title: TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Bristol, UK.
authors: Chris
authors: http://orcid.org/0000-0002-4378-3960
authors: C
authors: Salisbury
authors: University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Bristol, UK.
authors: Clare
authors: C
authors: Thomas
authors: University of Sheffield, Medical Care Research Unit, School of Health and Related Research (ScHARR), Sheffield, UK.
authors: Alicia
authors: A
authors: O'Cathain
authors: University of Southampton, School of Health Sciences, Southampton, UK.
authors: Anne
authors: A
authors: Rogers
authors: University of Southampton, School of Health Sciences, Southampton, UK.
authors: Catherine
authors: C
authors: Pope
authors: University of Southampton, Centre for Applications of Health Psychology, Southampton, UK.
authors: Lucy
authors: L
authors: Yardley
authors: University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Bristol, UK.
authors: Sandra
authors: http://orcid.org/0000-0003-0782-3117
authors: S
authors: Hollinghurst
authors: Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Medical School, Dublin 2, Ireland.
authors: Tom
authors: T
authors: Fahey
authors: Division of Psychiatry, University College London, London, UK.
authors: Glyn
authors: G
authors: Lewis
authors: NHS Direct, Hampshire, UK.
authors: Shirley
authors: S
authors: Large
authors: University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Bristol, UK.
authors: Louisa
authors: L
authors: Edwards
authors: University of Southampton, Centre for Applications of Health Psychology, Southampton, UK.
authors: Alison
authors: A
authors: Rowsell
authors: The University of Manchester, Centre for Primary Care, Institute of Population Health, Manchester, UK.
authors: Julia
authors: J
authors: Segar
authors: University of Sheffield, Medical Care Research Unit, School of Health and Related Research (ScHARR), Sheffield, UK.
authors: Simon
authors: S
authors: Brownsell
authors: Nottingham Clinical Trials Unit, University of Nottingham, Nottingham Health Science Partners, Nottingham, UK.
authors: Alan A
authors: AA
authors: Montgomery
mesh_terms: D002318:Cardiovascular Diseases / Q000628:therapy*; D002908:Chronic Disease; D003210:Concept Formation; D003362:Cost-Benefit Analysis; D003863:Depression / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D008962:Models, Theoretical; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods*
keywords: PRIMARY CARE