Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review
Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review
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DOI：
10.1111/jgs.15959
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发表时间：
2019-08-01
影响因子：
6.3
通讯作者：
Bartels, Stephen J.
中科院分区：
文献类型：
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作者：
Batsis, John A.;DiMilia, Peter R.;Bartels, Stephen J.
由交通和卫生人力困难造成的医疗保健获取和提供方面的差异对生活在农村地区的个人产生了负面影响。这些挑战在老年人中尤为突出。设计我们系统地评估了提供远程医疗（TMed）的可行性、可接受性和有效性，在以下数据库中检索了英语文献中的研究（2012年1月至2018年7月）：Medline（PubMed）;科克伦图书馆（Wiley）; Web of Science; CINAHL; EMBASE（奥维德）;和PsycINFO（EBSCO）。参与者老年人（平均年龄= 65岁或以上，无年龄小于60岁）。干预措施包括现场，同步，双向视频会议通信在非医院设置。包括所有医疗干预。使用科克伦协作组的偏倚风险工具对所有纳入的文章进行质量评估，包括所有文章的定性总结。结果在6616篇引文中，我们回顾了1173篇文章的全文，排除了1047篇不符合标准的文章。在17项随机对照试验中，美国是试验最多的国家（6项[35%]），队列规模范围为3至844（中位数= 35）例受试者。纳入研究的偏倚风险从低到高不等。我们的定性分析表明，TMed可以改善老年人的健康结果，它可以用于这一人群。结论：TMed在为老年人提供护理方面是可行和可接受的。研究应该集中在设计良好的随机试验，以克服我们的综合观察到的高度偏倚。临床医生应考虑在常规实践中使用TMed，以克服距离和获得护理的障碍。J Am Geriatr Soc 67：1737-1749，2019
BACKGROUND Disparities in healthcare access and delivery, caused by transportation and health workforce difficulties, negatively impact individuals living in rural areas. These challenges are especially prominent in older adults. DESIGN We systematically evaluated the feasibility, acceptability, and effectiveness in providing telemedicine (TMed), searching the English-language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO). PARTICIPANTS Older adults (mean age = 65 years or older, and none were younger than 60 years). INTERVENTIONS Interventions consisted of live, synchronous, two-way videoconferencing communication in nonhospital settings. All medical interventions were included. MEASUREMENTS Quality assessment, using the Cochrane Collaboration's Risk-of-Bias Tool, was applied on all included articles, including a qualitative summary of all articles. RESULTS Of 6616 citations, we reviewed the full text of 1173 articles, excluding 1047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]), with cohort sizes ranging from 3 to 844 (median = 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that TMed can improve health outcomes in older adults and that it could be used in this population. CONCLUSIONS TMed is feasible and acceptable in delivering care to older adults. Research should focus on well-designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using TMed in routine practice to overcome barriers of distance and access to care. J Am Geriatr Soc 67:1737-1749, 2019