Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Department of Medicine, University of Alberta, Edmonton, Canada.
Am J Kidney Dis. 2018 Oct;72(4):592-600. doi: 10.1053/j.ajkd.2018.02.353. Epub 2018 Apr 23.
Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain.
照顾需要透析的终末期肾病 (ESRD) 患者需要投入大量的精力和费用。远程医疗可能会提高 ESRD 护理的可及性和效率。在这篇观点文章中，我们系统地回顾了评估远程医疗与常规护理相比或在常规护理之外用于 ESRD 管理的有效性的研究。确定了 10 项研究，包括 7 项随机试验和 3 项队列研究。研究人群、提供方式（包括电话、遥测或视频会议）以及评估的结果在研究之间差异很大。两项研究比较了远程医疗干预与标准 ESRD 护理，在护理过程方面的结果喜忧参半，对 ESRD 护理的实验室替代标志物无差异，住院率降低或相似。八项研究评估了远程医疗在常规护理中的附加作用，在护理过程或替代实验室措施方面没有显著改善，对住院率的影响存在差异，对某些生活质量领域的影响也存在差异，包括心理健康的改善。尽管已经报道了远程医疗在 ESRD 护理中的潜在益处，但远程医疗的最佳设计和可能通过远程医疗改善的护理要素仍不确定。
