Nederlandse Service Apotheek Beheer BV, 's-Hertogenbosch, Netherlands.
Asc Academics, Groningen, Netherlands.
J Med Internet Res. 2023 Sep 26;25:e42474. doi: 10.2196/42474.
BACKGROUND: eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE: We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. METHODS: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. RESULTS: Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS: There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.
背景:电子健康越来越被认为是支持药物治疗管理的重要工具。
目的:我们旨在评估(1)电子健康在哮喘或慢性阻塞性肺疾病(COPD)、糖尿病或心血管疾病(CVD)患者药物治疗管理中的应用;(2)这些干预措施对药物治疗管理和临床结果的有效性;以及(3)电子健康干预药物治疗管理成功的关键因素。
方法:我们根据 PRISMA-ScR(系统评价和荟萃分析扩展的首选报告项目用于范围综述)声明进行了范围综述。搜索的数据库包括 Embase、MEDLINE(PubMed)和 Cochrane 图书馆。由 2 名独立研究人员进行筛选。合格的文章是随机对照试验和队列研究,评估了电子健康干预措施与常规护理相比在药物治疗管理或哮喘或 COPD、CVD 或糖尿病患者临床结果方面的效果。这些干预措施按 Shaw 等人的电子健康概念模型(我们手中的健康、互动促进健康、数据使能健康)中描述的设备类型、药物治疗管理、交付模式、功能和领域进行分类。根据干预措施的分类,按域和功能的数量分析药物治疗管理结果和患者和临床医生报告的临床结果,以确定趋势。
结果:在 63 项研究中,分别有 16 项(25%)、31 项(49%)、13 项(21%)和 3 项(5%)纳入了哮喘或 COPD、CVD、糖尿病或 CVD 和糖尿病患者。大多数(38/63,60%)干预措施旨在提高药物依从性,通常结合治疗计划优化。在 16 项哮喘或 COPD 干预措施中,有 6 项旨在改善吸入药物的使用。大多数(63/63,76%)研究提供了患者反馈的选择。大多数(20/63,32%)电子健康干预措施结合了 Shaw 等人的所有 3 个领域,而 25%(16/63)结合了互动促进健康和数据使能健康。三分之二(42/63,67%)的研究显示出整体积极效果。分别有 48%(23/48)、57%(28/49)和 39%(12/31)报告对药物治疗管理和临床医生和患者报告的临床结果有积极影响。在具有≥3 个功能的干预措施中,药物治疗管理和患者报告的临床结果更常具有积极影响,而临床医生报告的临床结果则不然。具有更多 Shaw 等人描述的域的研究报告对所有 3 个结果都有积极影响的趋势。在提供患者反馈的研究中,与没有反馈的研究相比,更多的研究显示出积极的临床结果。在药物治疗管理结果方面,没有观察到这种效果。
结论:有各种各样的电子健康干预措施,结合了各种领域和功能,以针对哮喘或 COPD、CVD 和糖尿病的药物治疗管理。结果表明,反馈是对临床医生报告的临床结果产生积极影响的关键。当结合领域时,电子健康干预措施变得更有影响力。
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