Hersh William R, Hickam David H, Severance Susan M, Dana Tracy L, Pyle Krages Kathryn, Helfand Mark
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 97239, USA.
J Telemed Telecare. 2006;12 Suppl 2:S3-31. doi: 10.1258/135763306778393117.
Telemedicine services are being increasingly used. Although insurers and other payers are covering some services in the USA, the rationale for these coverage decisions is not always evidence-based. We reviewed the literature for telemedicine services that substitute for face-to-face medical diagnosis and treatment. We focused on three types of telemedicine services: store-and-forward, home-based and office/hospital-based services. Studies were included if they were relevant to at least one of the three study areas, addressed at least one key question and contained reported results. We excluded articles that did not study a service requiring face-to-face encounters (i.e. teleradiology was excluded). Our search initially identified 4083 citations. After review, 597 were judged to be potentially relevant at the title/abstract level. Following a full-text review, 106 studies were included. Store-and-forward services have been studied in many specialties, the most common being dermatology, wound care and ophthalmology. The evidence for their efficacy is mixed. Several limited studies showed the benefits of home-based telemedicine interventions in chronic diseases. Studies of office/hospital-based telemedicine suggest that telemedicine is most effective for verbal interactions, e.g. videoconferencing for diagnosis and treatment in specialties like neurology and psychiatry. There are still significant gaps in the evidence base between where telemedicine is used and where its use is supported by high-quality evidence. Further well-designed research is necessary to understand how best to deploy telemedicine services in health care.
远程医疗服务的使用越来越广泛。尽管在美国，保险公司和其他付款方正在为一些服务提供覆盖，但这些覆盖决策的依据并不总是基于证据的。我们查阅了有关替代面对面医疗诊断和治疗的远程医疗服务的文献。我们重点关注三种类型的远程医疗服务：存储转发、居家和基于办公室/医院的服务。如果研究与三个研究领域中的至少一个相关、解决了至少一个关键问题并包含报告的结果，则将其纳入。我们排除了未研究需要面对面接触的服务的文章（即排除了远程放射学）。我们的搜索最初识别出4083条引文。经过审查，在标题/摘要层面有597条被判定可能相关。经过全文审查，纳入了106项研究。存储转发服务已在许多专科中得到研究，最常见的是皮肤科、伤口护理和眼科。其疗效的证据好坏参半。几项有限的研究显示了居家远程医疗干预在慢性病中的益处。基于办公室/医院的远程医疗研究表明，远程医疗在言语互动方面最有效，例如在神经科和精神科等专科通过视频会议进行诊断和治疗。在远程医疗的使用现状与高质量证据支持其使用的情况之间，证据基础仍存在重大差距。需要进一步精心设计的研究来了解如何在医疗保健中最佳地部署远程医疗服务。
