The Empirical Foundations of Telemedicine Interventions in Primary Care
The Empirical Foundations of Telemedicine Interventions in Primary Care
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DOI：
10.1089/tmj.2016.0045
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发表时间：
2016-05-01
影响因子：
4.7
通讯作者：
Doarn, Charles R.
中科院分区：
文献类型：
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作者：
Bashshur, Rashid L.;Howell, Joel D.;Doarn, Charles R.
导言：这篇文章为远程医疗干预在初级保健中的优点提供了科学证据。尽管初级保健没有统一和一致的定义，但大多数人都认为，初级保健作为寻求护理的患者的第一次接触，以及护理的看门人和协调员，在医疗保健系统中占据着核心角色。它支持和支持以患者为中心的护理、医疗之家、管理式护理、责任护理和人口健康。对可持续性的日益担忧和初级保健医生的预期短缺引发了人们对探索远程医疗在解决美国和世界初级保健面临的许多挑战方面的潜力的兴趣。材料和方法：这些发现基于对2005年至2015年发表的科学研究的系统回顾。最初的检索产生了2308篇文章，其中86篇符合纳入标准。根据可行性/接受性、中间结果、健康结果和成本对证据进行组织和评估。结果：大多数研究支持远程医疗用于初级保健的可行性/接受性，尽管它因人口统计变量而有显著差异，例如性别、年龄和社会经济地位，而且远程医疗通常比医疗保健提供者更容易被患者接受。结果数据有限，但总体上表明，远程医疗干预通常至少与传统护理一样有效。成本分析各不相同，但初级保健中的远程医疗越来越显示出具有成本效益。结论：远程医疗在解决当今医疗环境中初级保健面临的许多挑战方面具有巨大的潜力。在用科学的严谨性验证远程医疗对临床结果的影响以及标准化评估成本的方法方面仍然存在挑战，但患者和提供者的接受度越来越高，使远程医疗成为世界各地初级保健的可行和不可或缺的组成部分。
Introduction: This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. Materials and Methods: The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. Results: The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. Conclusions: Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.