初级卫生保健中患者报告结局测量的电子实施：混合方法系统评价

Electronic Implementation of Patient-Reported Outcome Measures in Primary Health Care: Mixed Methods Systematic Review.

作者信息

Sasseville Maxime, Supper Wilfried, Gartner Jean-Baptiste, Layani Géraldine, Amil Samira, Sheffield Peter, Gagnon Marie-Pierre, Hudon Catherine, Lambert Sylvie, Attisso Eugène, Ouellet Steven, Breton Mylaine, Poitras Marie-Eve, Roux-Lévy Pierre-Henri, Plaisimond James, Bergeron Frédéric, Ashcroft Rachelle, Wong Sabrina T, Groulx Antoine, Paquette Jean-Sébastien, D'Anjou Natasha, Langlois Sylviane, LeBlanc Annie

机构信息

Faculty of Medicine, Université Laval, Quebec City, QC, Canada.

Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.

出版信息

J Med Internet Res. 2025 May 5;27:e63639. doi: 10.2196/63639.

DOI:10.2196/63639

PMID:40324173

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12089857/

Abstract

BACKGROUND

Managing chronic diseases remains a critical challenge in primary health care (PHC) across the Organization for Economic Co-operation and Development countries. Electronic patient-reported outcome measures (ePROMs) are emerging as valuable tools for enhancing patient engagement, facilitating clinical decision-making, and improving health outcomes. However, their implementation in PHC remains limited, with significant variability in effectiveness and adoption.

OBJECTIVE

This systematic review aimed to assess the implementation and effectiveness of ePROMs in chronic disease management within PHC settings and to identify key barriers and facilitators influencing their integration.

METHODS

A mixed methods systematic review was conducted following the Cochrane Methods and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies that implemented ePROMs among adults for chronic disease management in PHC. The extracted data included patient health outcomes, provider workflow implications, implementation factors, and cost considerations. The reach, effectiveness, adoption, implementation, and maintenance framework was used.

RESULTS

Our search yielded 12,525 references, from which 22 (0.18%) studies were included after screening and exclusions. These studies, primarily conducted in the United States (n=9, 41%) and Canada (n=8, 36%), covered various chronic diseases and used diverse ePROM tools, predominantly mobile apps (n=9, 41%). While some studies (n=10, 45%) reported improvements in patient health outcomes and self-management, others (n=12, 55%) indicated no significant change. Key barriers included digital literacy gaps, integration challenges within clinical workflows, and increased provider workload. Facilitators included strong patient-provider relationships, personalized interventions, and technical support for users. While some studies (n=10, 45%) demonstrated improved patient engagement and self-management, long-term cost-effectiveness and sustainability remain uncertain.

CONCLUSIONS

Success in implementing ePROMs in PHC appears to hinge on addressing digital literacy, ensuring personalization and meaningful patient-provider interactions, carefully integrating technology into clinical workflows, and conducting thorough research on their long-term impacts and cost-effectiveness. Future efforts should focus on these areas to fully realize the benefits of digital health technologies for patients, providers, and health care systems.

TRIAL REGISTRATION

PROSPERO CRD42022333513; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022333513.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/48155.

摘要

背景

在经济合作与发展组织国家的初级卫生保健（PHC）中，慢性病管理仍然是一项严峻挑战。电子患者报告结局测量（ePROMs）正逐渐成为增强患者参与度、促进临床决策制定以及改善健康结局的宝贵工具。然而，它们在初级卫生保健中的实施仍然有限，在有效性和采用率方面存在显著差异。

目的

本系统评价旨在评估ePROMs在初级卫生保健环境下慢性病管理中的实施情况和有效性，并确定影响其整合的关键障碍和促进因素。

方法

按照Cochrane方法和PRISMA（系统评价与Meta分析的首选报告项目）指南进行混合方法系统评价。我们纳入了在初级卫生保健中针对成人慢性病管理实施ePROMs的研究。提取的数据包括患者健康结局、对医疗服务提供者工作流程的影响、实施因素和成本考量。使用了可及性、有效性、采用率、实施和维持框架。

结果

我们的检索共获得12525篇参考文献，经过筛选和排除后纳入了22项（0.18%）研究。这些研究主要在美国（n = 9，41%）和加拿大（n = 8，36%）开展，涵盖了各种慢性病，并使用了多种ePROM工具，其中主要是移动应用程序（n = 9，41%）。虽然一些研究（n = 10，45%）报告了患者健康结局和自我管理方面的改善，但其他研究（n = 12，55%）表明没有显著变化。关键障碍包括数字素养差距、临床工作流程中的整合挑战以及医疗服务提供者工作量增加。促进因素包括良好的医患关系、个性化干预以及对用户的技术支持。虽然一些研究（n = 10，45%）显示患者参与度和自我管理有所改善，但长期成本效益和可持续性仍不确定。