Palacholla Ramya Sita, Fischer Nils, Coleman Amanda, Agboola Stephen, Kirley Katherine, Felsted Jennifer, Katz Chelsea, Lloyd Stacy, Jethwani Kamal
Partners HealthCare Pivot Labs, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
JMIR Cardio. 2019 Mar 26;3(1):e11951. doi: 10.2196/11951.
The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management.
This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators.
This review followed the methodological framework developed by Arskey and O'Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies.
A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients.
Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness.
数字健康技术（DHT）在临床实践中的应用率出奇地低。尽管DHT在改善患者治疗效果和疾病管理方面显示出巨大潜力，但关于导致DHT采用受限的因素的信息有限，尤其是在高血压管理方面。
本范围综述全面总结了已发表文献中报道的DHT用于高血压管理的障碍和促进因素，重点关注与提供者和患者相关的障碍和促进因素。
本综述遵循Arskey和O'Malley制定的方法框架。在PubMed或医学文献分析与检索系统在线数据库、护理学与健康相关文献累积索引以及医学文摘数据库中进行了系统的文献检索。2008年至2017年期间以英文发表的报道DHT用于高血压管理的障碍和/或促进因素的文章符合要求。未报道DHT用于高血压管理的障碍或促进因素的研究被排除。根据上述标准，在去除重复项后共识别出2299篇文章，并对其进行了资格评估。其中，2165篇参考文献不符合纳入标准。在对134项研究进行全文评估后，排除了98项研究（全文不可用或研究未满足纳入标准），最终得到32篇文章。此外，还挑选了4篇文章纳入本综述，共计36项研究。
经过2名独立评审员的摘要和全文筛选，共选择了36项研究进行数据提取。所有分歧均由第三名评审员解决。进行了主题分析，以从提供者和患者的角度确定与DHT的障碍和促进因素相关的主要主题。确定的医生采用DHT的关键促进因素包括易于与临床工作流程整合、改善患者治疗效果以及技术可用性和技术支持。技术可用性和及时的技术支持改善了自我管理和患者体验，对患者与提供者沟通产生积极影响是患者最常报告的促进因素。医生报告的DHT使用障碍包括与临床工作流程缺乏整合、技术未经验证以及技术可用性和技术支持不足。最后，技术可用性和技术支持不足、干扰患者与提供者的关系以及技术未经验证是患者最常报告的障碍。
研究结果表明，DHT的实施环境和背景以及参与实施的个人会影响其采用。最后，为了充分实现数字化高血压管理的潜力，更需要对这些技术进行验证，以便为患者和提供者提供关于临床结果和成本效益的可靠准确信息。
