Social Gerontology Division, National Ageing Research Institute, Parkville, Australia.
Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam.
J Med Internet Res. 2023 Apr 5;25:e43224. doi: 10.2196/43224.
BACKGROUND: A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam's health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. OBJECTIVE: This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. METHODS: A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. RESULTS: Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users' individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. CONCLUSIONS: The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake.
背景:人口老龄化迅速、疾病负担转移以及传染病爆发的持续威胁,对越南的医疗体系构成了重大挑战。在该国许多地区,特别是在农村地区,健康差距明显存在,而且民众获得以患者为中心的医疗服务存在不平等。因此,越南必须探索并实施以患者为中心的医疗服务的先进解决方案,同时减轻医疗系统的压力。使用数字健康技术(DHTs)可能是这些解决方案之一。
目的:本研究旨在确定亚太地区(APR)中低收入国家应用 DHTs 以支持以患者为中心的医疗服务的情况,并为越南提供经验教训。
方法:进行了范围综述。2022 年 1 月,系统地在 7 个数据库中进行了搜索,以确定 APR 中关于 DHTs 和以患者为中心的医疗服务的出版物。进行了主题分析,并使用国家卫生与保健卓越研究所(NICE)的 DHTs 证据标准框架(A、B 和 C 级)对 DHTs 进行了分类。报告符合系统评价和荟萃分析扩展的 PRISMA-ScR(首选报告项目)指南。
结果:在确定的 264 篇出版物中,有 45 篇(17%)符合纳入标准。大多数 DHTs 被归类为 C 级(15/33,45%),其次是 B 级(14/33,42%)和 A 级(4/33,12%)。在个体层面上,DHTs 增加了医疗保健和健康相关信息的可及性,支持个人自我管理,并改善了临床和生活质量结果。在系统层面上,DHTs 通过提高效率、减轻医疗资源压力以及支持以患者为中心的临床实践,支持以患者为中心的结果。使用 DHTs 进行以患者为中心的护理的最常报告的促成因素包括:DHTs 与用户个体需求的一致性、易用性、获得医疗保健专业人员的直接支持、提供技术支持以及用户教育和培训、隐私和安全的适当治理以及跨部门合作。常见的障碍包括用户读写能力和数字素养低、用户对 DHT 基础设施的访问有限,以及缺乏指导 DHTs 的实施和使用的政策和协议。
结论:在越南,使用 DHTs 是增加公平获得优质、以患者为中心的医疗服务的可行选择,同时减轻医疗系统的压力。越南可以借鉴 APR 中其他中低收入国家的经验教训,制定国家数字健康转型路线图。越南政策制定者可以考虑的建议包括:强调利益相关者的参与、加强数字素养、支持 DHT 基础设施的改善、增加跨部门合作、加强网络安全治理以及引领 DHT 的采用。
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