Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
Research Group in Epidemiology and Public Health in the Digital Health context, Universitat Oberta de Catalunya, Barcelona, Spain.
J Med Internet Res. 2022 Oct 27;24(10):e40877. doi: 10.2196/40877.
BACKGROUND: Several systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted. OBJECTIVE: This overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions. METHODS: Through a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors. RESULTS: This overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted. CONCLUSIONS: The application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients' clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375.
背景:近年来,已经有几项针对世界卫生组织(WHO)欧洲区域 53 个成员国的临床医生、患者和卫生当局使用远程医疗改善医疗服务的效果进行了评估的系统评价。然而,尚未对这些综述的研究结果进行总结。
目的:本综述系统评价旨在总结远程医疗在 53 个成员国中的应用情况,并确定已证明远程医疗的有效性、可行性和适用性的医疗领域和医疗保健层级。还评估和整理了远程医疗使用的障碍和促进因素,以帮助设计和实施远程医疗干预措施。
方法:通过对已发表和未发表文献的全面系统评价,我们从研究中纳入的每项综述中提取了临床、流行病学和技术相关数据。我们重点评估了在考虑的 53 个成员国中使用远程医疗应用程序的障碍和促进因素。我们根据 A Measurement Tool to Assess Systematic Review 2 方法对纳入的每项综述的方法学质量进行了评分,并使用 Grading of Recommendations, Assessment, Development, and Evaluations 方法来评估证据的总体确定性。整个过程由 2 名独立作者完成。
结果:本综述利用了来自 WHO 欧洲区域 2239 项主要研究的数据,总共纳入了 20000 多名患者。基于来自几个国家的随机试验、观察性研究和经济评估的数据,结果表明远程医疗技术在一系列慢性病的筛查、诊断、管理、治疗和长期随访方面具有明显优势。然而,由于干预方法学、调度、主要研究设计差异、设置和地理位置的高度异质性,我们无法将结果汇总为可靠的数值参数。除了干预措施的临床结果外,还强调了社会和经济方面的结果。
结论:远程医疗在 WHO 欧洲区域的各国中得到了广泛应用;然而,一些国家仍可以从这些数字解决方案的广泛应用中受益。与用户、技术和基础设施相关的障碍最大。相反,使用技术设备提供医疗服务被发现可以显著改善患者的临床结局,改善医疗专业人员对患者的长期随访,并为患者和卫生工作者提供后勤方面的便利。
试验注册:PROSPERO(国际前瞻性系统评价注册库)CRD42022309375;https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375。
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