Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.
NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.
J Med Internet Res. 2021 Jul 20;23(7):e26492. doi: 10.2196/26492.
Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic.
We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature.
Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings.
In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking.
This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
在 COVID-19 大流行期间，远程医疗已迅速被采用以维持服务，现在人们对其未来的作用产生了浓厚的兴趣。从大流行中恢复和未来的服务规划和政策制定应该借鉴 COVID-19 的经验以及大流行前积累的大量研究证据。
我们旨在对远程医疗的文献进行系统评价和基于证据的指南进行伞式综述，包括定性和定量文献。
在 2010 年 1 月至 2020 年 8 月期间，我们在三个数据库中搜索符合预定义标准的系统评价。对检索到的综述进行独立筛选，对符合纳入标准的综述进行综合并评估偏倚风险。采用叙述性综合报告这些发现。
共有 19 项系统评价符合纳入标准。共有 15 项综述考察了临床效果，8 项报告了远程医疗实施方面，10 项报告了服务使用者和临床医生的可接受性，2 项报告了成本效益，1 项报告了指南。大多数综述被评估为质量较低。研究结果表明，基于视频的沟通至少在短期内可以与面对面的格式一样有效和可接受。关于数字排斥的程度以及如何克服数字排斥以及在一些重要背景下，如儿童和青少年服务和住院环境，证据不足。
本伞式综述表明远程医疗有可能成为一种有效和可接受的服务提供形式。然而，我们发现关于其在整个服务区域范围内大规模实施的影响的证据有限。结合以往的证据和 COVID-19 的经验，可能会为未来远程医疗的实施进行现实规划。
