The study by Takahashi et al1 provides useful information about the effectiveness of telemedicine. We believe that their negative results, although in line with others reported in the literature, should nonetheless be interpreted while taking into account some issues, the most evident being that the much higher mortality in the intervention group casts doubts on the real comparability of the study arms.
Furthermore, the population studied was heterogeneous with respect to the main disease. The experience with comprehensive geriatric assessment, however, clearly demonstrates that elderly and frail patients benefit from a strategy of care tailored to individual needs.2 There is no reason for thinking that such a conclusion does not apply to telemonitoring. In addition, the efficacy of telemonitoring may change according to the main disease: despite some negative trials, a recent Cochrane review indicates that in patients with congestive heart failure, telemonitoring is effective in reducing the risk of all-cause mortality and congestive heart failure–related hospitalizations.3 The lack of focus on a specific disease may also reduce the capacity of the telemonitoring team of detecting changes in health status. For example, symptoms of chronic obstructive pulmonary disease exacerbation may be aspecific4 and may be missed by study personnel not specifically trained for (tele)assisting people with this disease.
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