Khanal Sumesh, Burgon Joseph, Leonard Saoirse, Griffiths Matthew, Eddowes Lucy A
1 Institute of Medicine, Tribhuvan University , Maharajgunj, Kathmandu, Nepal .
2 Costello Medical Consulting Ltd., Cambridge , United Kingdom .
Telemed J E Health. 2015 Nov;21(11):903-15. doi: 10.1089/tmj.2014.0194. Epub 2015 Jun 23.
A lack of decisive evidence on the impact of telemedicine on financial and clinical outcomes has not prohibited significant investment in developing countries. Understanding characteristics that facilitate effective telemedicine programs is required to allow telemedicine to be used to its full potential. This systematic review aimed to identify organizational, technological, and financial features of successful telemedicine programs providing direct clinical care in developing countries.
Databases were searched, and the results were reviewed systematically according to predefined inclusion/exclusion criteria. Information on location(s), measure of success, and organizational, technological, and financial characteristics were extracted. This review was impeded by inadequate program reporting, and so a concise checklist was developed to aid improved reporting, enabling future reviews to identify key characteristics of effective programs.
This systematic review identified 46 articles reporting 36 programs that fulfilled the inclusion/exclusion criteria. Programs were distributed globally, including regional, national, and international programs. Technological modalities included synchronous technology, real-time teleconsultations, and asynchronous technology. Program integration with existing systems and twinning of international institutions were identified as factors enabling program success. Other factors included simple and easy-to-use technology, ability to reduce the burden on healthcare professionals, and technology able to maintain functionality in challenging environmental circumstances. Reports describing effectiveness and costs were limited.
This systematic review identified key factors associated with telemedicine program success. However, inconsistencies in reporting represent an obstacle to establishment of successful programs in developing countries by limiting the application of previous experiences. Adhering to the guidelines suggested here may allow more quantitative assessments of effectiveness and impact for future programs.
尽管缺乏关于远程医疗对财务和临床结果影响的确凿证据，但这并未阻止发展中国家进行大量投资。需要了解有助于有效开展远程医疗项目的特征，以便充分发挥远程医疗的潜力。本系统评价旨在确定在发展中国家提供直接临床护理的成功远程医疗项目的组织、技术和财务特征。
检索数据库，并根据预先定义的纳入/排除标准对结果进行系统评价。提取有关地点、成功指标以及组织、技术和财务特征的信息。由于项目报告不充分，本评价受到阻碍，因此制定了一份简明清单以帮助改进报告，使未来的评价能够确定有效项目的关键特征。
本系统评价确定了46篇报告36个符合纳入/排除标准项目的文章。项目分布在全球，包括区域、国家和国际项目。技术模式包括同步技术、实时远程会诊和异步技术。项目与现有系统的整合以及国际机构的结对被确定为项目成功的因素。其他因素包括简单易用的技术、减轻医疗保健专业人员负担的能力以及能够在具有挑战性的环境条件下保持功能的技术。描述有效性和成本的报告有限。
本系统评价确定了与远程医疗项目成功相关的关键因素。然而，报告的不一致性限制了以往经验的应用，成为在发展中国家建立成功项目的障碍。遵循此处建议的指南可能会使未来项目对有效性和影响进行更多的定量评估。
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