Norwegian Centre for Integrated Care and Telemedicine, Tromsø, Norway.
J Telemed Telecare. 2012 Jun;18(4):211-20. doi: 10.1258/jtt.2012.120219.
A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory.
进行了文献回顾，以了解远程医疗在管理五种常见慢性病（哮喘、COPD、糖尿病、心力衰竭、高血压）方面的价值。共确定了 141 项随机对照试验（RCT），其中总共对 37695 名患者测试了 148 种不同类型的远程医疗干预措施。每种干预措施的价值都根据该试验中研究人员指定的结果进行分类，即没有尝试从所有研究中提取一个共同的结果，因为这需要进行常规的荟萃分析。总结这些干预措施的价值表明，首先，大多数研究报告了积极的效果（n=108），几乎没有研究报告了负面效果（n=2）。这表明存在发表偏倚。其次，慢性病之间没有显著差异，即远程医疗在研究的疾病中似乎同样有效（或无效）。第三，大多数研究都是短期的（中位数持续时间为 6 个月）。在慢性病中，任何干预措施都不可能产生太大效果，除非长期应用。最后，很少有关于成本效益的研究。因此，远程医疗在管理慢性病方面的价值的证据基础总体上是薄弱和相互矛盾的。
