This risk was underscored in a large scale, multicentre evaluation of automated telephone based monitoring for patients with heart failure.55 By contrast with a recently updated Cochrane review,36 this study found no evidence of benefit for interactive telemonitoring on any outcome examined.

These results highlight the need for rigorous, large scale, high quality independent studies to evaluate healthcare interventions before wide scale adoption.54 55Part of the UK government’s response to this need for robust evidence was to fund the WSD Evaluation18 to investigate the effects of two broad classes of technologies (telehealth and telecare) on a comprehensive range of outcomes in regions of England that had undergone the Whole Systems Redesign (web appendix 1).

Evaluations of service innovations such as telehealth need to assess the effect from the patient’s perspective, using self report measures such as quality of life (Qo L), psychological outcomes, and acceptability of services.

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Additional qualitative studies of purposive subsamples explored the experiences of patients, carers, healthcare professionals, and healthcare organisations.

Collectively, the WSD Evaluation is the largest and most comprehensive investigation of telehealth and telecare so far.

Telehealth enables the remote exchange of data between a patient and healthcare professionals to facilitate diagnosis, monitoring, and management of long term conditions.8 9 Some telehealth systems incorporate an educational component aimed at improving patient knowledge10 and self care (for example, treatment adherence).11 12 Telehealth systems that send physiological or symptom data to a remote monitoring centre can alert healthcare professionals when disease specific clinical parameters are breached.

Thus, telehealth affords the opportunity for earlier intervention, which may reduce the frequency with which expensive hospital based care is required.

Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates.

Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort).

Participants Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009.

Main outcome measures Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale).

Objective To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.