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Health Information Technology: Comprehensive Telehealth Interventions to Improve Diet Among Patients with Chronic Diseases

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What the CPSTF Found

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to nutrition.

Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Telehealth methods to deliver dietary interventions in adults with chronic disease: a systematic review and meta-analysis. American Journal of Clinical Nutrition 2016;104(6):1693-702.

The systematic review and meta-analysis included 25 randomized controlled trials (search period through 2015).

The CPSTF finding is based on results from the published review and expert input from team members and the CPSTF.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 25 studies.

  • Dietary Change Outcomes
    • Diet quality improved significantly (3 studies).
    • Sodium intake decreased significantly (5 studies).
    • Fruit and vegetable intake increased by one serving per day (4 studies) and three servings per week (2 studies).
    • Patients reported significant improvements in diet quality and sodium intake at 12 and 24 months (4 studies).
    • Interventions to increase the consumption of fruit and vegetables were more effective when delivered weekly rather than monthly (1 study).
  • Clinical Outcomes
    • While telehealth interventions led to improvements in blood pressure, weight loss, and waist circumference, conclusions were limited by the small number of studies and inconsistent results.
    • Studies reported mixed effects on patient illness (2 studies).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results of the systematic review, findings are applicable to the following:

  • Community and ambulatory care settings
  • Patients with diet-related chronic conditions (e.g., diabetes and cardiovascular disease)
  • Healthcare providers, including nurses, social workers, health educators, and physicians
  • Media, including telephone, email, video, internet, or mobile applications

Evidence Gaps

Additional research and evaluation are needed in the following areas to fill existing gaps in the evidence base.

  • Are interventions effective in changing dietary behaviors using additional communication channels (e.g., web-paged programs, videoconferencing)?
  • Do these interventions improve clinical outcomes and reduce morbidity and mortality?
  • How does intervention effectiveness vary when implemented for the following groups?
    • Patients who vary by race, ethnicity, or socioeconomic status
    • Patients with chronic conditions other than those included in this review

Study Characteristics

  • Participants in the evaluated interventions reported a range of chronic health conditions, including cardiovascular disease (15 studies), diabetes (5 studies), end-stage renal disease (2 studies), and obesity (1 study).
  • Over half of the studies reported a study duration of less than six months (15 studies).
  • The median number of participants reported in studies was 131.
  • The telephone was the most common telehealth delivery method (13 studies).