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This omission is important, given concerns about the potential detrimental effects of telehealth on patients.

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Setting Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems.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.In the present study, we focus on the WSD telehealth questionnaire study and report on the effect of telehealth on health related Qo L and two psychological outcomes (anxiety and depressive symptoms).For this part of the WSD Evaluation, we assessed the hypothesis that introduction of a broad class of home based telehealth improves quality of life, anxiety, and depressive symptoms over a 12 month period for patients with chronic obstructive pulmonary disease, diabetes, or heart failure, compared with usual care only.Generic health related Qo L, anxiety, and depression are outcomes relevant to patients with the three long term conditions that are the focus of the Whole Systems Demonstrator (WSD) Evaluation.18 It is well established that health related Qo L is reduced and anxiety and depression are elevated for patients with diabetes,19 20 21 chronic obstructive pulmonary disease,22 23 24 and heart failure.25 26 27 Health related Qo L, anxiety, and depression have been linked with poorer outcomes on endpoints including self management, disease control, health service use, costs, and mortality.28 29 30 31 32However, evidence for the effect of telehealth on these outcomes is unclear.

At least seven systematic reviews have examined this effect on health related Qo L in heart failure,33 34 35 36 37 38 39 and while most conclude that telehealth is beneficial, such inferences are not supported by the evidence they present.

Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth usual care) was non-significant for any outcome (complete case cohort 0.273≤P≤0.761; available case cohort 0.145≤P≤0.696).

Conclusions Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only.

Results In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480≤P≤0.904) or available case (0.181≤P≤0.905) cohorts.

The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months.

General practice was the unit of randomisation, and telehealth was compared with usual care.