School of Public Health, University of Edinburgh, Edinburgh, UK.
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
J Glob Health. 2021 Apr 3;11:04023. doi: 10.7189/jogh.11.04023.
In resource-constrained settings, mobile health (mHealth) has varied applications. While there is strong evidence for its use in chronic disease management, the applications of mHealth for management of acute illness in low- and middle-income countries (LMICs) are not as well described. This review systematically explores current available evidence on the effectiveness of mHealth interventions at improving health outcomes in emergency care settings in LMICs.
A systematic search of the literature was performed in accordance with PRISMA guidelines, utilizing seven electronic databases and manual searches to identify peer-reviewed literature containing each of three search elements: mHealth, emergency care (EC), and LMICs. Articles quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
After removing duplicates, 6498 studies met initial search criteria; 108 were eligible for full text review and 46 met criteria for inclusion. Thirty-six pertained to routine emergency care, and 10 involved complex humanitarian emergencies. Based on the GRADE criteria, 15 studies were rated as "Very Low" quality, 24 as "Low" quality, 6 as "Moderate" quality, and 1 as "High" quality. Eight studied data collection, 9 studied decision support, 15 studied direct patient care, and 14 studied health training. All 46 studies reported positive impacts of mHealth on EC in LMICs.
Mobile health interventions can be effective in improving provider-focused and patient-centered outcomes in both routine and complex EC settings. Future investigations focusing on patient-centered outcomes are needed to further validate these findings.
在资源有限的环境下，移动医疗（mHealth）有多种应用。虽然有强有力的证据表明它在慢性病管理方面的应用，但在中低收入国家（LMICs），mHealth 在急性病管理方面的应用并没有得到很好的描述。本综述系统地探讨了目前关于 mHealth 干预措施在改善 LMICs 急诊环境下健康结果的有效性的现有证据。
根据 PRISMA 指南，系统地搜索文献，利用七个电子数据库和手动搜索，确定包含以下三个搜索要素的同行评审文献：移动医疗（mHealth）、急诊护理（EC）和中低收入国家（LMICs）。使用 Grading of Recommendations Assessment, Development and Evaluation（GRADE）标准评估文章的质量。
去除重复项后，有 6498 项研究符合初步搜索标准；108 项符合全文审查标准，46 项符合纳入标准。其中 36 项涉及常规急诊护理，10 项涉及复杂人道主义紧急情况。根据 GRADE 标准，15 项研究的质量被评为“极低”，24 项为“低”，6 项为“中”，1 项为“高”。8 项研究数据收集，9 项研究决策支持，15 项研究直接患者护理，14 项研究健康培训。所有 46 项研究都报告了 mHealth 在 LMICs 急诊中的积极影响。
移动医疗干预措施可以有效改善常规和复杂急诊环境中以提供者为中心和以患者为中心的结果。需要进一步的以患者为中心的结果为重点的研究来进一步验证这些发现。
