Dyrvig Anne-Kirstine, Gerke Oke, Kidholm Kristian, Vondeling Hindrik
Centre for Innovative Medical Technologies, Odense University Hospital and University of Southern Denmark
Centre of Health Economics Research (COHERE), Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark.
J Telemed Telecare. 2015 Oct;21(7):377-84. doi: 10.1177/1357633X15572202. Epub 2015 Mar 10.
The studies that constitute the knowledge base of evidence based medicine represent only 5%-50% of patients seen in routine clinical practice. Therefore, whether the available evidence applies to the implementation of a particular service often remains unclear. Chronic obstructive pulmonary disease (COPD) is no exception.
In this article, the effects of implementing a telemedicine intervention for COPD patients were analysed using data collected before, during, and after a randomised controlled trial (RCT).More specifically, regression techniques using robust variance estimators were used to analyse whether the use of telemedicine, patient age, and gender could explain the risk of readmission, length of hospital admission, and death during a five-year observation period.
Increased risk of readmission was significantly related to both use of telemedicine and increased age in three sub-periods of the study, whereas women showed a more pronounced risk of readmission than men only during and after the RCT period. The number of days admitted to hospital was higher for patients using telemedicine and being of older age. Risk of death during the observation period was decreased for patients using telemedicine and for female patients and increased for elderly patients. No interaction between intervention and time period was observed.Statistically significant relationships were identified between use of telemedicine and risk of readmission, days admitted to hospital, and death.
Research on effect modification in telemedicine is essential in designing future implementation of interventions as it cannot be taken for granted that effectiveness follows from efficacy.
构成循证医学知识库的研究仅涵盖了常规临床实践中5%-50%的患者。因此，现有证据是否适用于特定服务的实施往往仍不明确。慢性阻塞性肺疾病（COPD）也不例外。
在本文中，利用一项随机对照试验（RCT）之前、期间和之后收集的数据，分析了对COPD患者实施远程医疗干预的效果。更具体地说，使用稳健方差估计量的回归技术来分析远程医疗的使用、患者年龄和性别是否能够解释五年观察期内的再入院风险、住院时间和死亡风险。
在研究的三个子阶段，再入院风险增加与远程医疗的使用和年龄增长均显著相关，而仅在RCT期间及之后，女性的再入院风险比男性更为明显。使用远程医疗且年龄较大的患者住院天数更多。使用远程医疗的患者和女性患者在观察期内的死亡风险降低，而老年患者的死亡风险增加。未观察到干预与时间段之间的交互作用。在远程医疗的使用与再入院风险、住院天数和死亡之间确定了具有统计学意义的关系。
远程医疗中效应修饰的研究对于设计未来的干预措施实施至关重要，因为不能想当然地认为有效性源于疗效。
