Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom.
Health Division Organisation for Economic Co-operation and Development, Directorate for Employment, Labour and Social Affairs, Paris, France.
PLoS One. 2020 Aug 13;15(8):e0237585. doi: 10.1371/journal.pone.0237585. eCollection 2020.
Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation.
This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool.
Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings.
This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.
患者和政策制定者都对数字技术寄予厚望，希望其能成为以可持续成本提高医疗服务质量的工具。经济合作与发展组织（OECD）内的许多国家都在投资远程医疗计划，因此，相关主题的大量同行评议研究也随之发展。尽管如此，远程医疗在 OECD 内仍未得到广泛应用。本研究旨在概述 OECD 内远程医疗使用情况的现有证据，为此对系统综述进行了伞式综述，总结了四个与政策相关领域的发现：临床和成本效益、患者体验以及实施。
本综述遵循预先书面、未注册的方案。在 2014 年 1 月至 2019 年 2 月期间，四个数据库（PubMed/Medline、CRD 和 Cochrane Library）对发表的系统综述或荟萃分析进行了检索。根据纳入标准，选择了 98 篇系统综述进行分析。由于存在很大的异质性，因此未进行荟萃分析。使用 AMSTAR 2 工具评估纳入综述的质量。
大多数综述（n = 53）侧重于有效性，其次是成本效益（n = 18）、实施（n = 17）和患者体验（n = 15）。83%的临床有效性综述发现远程医疗至少与面对面护理同样有效，39%的成本效益综述发现远程医疗具有成本节约或成本效益。患者对远程医疗的接受度较高，实施的最常见障碍是可用性和缺乏报销。然而，大多数综述的方法学质量较低，甚至极低，限制了研究结果的推广和适用性。
本伞式综述发现，远程医疗干预措施可改善糖尿病患者的血糖控制；降低慢性心力衰竭导致的死亡率和住院率；帮助患者管理疼痛并增加其身体活动；改善心理健康、饮食质量和营养；并减少哮喘等呼吸疾病相关的恶化。在某些疾病和专业领域，远程医疗可能是一种不太有效的护理方式。虽然有证据表明远程医疗具有成本效益，但由于质量和报告标准较差，推广受到限制。本伞式综述还发现，患者报告对远程医疗干预措施的接受度和满意度较高，但仍然存在重要的使用障碍。
