Department of Cardiac, Thoracic, Vascular, and Public Health, Hygiene and Public Health Unit, University of Padova, Padova, Italy.
Hospital Direction, San Bortolo Hospital, Vicenza, Italy.
PLoS One. 2018 Nov 15;13(11):e0207332. doi: 10.1371/journal.pone.0207332. eCollection 2018.
Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues.
Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis.
None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0-4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5.
Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.
远程医疗家庭干预在慢性病管理中的有效性和成本效益的明确证据仍然缺乏。本研究考察了已发表的综述是否以及如何考虑和讨论不同因素对结果的影响，包括：干预的设置、目标和强度；患者参与度；患者、护理人员和卫生专业人员的观点；组织模式；患者教育和支持。对纳入的综述还评估了其经济和伦理问题。
开发了两种搜索算法，以扫描 2000 年至 2015 年间发表的关于基于 ICT 的干预措施用于管理高血压、糖尿病、心力衰竭、哮喘、慢性阻塞性肺疾病或老年患者护理的综述。根据我们的纳入标准，选择了 25 篇综述进行分析。
没有一篇纳入的综述涵盖了上述所有因素。它们主要考虑了目标（44%）和干预强度（24%）。设置、伦理问题、患者参与度和护理人员视角是最被忽视的因素（在 0-4%的综述中考虑）。只有 4 篇综述（16%）考虑了至少 11 个因素中的 4 个，综述中考虑的因素最多为 5 个。
可能涉及影响 ICT 干预有效性或成本效益的因素在文献中研究不足。这项研究建议考虑每个因素的作用，不仅比较疾病相关的结果，还比较患者和医疗保健组织的结果以及患者参与度，以了解干预措施的作用机制。
