Usher Institute, The University of Edinburgh, UK.
Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, The Netherlands.
Curr Opin Pulm Med. 2023 Jul 1;29(4):302-312. doi: 10.1097/MCP.0000000000000965. Epub 2023 May 2.
Digital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the over-arching societal themes of equity, trust and communication.
Technological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data.
Understanding and addressing the implementation challenges posed by gaps in policy, regulatory, financial, and technical infrastructure is essential to support delivery of equitable respiratory care that is acceptable to patients and professionals.
数字呼吸监测干预措施（如智能吸入器和数字肺活量计）可以改善临床结果和/或组织效率，并且重点正在转向可持续实施，作为提供呼吸护理的一种方法。本综述考虑了技术基础设施的关键方面，讨论了影响实施的监管、财务和政策背景，并强调了公平、信任和沟通的总体社会主题。
技术要求包括开发互操作和连接的系统；建立稳定、广泛的互联网覆盖范围；解决数据准确性和监测依从性问题；实现人工智能的潜力；并避免临床医生的数据过载。政策挑战包括对质量保证和日益复杂的监管系统的关注。财务障碍包括对成本效益、预算影响和报销缺乏明确性。社会关注的焦点是由于电子健康素养差、贫困或缺乏可用基础设施而增加不平等的可能性，需要了解将护理转移到远程提供对患者/专业人员互动的影响，并确保个人数据的保密性。
了解和解决政策、监管、财务和技术基础设施差距所带来的实施挑战对于支持提供公平的呼吸护理至关重要，这是患者和专业人员都能接受的。
