Kruse Clemens, Pesek Brandon, Anderson Megan, Brennan Kacey, Comfort Hilary
School of Health Administration, Texas State University, San Marcos, TX, United States.
JMIR Med Inform. 2019 Mar 20;7(1):e11496. doi: 10.2196/11496.
Chronic obstructive pulmonary disease (COPD) is a leading cause of death throughout the world. Telemedicine has been utilized for many diseases and its prevalence is increasing in the United States. Telemonitoring of patients with COPD has the potential to help patients manage disease and predict exacerbations.
The objective of this review is to evaluate the effectiveness of telemonitoring to manage COPD. Researchers want to determine how telemonitoring has been used to observe COPD and we are hoping this will lead to more research in telemonitoring of this disease.
This review was conducted in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Authors performed a systematic review of the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to obtain relevant articles. Articles were then accepted or rejected by group consensus. Each article was read and authors identified barriers and facilitators to effectiveness of telemonitoring of COPD.
Results indicate that conflicting information exists for the effectiveness of telemonitoring of patients with COPD. Primarily, 13 out of 29 (45%) articles stated that patient outcomes were improved overall with telemonitoring, while 11 of 29 (38%) indicated no improvement. Authors identified the following facilitators: reduced need for in-person visits, better disease management, and bolstered patient-provider relationship. Important barriers included low-quality data, increased workload for providers, and cost.
The high variability between the articles and the ways they provided telemonitoring services created conflicting results from the literature review. Future research should emphasize standardization of telemonitoring services and predictability of exacerbations.
慢性阻塞性肺疾病（COPD）是全球主要的死亡原因之一。远程医疗已被应用于多种疾病，且在美国其普及率正在上升。对慢性阻塞性肺疾病患者进行远程监测有潜力帮助患者管理疾病并预测病情加重。
本综述的目的是评估远程监测在管理慢性阻塞性肺疾病方面的有效性。研究人员希望确定远程监测是如何用于观察慢性阻塞性肺疾病的，并且我们希望这将引发对该疾病远程监测的更多研究。
本综述按照多系统评价评估（AMSTAR）进行，并按照系统评价和Meta分析的首选报告项目（PRISMA）进行报告。作者对PubMed和护理及联合健康文献累积索引（CINAHL）数据库进行了系统评价，以获取相关文章。然后通过小组共识接受或拒绝文章。阅读每篇文章，作者确定了慢性阻塞性肺疾病远程监测有效性的障碍和促进因素。
结果表明，关于慢性阻塞性肺疾病患者远程监测的有效性存在相互矛盾的信息。主要地，29篇文章中有13篇（45%）指出远程监测总体上改善了患者的预后，而29篇中有11篇（38%）表明没有改善。作者确定了以下促进因素：减少面对面就诊的需求、更好的疾病管理以及加强患者与提供者的关系。重要障碍包括数据质量低、提供者工作量增加和成本。
文章之间以及它们提供远程监测服务的方式存在很大差异，导致文献综述产生了相互矛盾的结果。未来的研究应强调远程监测服务的标准化和病情加重的可预测性。
