Anvari Sama, Neumark Samuel, Jangra Rhea, Sandre Anthony, Pasumarthi Keerthana, Xenodemetropoulos Ted
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Telemed J E Health. 2023 Jan;29(1):3-22. doi: 10.1089/tmj.2022.0004. Epub 2022 May 9.
Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care. The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters. A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data were synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) tool was used to evaluate the quality of evidence. A total of 60 guidelines for virtual care encounters were included; 52% of these were published in the context of the COVID-19 pandemic. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included guidelines, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. Thirty-one guidelines also provided guidance to patients or caregivers. Overall guideline quality was poor. General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation before a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices and guidelines on patient attitudes and outcomes to further optimize the provision of virtual care for specific patient populations.
远程医疗已成为多种临床环境中面对面护理的可行辅助手段，其作用在新冠疫情背景下得到了扩展。然而，围绕开展专科或特定疾病虚拟护理的最佳实践建议，普遍缺乏相关信息。本研究的目的是系统回顾现有的远程医疗问诊最佳实践指南。对MEDLINE、Embase和Cochrane对照试验中央注册库（CENTRAL）中现有的虚拟护理指南进行了系统回顾。使用非Meta分析综合法（SWiM）指南对数据进行综合，并使用研究与评价工具指南评估工具（AGREE II）来评估证据质量。共纳入了60项虚拟护理问诊指南；其中52%是在新冠疫情背景下发布的。大多数（95%）提供者指南明确了其指南所适用的虚拟问诊类型。在纳入的指南中，65%提供了关于保密/安全的指导，58%讨论了技术/设置，56%对患者同意发表了评论。31项指南还为患者或护理人员提供了指导。总体指南质量较差。成功进行远程医疗问诊的一般最佳实践包括确保保密和同意、就诊前准备以及与患者进行清晰沟通。未来的研究应旨在客观评估现有临床医生实践和指南对患者态度及结果的疗效，以进一步优化针对特定患者群体的虚拟护理服务。
