Project Background

In order to maximize patient safety, positively impact patient outcomes, and effectively manage (both fiscally and organizationally) healthcare in Canada, knowledge users (e.g., policy‐makers, health systems managers, and HHR planners) must have a comprehensive understanding of the solutions available to alleviate the contemporary pressures faced by the healthcare system. Experienced in all jurisdictions across Canada, foundational pressures include a shortage of healthcare providers, escalating wait times, and rising costs.[1] More recently, with continued growth in the aging population, healthcare professionals are increasingly being confronted with challenges related to managing patients with complex chronic diseases.[2][3] If this trend continues unabated, the economic healthcare burden will be substantial, and potentially crippling.

Patients who live in remote, rural and small urban areas are especially vulnerable to the consequences of chronic diseases due to reduced access to healthcare. When compared to their urban counterparts, these patients face higher rates of hospitalization and mortality, creating additional complexities for the healthcare system.[4] We must gain a profound understanding of available solutions for chronic disease management (CDM) in order to ensure that quality healthcare continues to be accessible for all Canadians.

Telehealth is increasingly being used in Canada to improve patient access to healthcare services across geographic, cultural and socio‐economic barriers.[5][6] As the burden of chronic illness on the Canadian healthcare system grows, and the scarcity of health and human resources (HHR) in rural and remote regions intensifies[7][8] home‐based telehealth services are progressively being recognized as an effective way to treat and rehabilitate patients with chronic diseases and facilitate management within the healthcare system[9][10][11][12][13]. Examples of home‐based telehealth applications include: consultations between health professionals and patients; lifestyle management and behavioural change support; and patient vital signs monitoring.[14],[15] Care that can be accessed directly from the patient’s home has the potential to prevent hospitalization, reduce healthcare costs, support patient self‐management, and provide an alternative to hospital outpatient or health professional visits.[16],[17],[18]

Given Canada’s widely dispersed population and the potential benefits of home‐based telehealth applications, achieving equitable, accessible and high quality home‐based healthcare has been identified as key priority.[19][20][21] If home‐based telehealth is to be effectively implemented on a large scale, knowledge users must have access to succinct, usable syntheses of applicable research. To this end, the proposed knowledge synthesis will support knowledge users in understanding knowledge gaps, and assessing the priorities and viability of home based telehealth for chronic disease management and health human resource planning in Canada.

[1] ACHDHR (Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources). 2005. A framework for collaborative pan‐Canadian health human resources planning. http://www.hc‐‐sss/alt_formats/hpb‐dgps/pdf/pubs/hhr/2007‐framecadre/

2007‐frame‐cadre_e.pdf (accessed on April 10, 2010).

[2] Manuel, D.G., S.E. Schultz, and J.A. Kopec. 2002. Measuring the health burden of chronic disease and injury using health adjusted life expectancy and the Health Utilities Index. Journal of Epidemiology and Community Health 56: 843‐50. 

[3] Patra, J., S. Popova, J. Rehm, S. Bondy, R. Flint, and N. Giesbrecht. March 2007. Economic Cost of Chronic Disease in Canada 1995‐2003. Report Prepared for the OCDPA and the OPHA. (accessed on April 8, 2010).

[4] DesMeules, M., and R. Pong. 2006. How Healthy are Rural Canadians: An Assessment of their Health Status and Health Determinants. Ottawa: Canadian Institute for Health Information.

[5] Jennett, P., R. Scott, D. Hailey, A. Ohinmaa, R. Thomas, C. Anderson, B. Young, D. Lorenzetti, L.A. Hall, L. Milkovich, C. Claussen, T. Perverseff, S. Brownell, A. Jadavji, J. Sanguins, and S. Yeo. 2002. Socio‐Economic Impact of Telehealth: Evidence Now for Health Care in the Future. (accessed on

April 15, 2009).

[6] Maheu, M., P. Whitten, and A. Allen. 2001. E‐Health, telehealth, and telemedicine: a guide to start‐up and success. San Francisco: Jossey‐Bass Publishers.


[7] Health Canada. 2004. Literature Review and Environmental Scan of Preferred Practices for Deployment of Health Human Resources and Decision Support Tools: Final Report.

http://www.hc‐‐sss/pubs/hhrhs/2004‐hhr‐rhs‐tools‐outils/2‐eng.php (accessed on April 15, 2009).

[8] Wranik D. 2008. Health human resource planning in Canada: A typology and its application.

Health Policy 86(1): 27‐41.

[9] Statistics Canada. 2008. Health Indicators, 2008. (accessed April 15, 2009 ).

[10] Hebert, M., B. Korabek, and R. Scott. 2006. Moving research into practice: A decision framework for integrating home telehealth into chronic illness care. Int. Journal of Medical

Informatics 75: 786‐794.

[11] Schaafsma, J., S. Pantazi, J.R. Moehr, C.R. Anglin, and N. Grimm. 2007. An economic evaluation of a telehealth network in British Columbia. Journal of Telemedicine and Telecare 13: 251‐256.

[12] Liddy, C., J. Dusseult, S. Dahrouge, W. Hogg, J. Lemelin, and J. Humbert. 2008. Telehomecare for patients with multiple chronic illnesses. Canadian Family Physician 54: 58‐65.

[13] Pare, G., M. Jaana, and C. Sicotte. 2007. Systematic review of home telemonitoring for chronic diseases: The evidence base. Journal of the American Medical

[14] DelliFrane, J., and K. Dansky. 2008. Home‐based telehealth: A review and meta‐analysis. Journal of Telemedicine and Telecare 14: 62‐66.

[15] Koch, S. 2006. Home telehealth – Current state and future trends. International Journal of Medical Informatics 75(8):565‐576.

[16] Pare, G., M. Jaana, and C. Sicotte. 2007. Systematic review of home telemonitoring for chronic diseases: The evidence base. Journal of the American Medical Informatics Association 14(3): 269‐277.

[17] Neubeck, L., J. Redfern, R. Fernandez, T. Briffa, A. Bauman, and S.B. Freedman. 2009. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J

Cardiovasc Prev Rehabil. 16(3):281‐9.

[18] Bensink, M., D. Hailey, and R. Wotton. 2006. A systematic review of successes and failures in home telehealth: Preliminary results. J Telemed Telecare 12:8‐16.

[19] Romanow, R. 2002. Building on Values: The Future of Health Care in Canada. (accessed on April 15, 2009).

[20] Campagnolo, I. 2005. Speech from the Throne (BC). 2005 Legislative Session: 6th Session, 37th Parliament.‐8‐37‐6.htm (accessed on April 15, 2009).

[21] Alvarez, R. 2002. The promise of ehealth ‐ a Canadian perspective. EHealth International, 1(4), 1‐6. ATA (American Telemedicine Association). (accessed April 16, 2009).

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