对慢性病管理中电子健康实施的关键因素进行的现实主义综述。

A realist review of factors critical for the implementation of eHealth in chronic disease management.

作者信息

Shahid Nida, Parker Gillian, Bielecki Joanna M, Rac Valeria, Berta Whitney

机构信息

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.

出版信息

BMC Health Serv Res. 2025 Apr 2;25(1):496. doi: 10.1186/s12913-025-12361-0.

DOI:10.1186/s12913-025-12361-0

PMID:40176012

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11966836/

Abstract

BACKGROUND

In Canada, chronic disease is responsible for 88% of deaths and $120 billion in cost each year. With 44% of Canadian adults living with at least one chronic condition, only 66% receive necessary care. Ehealth interventions are instrumental in chronic disease management (CDM), especially since the pandemic, as they provide accessible, cost-effective solutions for self-management. Despite its promise and accelerated use, its implementation remains challenging. This paper reports on a realist review of critical factors for the implementation of eHealth interventions relevant to conditions such as heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes. The findings are presented in terms of context, mechanisms, and outcomes.

METHODS

A realist review of the primary literature was conducted by searching five databases: Medline, Embase, Cochrane, CINALH and PsycInfo. The initial search was run for a date spanning from the databases' inception to September 2018 and subsequently updated to dates spanning from October 2018 to May 2022. A systematic and iterative approach to data extraction was used. Thematic analysis was used to identify context-mechanism-outcome (CMO) configurations.

RESULTS

Among the 13,209 citations retrieved, 64 articles were included. This paper reports the top ten configurations found to facilitate or hinder eHealth implementation. Key themes related to context, such as team-based care, and action, including program use, perceived usefulness and motivation, are reported.

CONCLUSIONS

This study explores the role of context, mechanisms, and outcomes in ehealth implementation, highlighting the nonlinear relationships between these factors. Future implications include empirical testing CMOs as middle-range theories in real-world settings to determine causality.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO (CRD42020208275) on 1 October 2020.

摘要

背景

在加拿大，慢性病导致每年88%的死亡和1200亿加元的费用。44%的加拿大成年人患有一种或多种慢性病，只有66%的人得到了必要的护理。电子健康干预措施在慢性病管理（CDM）中发挥着重要作用，尤其是自疫情以来，因为它们为自我管理提供了可及且具成本效益的解决方案。尽管其前景广阔且使用加速，但其实施仍具有挑战性。本文报告了一项关于与心力衰竭、慢性阻塞性肺疾病、慢性肾病和糖尿病等疾病相关的电子健康干预措施实施的关键因素的现实主义综述。研究结果从背景、机制和结果方面进行呈现。

方法

通过检索五个数据库（Medline、Embase、Cochrane、CINALH和PsycInfo）对主要文献进行现实主义综述。最初的检索时间跨度为从数据库创建到2018年9月，随后更新到2018年10月至2022年5月。采用系统且迭代的数据提取方法。运用主题分析法确定背景-机制-结果（CMO）配置。