Fahey Eoin, Elsheikh Mohamed F H, Davey Martin S, Rowan Fiachra, Cassidy John Tristan, Cleary May S
Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.
Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland.
Telemed J E Health. 2022 May;28(5):613-635. doi: 10.1089/tmj.2021.0221. Epub 2021 Aug 10.
Introduction:The coronavirus disease 2019 (COVID-19) pandemic has triggered transformative changes in how clinicians interact with patients. There has been a shift toward virtual consultations. The evidence to support this change in practice is unclear. The aim of this study was to systematically review the evidence base for virtual consultations for orthopedics.
Materials and Methods:Two independent reviewers performed a literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the MEDLINE, EMBASE, and Scopus databases. Only studies reporting outcomes following the use of telemedicine for diagnosis, consultation, rehabilitation, and follow-up were included. Outcomes analyzed were: (1) patient and clinician satisfaction, (2) clinical outcome measures, and (3) cost analysis of traditional versus teleconsultation.
Results:A total of 41 studies were included. Fifteen studies compared clinical outcomes of telemedicine against a matched traditional cohort. Of these 15 studies, 2 demonstrated noninferiority, 9 showed no statistically significant difference, and 4 found telemedicine to be superior. Eleven studies recorded patient reported outcomes, which demonstrated high patient satisfaction. Nine studies reported decreased costs when telemedicine was compared to traditional care. The remaining six studies had varied aims and methodologies that didn't fit well with any of these subheadings.
Discussion:While the available evidence is limited, the studies assessed here show that telemedicine can deliver high quality health care with good clinical outcomes and high patient satisfaction in a cost-effective manner. Our team thinks what this has highlighted is that communication technology is advancing rapidly and that we as a community of surgeons need to be able to adapt rapidly and adopt innovative technology to continue to improve patient experience and outcomes.
2019年冠状病毒病（COVID-19）大流行引发了临床医生与患者互动方式的变革性变化。出现了向虚拟会诊的转变。支持这种实践变化的证据尚不清楚。本研究的目的是系统回顾骨科虚拟会诊的证据基础。
两名独立评审员根据系统评价和Meta分析的首选报告项目（PRISMA）指南，利用MEDLINE、EMBASE和Scopus数据库进行文献检索。仅纳入报告使用远程医疗进行诊断、会诊、康复和随访后的结果的研究。分析的结果包括：（1）患者和临床医生满意度，（2）临床结局指标，以及（3）传统会诊与远程会诊的成本分析。
共纳入41项研究。15项研究将远程医疗的临床结局与匹配的传统队列进行了比较。在这15项研究中，2项显示非劣效性，9项显示无统计学显著差异，4项发现远程医疗更具优势。11项研究记录了患者报告的结果，显示患者满意度较高。9项研究报告称，与传统护理相比，远程医疗成本降低。其余6项研究的目标和方法各不相同，不太符合这些小标题中的任何一项。
虽然现有证据有限，但此处评估的研究表明，远程医疗能够以具有成本效益的方式提供高质量医疗服务，临床结局良好且患者满意度高。我们团队认为，这突出表明通信技术正在迅速发展，作为外科医生群体，我们需要能够迅速适应并采用创新技术，以持续改善患者体验和结局。
