Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer.
Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer.
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DOI：
10.2196/jmir.6688
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发表时间：
2017-05-17
影响因子：
7.4
通讯作者：
Pinnock H
中科院分区：
文献类型：
--
作者：
Hanlon P;Daines L;Campbell C;McKinstry B;Weller D;Pinnock H
自我管理支持是提出远程保健干预措施以促进长期条件管理的一种机制。这一元审查的目的是(1)评估远程保健干预措施对疾病控制和卫生保健利用的自我管理的影响，以及(2)确定远程保健支持的组成部分及其对疾病控制和自我管理过程的影响。我们的目标是综合远程健康支持的糖尿病(1型和2型)、心力衰竭、哮喘、慢性阻塞性肺疾病(COPD)和癌症的自我管理的证据，以确定有效的自我管理支持的组成部分。我们对远程健康干预的随机对照试验(RCT)进行了Metareview(系统回顾)，以支持在6个样本长期条件下的自我管理。我们在7个数据库中搜索2000年1月至2016年5月发表的综述，并根据资格标准筛选确定的研究。我们根据质量(修订后的评估系统评审的衡量工具)、规模和相关性对评审进行加权。然后，我们将我们的结果结合到一个叙事综合中，并使用收获情节。我们纳入了53篇系统性评价，包括232篇独特的随机对照试验。综述涉及糖尿病(1型6例；2型11例；混合型19例)、心力衰竭(n=9)、哮喘(n=8)、慢性阻塞性肺疾病(n=8)和癌症(n=3)。不同病区之间和病区内的研究结果各不相同。最高权重的综述显示，远程血糖监测和反馈以及一些教育和生活方式干预改善了2型糖尿病的血糖控制，但不能改善1型糖尿病的血糖控制，远程监测和电话干预降低了心力衰竭的死亡率和住院人数，但这些结果并不在所有综述中都是一致的。其他情况的结果好坏参半，尽管没有综述显示有害的证据。对自我管理的调解作用以及成功干预措施的组成部分的分析是有限的，也是不确定的。更密集和多方面的干预与糖尿病、心力衰竭和哮喘的更大改善相关。虽然远程医疗中介的自我管理并不总是优于常规护理，但没有一篇综述报告任何负面影响，这表明远程医疗是提供自我管理支持的安全选择，特别是在心力衰竭和2型糖尿病等证据基础更发达的情况下。在建立可利用远程保健技术支持自我管理的程度之前，需要根据明确的自我管理理论对远程保健支持的自我管理进行更大规模的试验。
Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.