Scott Anna Mae, Sanders Sharon, Atkins Tiffany, van der Merwe Madeleen, Sunner Carla, Clark Justin, Glasziou Paul
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Institute for Evidence-Based Healthcare, Bond University, Robina, Australia.
J Telemed Telecare. 2024 Jun 5:1357633X241259525. doi: 10.1177/1357633X241259525.
We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care.
We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes.
Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high.
Telehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.
我们比较了通过远程医疗（通过电话或视频）与面对面就诊获取医疗服务；以及通过电话与视频远程医疗服务，对升级至急诊护理的影响。
我们检索了截至2023年7月24日的Medline、Embase和Cochrane CENTRAL；并于2023年9月19日进行了文献引用分析。我们纳入了随机对照试验。使用Cochrane工具2评估偏倚风险。我们计算了二分结局的风险比和连续结局的标准化均值差。
十项试验将远程医疗（五项电话、四项视频、一项两者皆有）与面对面护理进行了比较。六项总体偏倚风险低，三项有一些担忧，一项偏倚风险高。在急诊就诊（风险比1.07，95%置信区间0.89至1.29）、长达12个月的住院治疗（风险比0.89，95%置信区间0.56至1.41）、死亡或其他不良事件方面，远程医疗与面对面护理之间没有差异。护理成本相似，患者满意度得分也相似。六项试验比较了电话远程医疗与视频远程医疗：三项总体偏倚风险低，两项有一些担忧，一项偏倚风险高。在急诊就诊（风险比0.67，95%置信区间0.41至1.12）、住院治疗（风险比1.04，95%置信区间0.73至1.48）、死亡、其他不良事件、成本或患者满意度方面，电话与视频之间没有差异。医疗服务提供者满意度较高。
通过电话或视频提供的远程医疗服务，可能是面对面提供护理的合适替代方案，因为对于初级保健患者、医院门诊患者、出院后患者或老年护理机构居民而言，它不会增加升级至急诊护理的可能性。
