Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review.
Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review.
复制标题
远程医疗的慢性疾病纵向管理：系统评价。
DOI：
10.2196/37100
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发表时间：
2022-08-26
影响因子：
7.4
通讯作者：
Goldstein, Karen M.
中科院分区：
文献类型：
--
作者：
Lewinski, Allison A.;Walsh, Conor;Rushton, Sharron;Soliman, Diana;Carlson, Scott M.;Luedke, Matthew W.;Halpern, David J.;Crowley, Matthew J.;Shaw, Ryan J.;Sharpe, Jason A.;Alexopoulos, Anastasia-Stefania;Tabriz, Amir Alishahi;Dietch, Jessica R.;Uthappa, Diya M.;Hwang, Soohyun;Ricks, Katharine A. Ball;Cantrell, Sarah;Kosinski, Andrzej S.;Ear, Belinda;Gordon, Adelaide M.;Gierisch, Jennifer M.;Williams, John W., Jr.;Goldstein, Karen M.
关键词：
大量文献支持将远程医疗作为充血性心力衰竭（CHF）和2型糖尿病（T2DM）等慢性病管理中面对面诊疗的补充或辅助手段。然而，需要有证据来支持将远程医疗作为与面对面诊疗等效且公平的替代方式，并评估其潜在的不良影响。
我们开展了一项系统评价，以解决以下问题：对于成年人，在CHF、慢性阻塞性肺疾病和T2DM的慢性病管理方面，同步远程医疗（通过电话或电话与视频实现个体间实时响应）与面对面诊疗（若为同步视频诊疗，则与电话诊疗相比）相比，对关键的疾病特异性临床结局和医疗保健利用情况有何影响？
我们遵循系统评价方法，检索了两个数据库（MEDLINE和Embase）。我们纳入了随机或准实验研究，这些研究评估了同步实施的远程医疗对相关慢性病的影响，要求研究涉及至少2次诊疗接触，且部分或全部面对面诊疗被通过电话或视频提供的诊疗所取代。我们使用Cochrane有效实践与医疗照护组织偏倚风险（ROB）工具评估偏倚，并使用推荐分级的评估、制定与评价（GRADE）方法评估证据的确定性。由于研究数量较少且已确定的干预措施在概念上存在异质性，我们对研究结果进行了叙述性描述，未进行荟萃分析。
我们共检索到8662项研究，其中129项（1.49%）进入全文审查阶段。最终，3.9%（5/129）的文章被保留用于数据提取，所有这些文章（5/5，100%）均为随机对照试验。关于CHF的研究（1/5，20%）被发现存在高偏倚风险，该研究将210名患者随机分组，一组接受每季度基于网络的自动异步遥测数据审查及随访，另一组接受为期1年的同步个人随访（面对面随访与电话随访）。对各研究组进行的三方比较发现，临床结局无显著差异。总体而言，80%（4/5）的研究（n = 466）评估了针对T2DM患者的同步诊疗（其中2项研究，即50%的研究，ROB被判定为低；另外2项研究，即50%的研究，ROB被判定为高）。总计，20%（1/5）的研究有足够的效能来评估组间糖化血红蛋白水平的差异，但未发现显著差异。干预设计差异很大，从结合视频的远程血糖监测与内分泌科门诊面对面就诊，到为期3周的简短远程干预以稳定未控制的糖尿病病情。未检索到关于慢性阻塞性肺疾病的相关文章。
本综述发现，将远程医疗作为面对面诊疗替代方式且设计和干预多样的研究较少。未来的研究应考虑纳入观察性研究以及针对其他高发性慢性病的研究。
Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases.
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