Centro de Estudos Estratégicos Antonio Ivo de Carvalho, Fundação Oswaldo Cruz (Fiocruz), Ministério da Saúde, Rio de Janeiro, Brazil.
Intelligent Decision Support Systems Laboratory, Research & Development Unit for Mechanical and Industrial Engineering (UNIDEMI), NOVA School of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal.
J Med Internet Res. 2024 Oct 29;26:e53594. doi: 10.2196/53594.
Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence.
This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC.
This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included.
A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients' health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients' clinical conditions and behavior changes.
Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients' clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings.
数字健康是一个快速发展的领域，自 COVID-19 大流行以来，许多数字干预措施已经大规模实施，主要集中在初级卫生保健（PHC）。世界卫生组织鼓励开发数字健康干预措施并将其应用于 PHC。关于这个主题的已发表科学论文数量的增加导致了信息的压倒性数量，但没有综述来总结这些证据。
本研究旨在为政策制定者、卫生管理人员和研究人员提供 PHC 中使用的数字干预措施的证据总结。
本综述搜索了 Web of Science 和 MEDLINE 数据库，以获取 2007 年 1 月至 2023 年 3 月发表的评估在 PHC 中实施的数字技术的系统评价和范围综述。仅包括针对实际患者或卫生保健提供者（HCP）为目标的数字干预措施的综述。
从搜索策略中确定了 236 条记录，其中 42 篇（17.8%）全文论文被选入分析，18 篇（7.6%）综述符合入选标准。总共，61%（11/18）的综述将其分析重点放在特定的数字健康干预措施上（医患远程医疗、医护远程医疗、卫生工作者决策支持系统、跟踪患者健康状况的系统、患者参与和自我护理平台，以及为卫生工作者提供教育和培训），39%（7/18）的综述侧重于与 PHC 相关的特定主题（预防保健、慢性病管理、行为健康障碍、COVID-19 大流行、多组分 PHC 干预措施、和护理协调）。纳入综述中的大多数研究都同意实施障碍，例如没有让最终用户参与开发的软件和应用程序、HCP 和患者在数字技术使用方面缺乏培训，以及远程咨询的报销和计费策略缺失。然而，他们显示了与卫生服务质量和患者临床状况和行为变化相关的一些混合结果。
应用于 PHC 的数字健康研究仍然集中在高收入国家，主要是在北美和欧洲。与卫生服务质量和患者临床状况或行为变化相关的混合结果可能是由于数字干预措施实施过程中的缺陷所致。有必要检查实施、卫生服务质量和临床结果之间的整个影响途径和因果关系，以支持数字健康在 PHC 环境中的传播。
