Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
JMIR Mhealth Uhealth. 2020 Apr 17;8(4):e15095. doi: 10.2196/15095.
High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions.
The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP?
A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review.
Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention's design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles.
Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.
高血压会使 2%至 8%的妊娠复杂化，其并发症存在于产前和产后期间。在就诊期间，通常会监测怀孕期间和之后的血压。一些指南建议使用家庭血压测量来管理和治疗高血压，并增加对高危妊娠的监测频率。血压自我监测可能有助于识别处于高危组的患者。因此，该高危妊娠组可能非常适合远程监测干预。
本研究旨在探讨在产前和产后期间使用远程监测对患有妊娠高血压疾病（HDP）高危患者的应用。本文旨在回答以下问题：与使用远程监测干预管理 HDP 高危患者相关的当前知识库是什么？
按照 Arksey 等人和 Levac 等人描述的方法框架进行文献回顾，以分析描述对 HDP 高危患者进行远程监测的研究。本范围综述纳入了定性研究、观察性研究和随机对照试验。
最初确定的 3904 篇文章中，有 20 篇符合纳入标准。大多数研究（20/20，65%）发表于 2017 年至 2018 年之间。总共在 20 篇文章中描述了 16 种独特的干预措施，所有这些措施都提供了临床决策支持，其中 12 种还用于促进 HDP 的自我管理。每个干预措施的设计和实施过程都有所不同。总体而言，HDP 管理的远程监测干预措施被认为是可行和方便的，并且可以方便地获得医疗服务。两项独特的研究报告了远程监测组的显著发现，即自然分娩的可能性更高，而一项研究，以两篇论文的形式发表，描述与对照组相比，诱导分娩的可能性更低。然而，由于样本量小、非随机分组和研究持续时间短，限制了纳入文章的研究结果。
尽管目前的证据表明远程监测可能对管理 HDP 高危患者有益，但仍需要更多的研究来证明其安全性和有效性。本综述提出了四项未来研究建议：（1）实施大型前瞻性研究以确定远程监测干预措施的安全性和有效性；（2）进一步研究确定特定情况下的要求和患者适用性，以增强远程地区和服务不足人群获得医疗保健服务的可及性；（3）纳入远程监测干预措施的隐私和安全考虑因素，以更好地遵守医疗保健信息法规和准则；（4）实施研究以更好地了解远程监测干预措施的有效组成部分。
