Department of Social Medicine, China Medical University, P.R. China.
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, USA.
J Telemed Telecare. 2021 Jan;27(1):3-22. doi: 10.1177/1357633X19856746. Epub 2019 Jul 18.
Mobile health has a promising future in the healthcare system in most developed countries. China's rapidly developing mobile technology infrastructure offers an unprecedented opportunity for wide adoption of mobile health interventions in the delivery of effective and timely healthcare services. However, there is little data on the current extent of the mobile health landscape in China. The aim of this study was to systematically review the existing mobile health initiatives in China, characterise the technology used, disease categories targeted, location of the end user (urban versus rural), and examine the potential effects of mobile health on health system strengthening in China. Furthermore, we identified gaps in development and evaluation of the effectiveness of mobile health interventions.
A systematic review of the literature published from 18 December 2015 - 3 April 2019 was conducted and yielded 2863 articles from English and Chinese retrieval database and trial registries, including PubMed, EMBASE, China National Knowledge of Infrastructure and World Health Organization International Clinical Trials Registry Platform. Studies were included if they used mobile health to support patient healthcare outcomes.
A total of 1129 full-text articles were assessed and 338 were included in this study. The review found that most studies targeted client education and behaviour change via applications (apps) (65.4%), including WeChat, and text messaging (short text messages) (19.8%) to improve patient medical treatment outcomes such as compliance and appointment reminders. The most common disease-specific mobile health interventions focused primarily on chronic disease management and behaviour change in cardiology (13.3%), endocrinology/diabetes (12.1%), behavioural health (11.8%), oncology (11.2%) and neurology (6.8%). The mobile health interventions related to nutrition (0.6%) and chronic respiratory diseases (1.6%) are underrepresented in mobile health in comparison to the burden of disease in China. The majority (90.0%) of the mobile health interventions were conducted exclusively in urban areas, with few opportunities reaching rural populations.
Overall, mobile health has a promising future in China, with recent rapid growth in initiatives. The majority are focused on education and behaviour change in the realm of chronic diseases and target patients in urban areas. The imbalance in mobile health between the urban and rural areas, as well as between population disease spectrum and health service delivery, pose substantial dilemmas. However, mobile health may be redirected to correct this imbalance, possibly improving access to healthcare services, and filling the gaps in order to improve health equity for the underserved populations in China.
移动医疗在大多数发达国家的医疗体系中有广阔的前景。中国快速发展的移动技术基础设施为广泛采用移动医疗干预措施提供了前所未有的机会，以提供有效和及时的医疗服务。然而，关于中国移动医疗的现状，数据很少。本研究的目的是系统地回顾中国现有的移动医疗计划，描述所使用的技术、针对的疾病类别、最终用户的位置（城市与农村），并研究移动医疗对中国加强卫生系统的潜在影响。此外，我们还发现了移动医疗干预措施的发展和评估方面的差距。
对 2015 年 12 月 18 日至 2019 年 4 月 3 日发表的文献进行了系统的文献回顾，从英语和中文检索数据库以及试验登记处（包括 PubMed、EMBASE、中国国家知识基础设施和世界卫生组织国际临床试验注册平台）中检索到 2863 篇文章。如果使用移动医疗支持患者医疗结果，则将研究纳入。
共评估了 1129 篇全文文章，其中 338 篇纳入本研究。综述发现，大多数研究通过应用程序（apps）（65.4%），包括微信和短信（19.8%）来进行客户端教育和行为改变，以改善患者的医疗效果，如依从性和预约提醒。最常见的特定疾病的移动医疗干预主要集中在心脏病学的慢性病管理和行为改变上（13.3%）、内分泌/糖尿病（12.1%）、行为健康（11.8%）、肿瘤学（11.2%）和神经病学（6.8%）。与中国的疾病负担相比，与营养（0.6%）和慢性呼吸道疾病（1.6%）相关的移动医疗干预措施在移动医疗中代表性不足。大多数（90.0%）移动医疗干预措施仅在城市地区进行，农村地区的机会很少。
总体而言，移动医疗在中国有着广阔的前景，最近的举措迅速增加。大多数措施都集中在慢性病教育和行为改变领域，目标人群是城市地区的患者。城乡之间、人口疾病谱与卫生服务提供之间的移动医疗不平衡，构成了重大的困境。然而，移动医疗可能会被重新定位，以纠正这种不平衡，可能会改善医疗服务的可及性，并填补差距，从而改善中国服务不足人群的健康公平性。
