Impact assessment of telehealth medical nutrition therapy for managing cardiovascular disease risk in rural and remote NSW: the Healthy Rural Hearts study.

backgroundThe impact of clinical trials extends beyond knowledge gained. However, broader impacts, including social, health and economic benefits to patients and communities are rarely assessed. In rural and remote regions where inclusion of local populations in clinical trials is limited, these assessments are even more rare. The Healthy Rural Hearts (HealthyRHearts) study aimed to reduce cardiovascular disease (CVD) risk in rural Australians through a medical nutrition therapy (MNT) intervention delivered via telehealth following a primary care heart health assessment. This provided an opportunity to evaluate its impacts more broadly and to guide future investment in rural clinical trials.

methodsData on the impacts of the HealthyRHearts study were obtained from administrative records, document analysis, relevant websites/databases and in-depth interviews using three methods within the Framework to Assess Impact from Translational Health Research (FAIT). These include (1) a modification of the Payback Framework reported as quantified metrics, (2) a cost-consequence analysis (CCA) to determine return on investment and (3) a narrative account of impact generated from the study using qualitative data.

resultsThe modified Payback Framework identified significant knowledge advancement through publications, training materials and economic benefits from employment opportunities and leveraged funding. However, the greatest impacts were improvements in rural healthcare and research capacity through training and support offered to dietitians, project staff, general (primary care) practice staff and patients. The majority of patients had improved CVD risk scores, activation in healthcare participation, health literacy and quality of life at trial completion. The CCA demonstrated a modest return of $1.31 ($0.69-1.89) for each Australian dollar invested. Dietitians and general practice staff interviewed identified personal satisfaction as a benefit of participation, with dietitians reporting economic benefits as a result of their new skills. Patients reported that their nutrition knowledge and dietary behaviours improved, leading to perceived improvements in their health and wellbeing.

conclusionsThe HealthyRHearts trial delivered significant impact in knowledge gain, while building healthcare and research capacity and capability in rural communities. Patient and community benefits were also delivered, with a potentially small but positive return on investment, suggesting that investment in rural clinical trials has broad-ranging benefits beyond research outcomes alone.