Alvarado Michelle M, Kum Hye-Chung, Gonzalez Coronado Karla, Foster Margaret J, Ortega Pearl, Lawley Mark A
Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.
Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, United States.
J Med Internet Res. 2017 Feb 13;19(2):e28. doi: 10.2196/jmir.6382.
Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption.
The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes.
The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified.
A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%).
The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability.
糖尿病自我管理涉及坚持健康的日常习惯，通常包括血糖监测、药物治疗、运动和饮食。为支持自我管理，一些医疗服务提供者已开始试验远程干预措施，以便在门诊就诊期间对患者进行监测和协助。尽管一些研究已取得成功，但广泛采用仍存在障碍。
我们研究的目的是识别并分类2型糖尿病管理中远程健康采用的障碍。
检索了以下6个电子数据库，以查找2010年至2015年发表的文章：MEDLINE（Ovid）、Embase（Ovid）、CINAHL、Cochrane Central、Northern Light Life Sciences Conference Abstracts和Scopus（爱思唯尔）。该检索确定了涉及2型糖尿病自我管理远程技术的研究。评审人员以两人一组的形式工作，对选定论文进行评审并提取数据。收集的信息包括研究特征、结果、退出率、使用的技术以及识别出的障碍。
共有41项研究的53篇出版物符合指定标准。因输入偏差导致的数据准确性不足（32%，13/41）、可扩展性限制（24%，10/41）和技术文盲（24%，10/41）是最常被提及的障碍。技术文盲在低收入人群中最为突出，而可扩展性限制在中等收入人群中更为突出。识别出的障碍被应用于成功的远程健康概念模型，该模型包括患者参与度、患者技术可及性、护理质量、系统技术成本和医疗服务提供者的生产力。总共40.5%（60/148）的已识别障碍实例阻碍了患者参与度，这在引用的高退出率（高达57%）中得到体现。
识别出的障碍代表了糖尿病远程健康干预设计中的重大挑战。需要突破性技术和系统来缓解迄今识别出的障碍，特别是那些与患者参与度相关的障碍。能够提供关于药物治疗、运动、饮食和血糖监测的客观可靠数据流的监测设备对于广泛的有效性至关重要。需要开展更多工作来了解高退出率的根本原因，并且需要新的干预措施来识别和帮助那些退出风险最大的人。最后，未来的研究必须量化成本和效益，以确定财务可持续性。
