Brunton Lisa, Bower Peter, Sanders Caroline
NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
PLoS One. 2015 Oct 14;10(10):e0139561. doi: 10.1371/journal.pone.0139561. eCollection 2015.
As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake.
Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool.
705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or empowerment).
Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at an earlier stage of telehealth/service development.
随着全球慢性病负担的增加，政策制定者对采用远程医疗技术用于长期疾病管理（包括慢性阻塞性肺疾病（COPD））表现出浓厚兴趣。然而，其实施和持续使用仍然存在障碍。迄今为止，关于用户（患者/护理人员和工作人员）如何看待和体验该技术的定性研究有限。我们旨在系统地回顾和综合定性研究的结果，这些研究调查了COPD管理中远程医疗的用户观点和体验，以确定可能影响采用率的因素。
对已发表的关于用户（患者、其护理人员和临床医生）使用远程医疗技术管理慢性阻塞性肺疾病的定性研究进行系统回顾和元综合分析。检索截至2014年10月的ASSIA、CINAHL、Embase、Medline、PsychInfo和Web of Knowledge数据库。还检索了纳入研究的参考文献列表和关键论文的参考文献列表。质量评估以改编版的CASP定性评估工具为指导。
共识别出705篇参考文献（去除重复后），10篇与7项研究相关的论文纳入综述。纳入研究的大多数作者都确定了远程医疗在COPD管理中的积极和消极体验。通过一系列论证综合，我们能够从数据中得出新的见解，以确定三个总体主题，这些主题能够阻碍或促进COPD患者对远程医疗的积极用户体验：对寻求帮助的道德困境的影响（导致依赖或自我护理）；改变互动（增加风险或安心）以及“工作”实践的重新配置（造成负担或赋予权力）。
该元综合分析的结果对远程医疗服务的未来设计和实施具有启示意义。未来的研究需要在远程医疗/服务开发的早期阶段纳入潜在用户。
