远程家庭监测对慢性阻塞性肺疾病（COPD）患者的有效性：系统评价。
Effectiveness of remote home monitoring for patients with Chronic Obstructive Pulmonary Disease (COPD): systematic review.
机构信息
School of Public Health, Health Technology and Policy Unit, University of Alberta, 3-021 Research Transition Facility, Edmonton, AB, T6G 2V2, Canada.
Alberta Health Services, Edmonton, AB, Canada.
出版信息
BMC Health Serv Res. 2022 May 14;22(1):646. doi: 10.1186/s12913-022-07938-y.
BACKGROUND
Although remote home monitoring (RHM) has the capacity to prevent exacerbations in patients with chronic obstructive pulmonary disease (COPD), evidence regarding its effectiveness remains unclear. The objective of this study was to determine the effectiveness of RHM in patients with COPD.
METHODS
A systematic review of the scholarly literature published within the last 10 years was conducted using internationally recognized guidelines. Search strategies were applied to several electronic databases and clinical trial registries through March 2020 to identify studies comparing RHM to 'no remote home monitoring' (no RHM) or comparing RHM with provider's feedback to RHM without feedback. To critically appraise the included randomized studies, the Cochrane Collaboration risk of bias tool (ROB) was used. The quality of included non-randomized interventional and comparative observational studies was evaluated using the ACROBAT-NRSI tool from the Cochrane Collaboration. The quality of evidence relating to key outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) on the following: health-related quality of life (HRQoL), patient experience and number of exacerbations, number of emergency room (ER) visits, COPD-related hospital admissions, and adherence as the proportion of patients who completed the study. Three independent reviewers assessed methodologic quality and reviewed the studies.
RESULTS
Seventeen randomized controlled trials (RCTs) and two comparative observational studies were included in the review. The primary finding of this systematic review is that a considerable amount of evidence relating to the efficacy/effectiveness of RHM exists, but its quality is low. Although RHM is safe, it does not appear to improve HRQoL (regardless of the type of RHM), lung function or self-efficacy, or to reduce depression, anxiety, or healthcare resource utilization. The inclusion of regular feedback from providers may reduce COPD-related hospital admissions. Though adherence RHM remains unclear, both patient and provider satisfaction were high with the intervention.
CONCLUSIONS
Although a considerable amount of evidence to the effectiveness of RHM exists, due to heterogeneity of care settings and the low-quality evidence, they should be interpreted with caution.
背景
尽管远程家庭监测（RHM）有能力预防慢性阻塞性肺疾病（COPD）患者的病情恶化，但关于其有效性的证据仍不清楚。本研究的目的是确定 RHM 在 COPD 患者中的有效性。
方法
使用国际公认的指南对过去 10 年内发表的文献进行了系统综述。通过 2020 年 3 月，在几个电子数据库和临床试验注册中心应用了搜索策略，以确定比较 RHM 与“无远程家庭监测”（无 RHM）或比较 RHM 与提供反馈的 RHM 与无反馈的 RHM 的研究。为了批判性地评价纳入的随机研究，使用 Cochrane 协作风险偏倚工具（ROB）。使用 Cochrane 协作的 ACROBAT-NRSI 工具评估纳入的非随机干预和比较观察性研究的质量。使用推荐评估、制定与评价（GRADE）对关键结局的证据质量进行评估：健康相关生活质量（HRQoL）、患者体验和病情恶化次数、急诊室（ER）就诊次数、COPD 相关住院次数以及作为完成研究的患者比例的依从性。三名独立的审稿人评估了方法学质量并审查了研究。
结果
本综述纳入了 17 项随机对照试验（RCTs）和 2 项比较观察性研究。系统综述的主要发现是，存在大量关于 RHM 疗效/有效性的证据，但质量较低。尽管 RHM 是安全的，但它似乎不会改善 HRQoL（无论 RHM 的类型如何）、肺功能或自我效能，也不会降低抑郁、焦虑或医疗资源利用。纳入来自提供者的定期反馈可能会减少 COPD 相关住院。虽然 RHM 的依从性仍不清楚，但患者和提供者对干预措施的满意度都很高。
结论
尽管存在大量关于 RHM 有效性的证据，但由于护理环境的异质性和低质量证据，应谨慎解释这些证据。
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