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

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) The Community Preventive Services Task Force (CPSTF) recommends comprehensive telehealth interventions to supplement the care of adults who have chronic diseases that are affected by diet, such as cardiovascular disease and diabetes. This finding is based on strong evidence of effectiveness in improving dietary outcomes such as diet quality, fruit and vegetable intake, and dietary sodium intake.

The full CPSTF Finding and Rationale Statement and supporting documents for Health Information Technology: Comprehensive Telehealth Interventions to Improve Diet Among Patients with Chronic Diseases are available in The Community Guide Collection on CDC Stacks.

Intervention

Telehealth interventions allow healthcare providers and patients to communicate by phone, email, web-based programs, or other electronic or digital media. Healthcare providers and patients may also interact in person, though in comprehensive telehealth interventions, most of their interactions are distance-based.

Comprehensive telehealth interventions can be used to help adults who have chronic diseases that are affected by dietary behaviors. This review assessed interventions designed to improve two or more patient dietary behaviors (e.g., sodium, fat, or fruit/vegetable intake).

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).

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).

Summary of Results

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

  • 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

Implementation Considerations and Resources

  • Implementers should understand state policies regarding application of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to electronic communications involving patients.
  • Comprehensive telehealth interventions may reduce the number of in-person visits and subsequently decrease opportunities for patients to receive other preventive services, such as blood pressure monitoring and periodic cancer screening.
  • This CPSTF recommendation should not be considered an endorsement of any specific technology.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.