On 19th January 2016, NHS England published a news item entitled ‘Social media and Skype keep young people with diabetes attending’. It went on to highlight that “Advice on using social media, texts and skype to keep young people engaged in treatment for their diabetes has been published as part of wider information to help commissioners improve care transition.” The document to which the article referred was the ‘Diabetes Transition Service Specification’ prepared by the Quality Strategy Team, Medical Directorate, NHS England. This is a blueprint which commissioners are encouraged to use when stipulating services for young people with diabetes going through the transition from paediatric to adult services.
So, what is the evidence base for this embracing of modern technology? The Transition Service Specification document does have references but none relate to social media nor Skype. The news item, with quotes from NHS England’s National Clinical Directors for children and young people and obesity and diabetes cites the Newham DAWN scheme, another NHS news release. Research staff working on the DAWN project provide positive quotes for a service development funded by a £75,000 Health Foundation award but no peer-reviewed reference. A PubMed search for the clinical lead at Newham links to a BMJ Open1 article on virtual online consultations but this is a description of an on-going project. So, no evidence?
This seems to reflect a common practice within the NHS; pilot projects, with extra funding, are trialed but then adopted as mainstream practice before any results have been published. But is it a ‘given’ that new technologies are certain to provide benefit (and wouldn’t any transition service improve with a cash injection of £75K)?
The answer to the first question was thrown into doubt on the same day of the NHS news release. The six-month long ‘Scripps Wired for Health study’2, published in a peer-reviewed on-line journal, showed no clinical or economic benefit from digital health monitoring. Scripps recruited 160 patients with hypertension, diabetes, or arrhythmia and randomised them into an intervention group and a control group. Members of the intervention group were issued an iPhone 4 and a connected device – how could it fail to show benefit, and yet it did….
This is a plea, not for nihilism regarding modern developments in medicine, but for proper peer-reviewed assessment of any technology before national institutions recommend widespread adoption. NICE mandates this level of evidence; why should standards be lower in other areas of practice?
Professor Steve Bain