The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review.
The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review.
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DOI：
10.2196/45944
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发表时间：
2023-06-28
影响因子：
7.4
通讯作者：
中科院分区：
文献类型：
--
作者：
多病是指一个人同时出现一种以上的病症，是初级保健中的一个全球性卫生问题。多病患者往往生活质量较差，护理过程复杂。临床决策支持系统（cdss）和远程医疗是常用的信息和通信技术，已被用于减少患者管理的复杂性。然而，远程医疗和cdss的每个要素通常是单独检查的，并且存在很大的差异。远程医疗已被用于简单的患者教育以及更复杂的咨询和病例管理。对于cdss，在数据输入、预期用户和输出方面存在可变性。因此，关于如何将cdss整合到远程医疗中，以及这些整合的技术干预在多大程度上可以帮助改善患有多种疾病的患者的预后，存在一些知识空白。我们的目的是：(1)广泛回顾cdss的系统设计，这些系统已经集成到初级保健中多病患者远程医疗的每个功能中，(2)总结干预措施的有效性，(3)确定文献中的空白。在PubMed、Embase、CINAHL和Cochrane上进行了截至2021年11月的文献在线搜索。从参考文献列表中进行检索，以找到其他潜在的研究。合格标准是该研究的重点是cdss在远程医疗中对初级保健中多病患者的使用。从软件和硬件、输入源、输入、任务、输出和用户四个方面进行了系统设计。每个组成部分按远程医疗功能分组：远程监护、远程会诊、远程病例管理和远程教育。本综述纳入7项实验研究：3项随机对照试验（rct）和4项非随机对照试验。干预措施旨在管理糖尿病、高血压、多种药物和妊娠糖尿病患者。cdss可用于各种远程医疗功能：远程监测（例如，反馈）、远程会诊（例如，指南建议、咨询材料的提供和对简单查询的回应）、远程病例管理（例如，跨设施和团队共享信息）和远程教育（例如，患者自我管理）。然而，cdss的结构（如数据输入、任务、输出和预期用户或决策者）各不相同。由于有限的研究检查了不同的临床结果，因此干预措施的临床有效性证据不一致。远程医疗和cdss在支持多病患者方面具有重要作用。可以将cdss纳入远程保健服务，以提高护理的质量和可及性。然而，围绕这些干预措施的问题需要进一步探讨。这些问题包括扩大所检查疾病的范围；检查cdss的任务，特别是在筛选和诊断多种疾病方面；探索患者作为CDSS直接使用者的角色。
Multimorbidity, the presence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies that have been used to reduce the complexity of patient management. However, each element of telemedicine and CDSSs is often examined separately and with great variability. Telemedicine has been used for simple patient education as well as more complex consultations and case management. For CDSSs, there is variability in data inputs, intended users, and outputs. Thus, there are several gaps in knowledge about how to integrate CDSSs into telemedicine and to what extent these integrated technological interventions can help improve patient outcomes for those with multimorbidity. Our aims were to (1) broadly review system designs for CDSSs that have been integrated into each function of telemedicine for multimorbid patients in primary care, (2) summarize the effectiveness of the interventions, and (3) identify gaps in the literature. An online search for literature was conducted up to November 2021 on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference lists was done to find additional potential studies. The eligibility criterion was that the study focused on the use of CDSSs in telemedicine for patients with multimorbidity in primary care. The system design for the CDSS was extracted based on its software and hardware, source of input, input, tasks, output, and users. Each component was grouped by telemedicine functions: telemonitoring, teleconsultation, tele–case management, and tele-education. Seven experimental studies were included in this review: 3 randomized controlled trials (RCTs) and 4 non-RCTs. The interventions were designed to manage patients with diabetes mellitus, hypertension, polypharmacy, and gestational diabetes mellitus. CDSSs can be used for various telemedicine functions: telemonitoring (eg, feedback), teleconsultation (eg, guideline suggestions, advisory material provisions, and responses to simple queries), tele–case management (eg, sharing information across facilities and teams), and tele-education (eg, patient self-management). However, the structure of CDSSs, such as data input, tasks, output, and intended users or decision-makers, varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions. Telemedicine and CDSSs have a role in supporting patients with multimorbidity. CDSSs can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined; examining tasks of CDSSs, particularly for screening and diagnosis of multiple conditions; and exploring the role of the patient as the direct user of the CDSS.
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