Verhoeven Fenne, van Gemert-Pijnen Lisette, Dijkstra Karin, Nijland Nicol, Seydel Erwin, Steehouder Michaël
Department of Technical and Professional Communication, University of Twente, Faculty of Behavioral Sciences, PO Box 217, 7500 AE Enschede, The Netherlands.
J Med Internet Res. 2007 Dec 14;9(5):e37. doi: 10.2196/jmir.9.5.e37.
A systematic literature review was carried out to study the benefits of teleconsultation and videoconferencing on the multifaceted process of diabetes care. Previous reviews focused primarily on usability of technology and considered mainly one-sided interventions.
The objective was to determine the benefits and deficiencies of teleconsultation and videoconferencing regarding clinical, behavioral, and care coordination outcomes of diabetes care.
Electronic databases (Medline, PiCarta, PsycINFO, ScienceDirect, Telemedicine Information Exchange, ISI Web of Science, Google Scholar) were searched for relevant publications. The contribution to diabetes care was examined for clinical outcomes (eg, HbA(1c), blood pressure, quality of life), behavioral outcomes (patient-caregiver interaction, self-care), and care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of care access). Randomized controlled trials (RCTs) with HbA(1c) as an outcome were pooled using standard meta-analytical methods.
Of 852 publications identified, 39 met the inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1, type 2, or gestational diabetes. Studies that evaluated teleconsultation or videoconferencing not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (eg, HbA(1c)). There were 22 interventions related to teleconsultation, 13 to videoconferencing, and 4 to combined teleconsultation and videoconferencing. The heterogeneous nature of the identified videoconferencing studies did not permit a formal meta-analysis. Pooled results from the six RCTs of the identified teleconsultation studies did not show a significant reduction in HbA(1c) (0.03%, 95% CI = - 0.31% to 0.24%) compared to usual care. There was no significant statistical heterogeneity among the pooled RCTs (chi(2) (7)= 7.99, P = .33). It can be concluded that in the period under review (1994-2006) 39 studies had a scope broader than clinical outcomes and involved interventions allowing patient-caregiver interaction. Most of the reported improvements concerned satisfaction with technology (26/39 studies), improved metabolic control (21/39), and cost reductions (16/39). Improvements in quality of life (6/39 studies), transparency (5/39), and better access to care (4/39) were hardly observed. Teleconsultation programs involving daily monitoring of clinical data, education, and personal feedback proved to be most successful in realizing behavioral change and reducing costs. The benefits of videoconferencing were mainly related to its effects on socioeconomic factors such as education and cost reduction, but also on monitoring disease. Additionally, videoconferencing seemed to maintain quality of care while producing cost savings.
The selected studies suggest that both teleconsultation and videoconferencing are practical, cost-effective, and reliable ways of delivering a worthwhile health care service to diabetics. However, the diversity in study design and reported findings makes a strong conclusion premature. To further the contribution of technology to diabetes care, interactive systems should be developed that integrate monitoring and personalized feedback functions.
开展了一项系统文献综述，以研究远程会诊和视频会议在糖尿病护理多方面过程中的益处。以往的综述主要关注技术的可用性，且主要考虑单方面干预措施。
目的是确定远程会诊和视频会议在糖尿病护理的临床、行为和护理协调结果方面的益处与不足。
检索电子数据库（Medline、PiCarta、PsycINFO、ScienceDirect、远程医疗信息交换库、ISI科学网、谷歌学术）以查找相关出版物。从临床结果（如糖化血红蛋白[HbA₁c]、血压、生活质量）、行为结果（患者与照护者互动、自我护理）和护理协调结果（技术可用性、成本效益、指南透明度、护理可及性公平性）方面考察对糖尿病护理的贡献。以HbA₁c作为结果的随机对照试验（RCT）采用标准荟萃分析方法进行汇总。
在识别出的852篇出版物中，39篇符合照护者（群体）与1型、2型或妊娠期糖尿病患者之间电子通信的纳入标准。排除了那些并非特别针对糖尿病评估远程会诊或视频会议的研究，以及那些仅描述旨在改善临床状况（如HbA₁c）的干预措施的研究。有22项干预措施与远程会诊相关，13项与视频会议相关，4项与远程会诊和视频会议相结合相关。已识别出的视频会议研究的异质性使得无法进行正式的荟萃分析。与常规护理相比，已识别出的远程会诊研究的六项RCT的汇总结果未显示HbA₁c有显著降低（0.03%，95%可信区间 = -0.31%至0.24%）。汇总的RCT之间不存在显著的统计学异质性（卡方(7)= 7.99，P = 0.33）。可以得出结论，在审查期间（1994 - 2006年），39项研究的范围比临床结果更广泛，且涉及允许患者与照护者互动的干预措施。报告的大多数改善涉及对技术的满意度（26/39项研究）、代谢控制改善（21/39）和成本降低（16/39）。几乎未观察到生活质量改善（6/39项研究）、透明度提高（5/39）和更好的护理可及性（4/39）。事实证明，涉及临床数据每日监测、教育和个人反馈的远程会诊项目在实现行为改变和降低成本方面最为成功。视频会议的益处主要与其对教育和成本降低等社会经济因素的影响有关，但也与疾病监测有关。此外，视频会议似乎在节省成本的同时维持了护理质量。
所选研究表明，远程会诊和视频会议都是为糖尿病患者提供有价值的医疗服务的实用、具有成本效益且可靠的方式。然而，研究设计和报告结果的多样性使得过早得出强有力的结论尚不成熟。为进一步提升技术对糖尿病护理的贡献，应开发整合监测和个性化反馈功能的交互式系统。
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