Flumignan Carolina Dutra Queiroz, Rocha Aline Pereira da, Pinto Ana Carolina Pereira Nunes, Milby Keilla Machado Martins, Batista Mayara Rodrigues, Atallah Álvaro Nagib, Saconato Humberto
MD, PhD. Postdoctoral Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), and Volunteer Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
MSc. Pharmacist and Doctoral Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), and Volunteer Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
Sao Paulo Med J. 2019 Jul 15;137(2):184-192. doi: 10.1590/1516-3180.0177240419.
Telemedicine has emerged as a tool for overcoming the challenges of healthcare systems and is likely to become increasingly viable, since information and communication technologies have become more sophisticated and user-friendly.
We aimed to identify all Cochrane systematic reviews (CSRs) on telemedicine within healthcare and to summarize the current evidence regarding its use.
Review of CSRs, developed at the Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo.
We searched for studies that compared use of telemedicine with conventional treatment or management of diseases within healthcare. Diagnostic telemedicine studies or studies using automatic text, voice-text or even self-managed care were excluded. The main characteristics and the certainty of evidence were synthetized and critically discussed by all authors.
We included 10 CSRs that investigated a broad range of diseases. There is still insufficient evidence to determine what types of telemedicine interventions are effective, for which patients and in which settings, and whether such interventions can be used as a replacement for the standard treatment. Harm relating to telemedicine technologies needs to be better investigated and addressed.
Telemedicine might be an excellent way to facilitate access to treatment, monitoring and dissemination of important clinical knowledge. However, given the recognition of systematic reviews as the best evidence resource available for decision-making, further randomized controlled trials with stricter methods are necessary to reduce the uncertainties in evidence-based use of telemedicine.
远程医疗已成为克服医疗保健系统挑战的一种工具，并且随着信息和通信技术变得更加先进且用户友好，它可能会变得越来越可行。
我们旨在识别所有关于医疗保健领域远程医疗的Cochrane系统评价（CSRs），并总结有关其应用的当前证据。
对圣保罗联邦大学保罗医科大学急诊与循证医学学科开展的CSRs进行综述。
我们搜索了比较远程医疗与医疗保健领域内疾病的传统治疗或管理方法的研究。排除了诊断性远程医疗研究或使用自动文本、语音文本甚至自我管理护理的研究。所有作者综合并批判性地讨论了主要特征和证据的确定性。
我们纳入了10项调查广泛疾病的CSRs。仍然没有足够的证据来确定哪些类型的远程医疗干预措施是有效的，针对哪些患者以及在哪些环境中有效，以及这些干预措施是否可以替代标准治疗。与远程医疗技术相关的危害需要得到更好的研究和解决。
远程医疗可能是促进获得治疗、监测和传播重要临床知识的绝佳方式。然而，鉴于系统评价被认为是可用于决策的最佳证据资源，有必要进行更严格方法的进一步随机对照试验，以减少远程医疗循证使用中的不确定性。
