The purpose of this systematic review is to identify evidence of the
appropriate dose of telehealth intervention services provided to community
dwelling adults experiencing chronic illness or disability related to
effectiveness, quality, safety, and cost. Academic Search Complete, CINAHL,
MEDLINE, Cochrane, and JBI were searched using combinations of “telehealth or
telemedicine or telemonitoring or telepractice or telenursing or telecare AND
chronic illness or chronic disease”. Of the
identified 449 articles, 47 articles met the inclusion criteria. Most study
designs were quasi-experimental one group pre-test post-test (N = 16) with few
Randomized Controlled Trials (N = 12). Twenty-three published articles studied
the effect of telehealth for one chronic condition (49.9%) while 24 (51.1%)
examined the effectiveness of telehealth for multiple chronic conditions.
Measurement of telehealth outcomes varied and included efficacy, healthcare
utilization, quality, adherence, cost, and safety. No standard measure of dose
could be extrapolated. Length of intervention was measured and reported
differently in each study. The dose of telehealth services that improve care
effectiveness, quality, safety, and cost is still unknown for community dwelling
adults experiencing chronic illness. The findings from this systematic review
do indicate that longer duration of telehealth services (51 weeks), regardless
of modality, produced positive outcomes as opposed to those with shorter
durations (37 - 38 weeks) that produced neutral or mixed results. Collecting and
reporting data related to clinical workflow such as dose of intervention
specific to disease and type of modality is recommended. Rigorous study design
including standard measurement at the RCT and Comparative Effectiveness level
is still needed.
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