Bashshur Rashid L, Howell Joel D, Krupinski Elizabeth A, Harms Kathryn M, Bashshur Noura, Doarn Charles R
1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan.
2 Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.
Telemed J E Health. 2016 May;22(5):342-75. doi: 10.1089/tmj.2016.0045.
This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world.
The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost.
The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective.
Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
本文介绍了远程医疗干预在初级保健中的优势的科学证据。虽然对于初级保健没有统一且一致的定义，但大多数人都认为它在医疗保健系统中占据核心地位，是患者寻求医疗服务的首次接触点，也是医疗服务的守门人和协调者。它促进并支持以患者为中心的医疗、家庭医疗、管理式医疗、 accountable care（可译为“责任医疗”）以及人群健康。对可持续性的日益关注以及预计的初级保健医生短缺引发了人们对探索远程医疗在应对美国和全球初级保健面临的诸多挑战方面的潜力的兴趣。
研究结果基于对2005年至2015年发表的科学研究的系统综述。初步检索得到2308篇文章，其中86篇符合纳入标准。证据根据可行性/可接受性、中间结果、健康结果和成本进行组织和评估。
大多数研究支持远程医疗在初级保健中使用的可行性/可接受性，尽管它因人口统计学变量（如性别、年龄和社会经济地位）而有显著差异，并且人们通常发现患者比医疗服务提供者更容易接受远程医疗。结果数据有限，但总体表明远程医疗干预通常至少与传统护理一样有效。成本分析各不相同，但初级保健中的远程医疗越来越被证明具有成本效益。
在当今的医疗环境中，远程医疗在应对初级保健面临的许多挑战方面具有巨大潜力。在以科学严谨性验证其对临床结果的影响以及标准化评估成本的方法方面仍存在挑战，但患者和提供者的接受度越来越使远程医疗成为全球初级保健中可行且不可或缺的组成部分。
