Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.
Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
JMIR Mhealth Uhealth. 2021 Apr 20;9(4):e24743. doi: 10.2196/24743.
The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations.
The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations.
A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations.
Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19-specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality "best practice" guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7).
Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing "best practice" guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).
COVID-19 大流行是医疗保健领域广泛采用远程监测技术（RMT）的催化剂。重要的是要展示这些技术在大流行早期阶段的实施情况，以确定其应用和采用的障碍，尤其是在弱势群体中。
本知识综合旨在介绍用于为 COVID-19 患者提供护理的各种 RMT，并确定使用这些技术的好处和障碍。该审查特别强调了健康公平方面的考虑。
使用 Embase、MEDLINE 和 QxMD 对从 COVID-19 开始（2019 年 12 月）到 2020 年 7 月 6 日发布的记录进行了快速审查。综合分析了在为 COVID-19 患者提供医疗保健时使用 RMT 的好处和障碍的报告，并考虑了健康公平因素。
在确定的 491 条记录中，有 48 篇出版物描述了 35 种不同的 RMT 被纳入本综述。RMT 包括使用现有技术（例如视频会议）和开发具有 COVID-19 特定应用的新技术。对感知到的好处的内容分析生成了 34 个描述 RMT 优势的独特代码，总体上映射到 10 个主题。此外，描述使用 RMT 障碍的 52 个独特代码映射到 18 个主题。与感知到的好处相关的突出主题包括降低护理负担（例如，对医院、医疗保健从业者而言；28 条记录）、降低感染风险（n=33）和支持弱势群体（n=14）。反映使用 RMT 障碍的突出主题包括与公平相关的障碍（例如，用户负担得起技术的能力、互联网连接不良、健康素养差；n=16）、需要制定用于临床护理的 RMT 使用的“最佳实践”指南（n=12）以及需要额外的资源来开发和支持新技术（n=11）。总体而言，48 篇记录中有 23 篇评论了影响健康机会和结果的分层特征，包括随时间变化的一般特征（例如年龄、合并症；n=17）、居住地（n=11）和社会经济地位（n=7）。
本快速审查的结果突出了用于监测和告知 COVID-19 治疗的各种 RMT 的使用情况、使用这些技术的潜在好处以及使用这些技术的现有障碍。结果可用于优先考虑 RMT 的实施工作（例如，制定 RMT 使用的“最佳实践”指南，并制定策略以改善边缘化人群的公平获取机会）。
