Table 3

Telehealth studies

Study, countryVulnerability/chronic diseaseIntervention and comparatorComponents and delivery of the interventionOutcomes assessedRigour/relevance
Dwight-Johnson et al 47, 2011, 
USA
Hispanic primary care patients with depression in rural Washington, USA.Telephone-based CBT versus enhanced usual care.Eight sessions of CBT by telephone. Patient given a workbook translated to Spanish. Sessions conducted by five-part time Spanish-speaking therapists with a master’s in social work.Satisfaction, symptom severity, use of medication and uptake/implementation.Moderate/thin
Eakin et al 48,
Australia*
Primary care patients within a socioeconomically disadvantaged region of Queensland, Australia, with multiple comorbid chronic conditions.Telephone counselling intervention (weight and physical activity) versus usual care.Mailed workbook with information on healthy eating and PA and a pedometer. 18 phone calls over 12 months from study counsellors. Calls went from biweekly to monthly and used the 4As approach (assessment and feedback, advice on PA and diet, assistance with goal setting and developing a personalised plan for modifying PA and diet according to guideline recommendations and arranging follow-up support in the form of subsequent calls).PA levels and diet, no meeting guideline recommendations, uptake/implementation.High/thick
Eakin et al,
Australia49 50*
Adult patients with type 2 diabetes from a socioeconomically disadvantaged area of Queensland, Australia.Telephone delivered weight loss intervention (living well with diabetes) versus usual care.Workbook and up to 27 telephone calls over 18 months. The telephone counsellor works with participants to encourage reduced energy intake by 2000 kJ per day and 30 min a day of moderate-intensity, planned activity. Multimodal behaviour therapies are used to promote self-monitoring, goal setting, problem solving, social support, stimulus control, positive self-talk and self-reward.No meeting programme targets for diet, physical activity, weight loss, weight circumference, levels of PA and uptake.High/thick
Gabrielian et al 30 2013,
USA
Previously homeless veterans with chronic disease who have been rehoused through US Dept. of Housing and Urban Development Supportive Housing Program.Care Coordination Home Telehealth (CCHT) plus peer support for ‘technology divide’ versus usual care.CCHT – protocol driven inhome messaging and recording of daily monitoring transmitted via the phone and stratified according to three risk categories (colour coded) prompting a telephone call by RN where indicated.
Biweekly veteran support by peers.
Feasibility, satisfaction.Weak/thin
Gellis et al 31 2014, USAMedically frail older homebound individuals with COPD or CHF and comorbid depression. Patients were recruited from a hospital-affiliated home care agency, which services low-income people.Integrated Telehealth Education and Activation Model versus usual care with inhome nursing plus psychoeducation.Telemonitoring for chronic illness and depression care management, and Problem-Solving Therapy (PST) for comorbid depression. Patients were given an inhome device to log symptoms and measurements daily. Nurses contacted for follow-up where required. Nurses provided brief PST over the phone for 8 weeks.Symptom severity, number of ED visits/days hospitalised, problem solving skills and satisfaction.Moderate/thin
Kahn et al 51 2009, USADisadvantaged – Members of Gold Choice, a partially capitated Medicaid managed care programme for individuals with diabetes and a behavioural health diagnosis.Telephonic nurse case management (TNCM).
No comparison group.
The TNCM monitors members with diabetes between office visits, provides diabetes counselling and facilitates self-care by reminding the patients about appointments, lab work and specialty referrals.Issues relating to implementation.Weak/thin
Pickett et al 52 2014, USARecently hospitalised older adults (>55 years) in an urban acute care hospital with depression.Telephone facilitated depression care versus usual care.Those in the facilitated group were reassessed by telephone at 2, 4, 6, 8 and 12 weeks, receiving techniques for problem solving, behavioural activation, self-management, monitoring response to treatment and countering premature discontinuation of medication.Initiation of medication/prescribing.Moderate/thin
Sheldon et al 44 2014,
USA
Low-income culturally diverse patients with depression attending any of eight primary care clinics.Telephone Assessment Support and Counselling Program.
No comparison group.
Six telephone calls (one assessment and up to five therapy calls) covering behavioural activation for depression (form of CBT) and motivational interviewing strategies into medication adherence and depression counselling.Recruitment, engagement/retention and fidelity.Moderate/thick
Wolf et al 29 2014,
USA
Patients with type 2 diabetes attending federally qualified health centres designed to cater for underserved US communities.Two intervention arms:
1. Carve in (clinic based).
2. Carve out (outsourced telephone-based support).
Carve in: patient diabetes guide, brief counselling and action plan with primary care provider with telephone follow-up at 2 weeks and 2 months and via phone or in person at 3, 6 and 9 months.
Carve out: diabetes guide distributed by primary care provider and referral to telephone diabetes educator who facilitates action plan and follow-up. Counselling provided by a research assistant. Patient followed up at same intervals as carve in by diabetes educator.
Knowledge/literacy, HbA1c, systolic BP and LDL cholesterol, uptake and satisfaction with service.Moderate/thick
  • *Associated citations.

  • BP, blood pressure; CBT, cognitive–behavioural therapy; COPD, chronic obstructive pulmonary disease; LDL, low-density lipoprotein; PA, physical activity; RN, Registered Nurse; CHF, congestive heart failure; ED, emergency department