dressing, bathing, toileting, transferring, ambulation and medication management).
Rehospitalisation and emergency department visits, compliance, quality of health perception, quality of care, mortality and satisfaction.Moderate/thin
Cherrington et al 40 2015, USA†54 55 Low-income African-American patients from safety net neighbourhoods with poorly controlled type 2 diabetes plus peer support Community Health Workers (CHW) who either also had type 2 diabetes or cared for someone with diabetes.Diabetes Connect web application and telephone coaching and goal setting provided by peer support CHW.Diabetes Connect web application that allowed for communication between the CHW, the patient and the diabetes team.
The web application consisted of three core features:
1. Contact tracking and call reminder system.
2. Secure communication system.
3. Progress reports.
CHWs were allocated to patients and provided telephone coaching and goal setting to patients via telephone (weekly for 3 months and monthly for another 3 months). They also held a monthly support/education group and tracked patient progress over time and linked them with the Diabetes Health Team and acted as a mediator between the patient and primary care.
Self-management education was provided by the CHW through group/telephone and face-to-face interactions. CHWs were trained in communication, problem solving, goal setting, motivational interviewing (24 hours) and via online modules on group facilitation, basic research and confidentiality.
Process outcomes from web-based application (number of contacts and number of goals set). Qualitative feedback regarding CHW roles, goals and challenges and feedback about messaging system and tracking of patients. Barriers to patient self-management.Moderate/thick
Chong and Moreno32 2012,
Hispanic low-income patients of a community health centre with major depression.Telepsychiatry services through the internet using a webcam versus usual care.Monthly telepsychiatry sessions at the community health centre for 6 months provided by one of two Hispanic psychiatrists using an online virtual meeting programme.Symptom severity/incidence,
acceptability of telepsychiatry, feasibility of implementing a telepsychiatry programme and satisfaction with care.
Davis et al 56 2011,

USA†57 58
Veterans from minority groups with depression.Telemedicine Enhanced Antidepressant Management study versus usual care.Stepped care model of depression treatment for up to 12 months. The off-site intervention team focused on optimising pharmacotherapy. The RN used a scripted uniform protocol during telephone calls to patients to address treatment barriers and reasons for non-adherence and strategies for managing side effects. A pharmacist called patients who had not responded to treatment to provide management. Psychiatrists supervised the off-site team and provided consultations via interactive video/Skype.Depression-related PC encounters and unintended increase in non-depression-related specialty PH encounters.
Response rate, cost.
Fortney et al 28 2013,
Medically underserved patients with depression attending five federally qualified rural health centres.Two intervention arms:
1. Practice-based collaborative care.
2. Telemedicine-based collaborative care.
1. Practice-based collaborative care: upskilled staff at clinic education/activation, self-management goal setting.
2. Telemedicine-based collaborative care: Full-time depression care manager – stepped depression care based on protocols with medication management by pharmacist. Psychiatric consultation via video conferencing. CBT was provided by videoconferencing.
No of primary care and mental health visits, levels of prescribing, response, remission, satisfaction and fidelity/uptake.Moderate/thick
Shea et al 43
USA†59 60
Older, ethnically diverse, Medicare beneficiaries with diabetes living in federally designated underserved areas of New York state.Telemedicine (IDEATel) versus usual care.Home telemedicine unit to videoconference with a diabetes educator every 4–6 weeks for self-management education, review of transmitted home blood glucose and blood pressure measurements and individualised goal setting. Access to special educational web page created for the project in both English and Spanish.Physical impairment, and physical activity and self-reported pedometer use.
BP, HbA1c and cholesterol.
Sheeran et al 42 2011,
Patients over 65 years with depression (English and Spanish speaking) who were enrolled in homecare with one of three homecare agencies (Vermont, New York and Florida).Telemonitor-based Depression Care Management (DCM) – Depression Tele-care Protocol.
No comparison group.
The DCM (nurse or social worker) coordinates care between the patient, physician and mental health specialist.
Telemonitors measure daily weight, blood sugar and heart rate through chime (synthetic voice through speakers) or touch screen, which prompts patients to enter measurements. They also ask simple questions about health and provide basic education. Protocol elements available in both Spanish and English.
Nurses followed up patients by telephone as needed on care, education and to reassure patients and encourage pleasurable activities and assess depression status.
Symptom severity, feasibility, acceptability and satisfaction.Moderate/thick
  • BP, blood pressure; CBT, cognitive–behavioural therapy; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; FU, follow-up; HF, heart failure; HTN, hypertension; PC, Primary Care; RN, Registered Nurse; HbA1C, glycated haemoglobin.

  • †Indicates there are associated publications.