TY - JOUR T1 - TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation JF - BMJ Open Y1 - 2015 A1 - Salisbury, C A1 - Thomas, C A1 - O'Cathain, A A1 - Rogers, A A1 - Pope, C A1 - Yardley, L A1 - Hollinghurst, S A1 - Fahey, T A1 - Lewis, G A1 - Large, S A1 - Edwards, L A1 - Rowsell, A A1 - Segar, J A1 - Brownsell, S A1 - Montgomery, A AB - Objective: To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression. Design: The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients’ and health professionals’ experience of telehealth; a quantitative survey of patients’ interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention (‘Healthlines’) was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations. Setting: Primary care. Results: The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care. Conclusions: A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions.It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to patients and providers, and cost-effective. VL - 5 UR - http://bmjopen.bmj.com/content/5/2/e006448.full IS - 2 ER - TY - JOUR T1 - Managing patients with multimorbidity in primary care JF - BMJ Y1 - 2015 A1 - Wallace, E A1 - Salisbury, C A1 - Guthrie, Bruce A1 - Lewis, Cliona A1 - Fahey, T A1 - Smith, SM KW - multimorbidity KW - primary care VL - 350 UR - http://www.bmj.com/content/350/bmj.h176 IS - h176 ER - TY - JOUR T1 - How to design and evaluate interventions to improve outcomes for patients with multimorbidity JF - Journal of Comorbidity Y1 - 2013 A1 - Smith, SM A1 - Bayliss, EA A1 - Mercer, Stewart W A1 - Gunn, J A1 - Vestergaard, M A1 - Wyke, Sally A1 - Salisbury, C A1 - Fortin, M KW - Comorbidity KW - Family Practice KW - interventions KW - multimorbidity AB - Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems VL - 3 UR - http://jcomorbidity.com/index.php/test/article/view/21 IS - 1 ER -