Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
BMJ Open. 2024 Jun 10;14(6):e075833. doi: 10.1136/bmjopen-2023-075833.
OBJECTIVES: Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs. DESIGN: Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES: Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline. ELIGIBILITY CRITERIA: Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal. DATA EXTRACTION AND SYNTHESIS: Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators. RESULTS: Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33). CONCLUSIONS: The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
目的:考虑到医疗成本的稳步增长、人口老龄化以及慢性病患者人数的增加,医疗保健领域的数字化转型势在必行。在患者护理中实施数字健康技术是解决这些问题的潜在方法,但仍存在一些挑战。为了应对这些复杂性,必须考虑医疗保健专业人员(HCP)的看法。本综述伞的目的是从 HCP 的角度确定数字健康技术实施中涉及的主要障碍和促进因素。
设计:根据系统评价和荟萃分析的首选报告项目进行系统综述伞。
数据来源:截至 2022 年 6 月 17 日,检索 Embase.com、PubMed 和 Web of Science Core Collection 中现有的评论。搜索词包括数字健康技术,结合与实施相关的术语,以及涵盖 HCP 的术语变体,如医生、医生和医学学科。
入选标准:评估包含患者互动的数字技术的定量和定性评论被认为符合条件。三名评审员独立综合评估合格的评论并进行批判性评估。
数据提取和综合:关于数据收集,两名评审员独立综合并解释了障碍和促进因素的数据。
结果:33 项审查符合纳入标准。障碍和促进因素分为四个层次:(1)组织,(2)HCP,(3)患者和(4)技术方面。确定的主要障碍和促进因素包括培训不足(n=22/33)、对技术不熟悉(n=17/33)、沟通不畅(n=13/33)和安全与保密性问题(n=17/33)。重要的障碍包括工作量增加(n=16/33)、技术破坏专业身份方面(n=11/33)、HCP 对患者使用技术能力的不确定性(n=9/33)和技术问题(n=12/33)。
结论:实施策略应解决 HCP 强调的主要障碍,例如,通过提供足够的培训使 HCP熟悉技术、使技术适应患者的偏好以及解决技术问题。可以通过调查最终用户的需求来克服 HCP 和患者层面的障碍。随着我们从传统的面对面护理模式向新的护理模式转变,需要进一步研究以更好地了解数字技术在 HCP-患者关系中的作用。
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