Sugawara Yuka, Hirakawa Yosuke, Iwagami Masao, Inokuchi Ryota, Wakimizu Rie, Nangaku Masaomi
Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
J Med Internet Res. 2025 Jan 31;27:e67929. doi: 10.2196/67929.
Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined.
This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials.
MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized.
Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51%), including cost assessment and quality-adjusted life year. Notably, only 25 (32%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10%; system usability: 3/79, 4%; and environmental impact: 2/79, 3%).
A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies.
Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7.
远程医疗涉及使用电信技术提供的医疗、诊断和治疗相关服务。远程医疗不仅通过减少患者就诊路途时间并使患者能在其熟悉的环境中接受诊疗，有助于提高患者生活质量和满意度，还可能通过让患者更便捷地看诊来改善疾病管理。近年来，由于信息技术的发展，关于远程医疗的研究不断增加；然而，由于远程医疗具有多方面影响，其在随机对照试验中的有效性和局限性仍不明确。此外，在比较远程医疗和面对面诊疗时可作为跨学科指标的具体衡量标准也尚未确定。
本综述旨在概述在随机对照试验中用于比较远程医疗和面对面诊疗的通用及跨学科衡量标准。此外，我们还确定了此前未评估的指标，并提出了在未来临床试验中应优先考虑的指标。
根据PRISMA-ScR（系统评价与Meta分析扩展版的范围综述优先报告项目），检索MEDLINE和Embase数据库，查找符合纳入标准的出版物。纳入2019年1月至2024年3月期间比较某种形式的远程医疗与面对面诊疗的随机对照试验的英文原文，并总结这些研究中使用的基本信息和通用衡量标准。
在最初确定的2275篇文章中，最终纳入分析79篇。可跨医学专科使用的常用衡量标准分为以下3类：（1）以患者为中心（67/79，85%），包括患者满意度、工作量和生活质量；（2）患者结局（57/79，72%），包括死亡、入院和不良事件等一般临床参数；（3）成本效益（40/79，51%），包括成本评估和质量调整生命年。值得注意的是，79项研究中只有25项（32%）评估了所有3类指标。其他指标，如工作人员便利性、系统可用性和环境影响，是从上述3类指标中不同方向提取的指标，尽管此前很少有报告对其进行评估（工作人员便利性：8/79，10%；系统可用性：3/79，4%；环境影响：2/79，3%）。
此前各项研究中使用的衡量标准存在显著差异。值得注意的是，即使使用了疾病特异性指标，也应使用通用指标，以增强其他领域人员对结果的理解。此外，应建立涵盖所有3类常用衡量指标的体系，以确保进行全面评估：以患者为中心、患者结局和成本效益。工作人员便利性、系统可用性和环境影响是未来试验应使用的重要指标。此外，未来的临床试验和研究需要对评估指标进行标准化。
开放科学论坛注册编号YH5S7；https://doi.org/10.17605/OSF.IO/YH5S7 。
