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远程会诊与常规护理对改善60岁及以上老年患者生活质量的疗效:一项随机对照试验。

Efficacy of Teleconsultation Versus Usual Care in Improving Quality of Life Among Geriatric Patients Aged 60 and Above: A Randomized Controlled Trial.

作者信息

Mahala Prakash, Kaeley Nidhi, Saxena Vartika, Arora Smriti, Bahurupi Yogesh, Kalyani Vasantha

机构信息

Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.

Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.

出版信息

Cureus. 2024 Sep 2;16(9):e68476. doi: 10.7759/cureus.68476. eCollection 2024 Sep.

Abstract

Introduction The geriatric population, aged 60 years and older, is rapidly growing worldwide. This demographic shift has led to a higher prevalence of chronic diseases, comorbidities, and functional impairments, placing immense pressure on healthcare systems. Teleconsultation, which uses telecommunication technologies to deliver healthcare services remotely, offers a potential solution. This study aimed to assess the efficacy of teleconsultation versus usual care in improving the quality of life among the geriatric population aged 60 years and older. Methods A parallel, randomized controlled trial with a 1:1 allocation ratio was conducted. Eligible participants, aged 60 and above, were recruited at the triage emergency department (ED) following a baseline eligibility assessment. Inclusion criteria included the ability to communicate in English or Hindi, possession of International Organization for Standardization (ISO-certified) instruments for self-monitoring, and willingness to comply with study procedures and provide written consent. Participants were randomly assigned to experimental and control arms using a computer-generated sequence, with allocation concealment achieved through sequentially numbered opaque sealed envelopes (SNOSEs), which were opened in front of participants after obtaining baseline data. A total of 2,000 participants (1,000 per arm) were enrolled and randomly assigned to either the teleconsultation or usual care group. Results In the teleconsultation group (n=1,000), 36.5% of participants (365) were female and 63.5% of participants (635) were male. Similarly, in the usual care group (n=1,000), 37.1% of participants (371) were female and 62.9% of participants (629) were male. The teleconsultation group significantly outperformed the usual care group in several domains pre-intervention, with higher mean scores in the physical health domain (11.16 vs. 10.96, P = 0.009), psychological domain (11.74 vs. 11.62, P = 0.020), and environment domain (12.44 vs. 12.26, P = 0.0001). No significant difference was observed in the social relationships domain (P = 0.452). The teleconsultation group significantly outperformed the usual care group in all domains post-intervention, with higher mean scores in the physical health domain (14.49 vs. 12.74), psychological domain (13.75 vs. 12.35), social relationships domain (14.05 vs. 12.90), and environment domain (13.91 vs. 12.94) (P < 0.001 for all). Conclusion These findings suggest that teleconsultation significantly improves the quality of life for elderly patients by providing a more accessible and convenient means of healthcare delivery and addressing the physical, emotional, and social challenges associated with chronic illnesses.

摘要

引言 60岁及以上的老年人口在全球范围内正迅速增长。这一人口结构转变导致慢性病、合并症和功能障碍的患病率更高,给医疗系统带来了巨大压力。远程会诊利用电信技术远程提供医疗服务,提供了一种潜在的解决方案。本研究旨在评估远程会诊与常规护理相比,在改善60岁及以上老年人口生活质量方面的疗效。

方法 进行了一项1:1分配比例的平行随机对照试验。在进行基线资格评估后,在分诊急诊科(ED)招募符合条件的60岁及以上参与者。纳入标准包括能够用英语或印地语交流、拥有国际标准化组织(ISO认证)的自我监测工具,以及愿意遵守研究程序并提供书面同意书。使用计算机生成的序列将参与者随机分配到实验组和对照组,通过顺序编号的不透明密封信封(SNOSEs)实现分配隐藏,在获得基线数据后在参与者面前打开这些信封。总共招募了2000名参与者(每组1000名),并随机分配到远程会诊组或常规护理组。

结果 在远程会诊组(n = 1000)中,36.5%的参与者(365名)为女性,63.5%的参与者(635名)为男性。同样,在常规护理组(n = 1000)中,37.1%的参与者(371名)为女性,62.9%的参与者(629名)为男性。在干预前,远程会诊组在几个领域的表现明显优于常规护理组,在身体健康领域(11.16对10.96,P = 0.009)、心理领域(11.74对11.62,P = 0.020)和环境领域(12.44对12.26,P = 0.0001)的平均得分更高。在社会关系领域未观察到显著差异(P = 0.452)。在干预后,远程会诊组在所有领域的表现均明显优于常规护理组,在身体健康领域(14.49对12.74)、心理领域(13.75对12.35)、社会关系领域(14.05对12.90)和环境领域(13.91对12.94)的平均得分更高(所有P < 0.001)。

结论 这些发现表明,远程会诊通过提供更便捷的医疗服务方式,并应对与慢性病相关的身体、情感和社会挑战,显著提高了老年患者的生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fab/11446495/951e0d391081/cureus-0016-00000068476-i01.jpg

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