Craig Adam, Lawford Harriet, Miller Maggie, Chen-Cao Liuyi, Woods Leanna, Liaw Siaw-Teng, Godinho Myron Anthony
Operational Research and Decision Support for Infectious Diseases Program, Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
J Med Internet Res. 2025 Jun 18;27:e66288. doi: 10.2196/66288.
BACKGROUND: Health care providers are at the forefront of the digital health transformation underway in low- and lower-middle-income countries (LLMICs). Digital health innovations (DHIs) promise more efficient and equitable health care delivery. However, their implementation often outpaces the generation of evidence supporting their effectiveness, resulting in fragmented projects that are poorly aligned with local system needs. Recognizing the diverse ways DHIs are used, the World Health Organization introduced a revised Classification of Digital Health Interventions in 2023 identifying 4 primary user groups, including health care providers. OBJECTIVE: This study aims to synthesize the current evidence on the use and impact of DHIs by health care providers in LLMICs. METHODS: We conducted an umbrella review of articles published between 2010 and 2024. Articles were sourced through PubMed, Embase, Scopus, and Web of Science. The search strategy combined keywords with Boolean operators. To be included, articles had to be original research published as systematic, thematic, or scoping reviews and had to use a systematic process for data identification and extraction. They needed to relate to a DHI implemented in at least 1 LLMIC and be available in English. World Bank country classifications were used to define LLMICs. Data extracted were deductively coded and thematically analyzed according to the 11 health system functions outlined in the 2023 World Health Organization classification of DHIs. RESULTS: Overall, 88 reviews were included. Telemedicine was the most commonly studied DHI (60/88, 68%), with evidence suggesting that it has improved information sharing among providers (eg, hospitals and private providers) and enhanced delivery efficiency, particularly in limited-access settings. Outside of telemedicine, the evidence remains thin and uneven across other categories of DHIs. While DHIs appear to help providers interact more effectively with clients, systems, and one another, many interventions remain short lived, limited in scale, or contextually misaligned. The use of personal mobile devices by health care providers emerged as a common and practical platform for delivering DHIs, highlighting the potential for cost savings and rapid uptake. Persistent challenges such as insufficient infrastructure, high setup costs, and limited workforce capacity remain key barriers to sustainable scale-up. CONCLUSIONS: Some evidence suggests DHIs are transforming health care delivery in LLMICs and contributing to broader health goals; however, robust and conclusive evidence on DHIs' impact on health outcomes, cost-effectiveness, and long-term sustainability is lacking. Caution is warranted when introducing DHIs that may not align with underlying system constraints. Policy makers and development partners are encouraged to support implementation research to build a more coherent global evidence base. DHIs should be seen not as a stand-alone solution but as a complementary tool to strengthen health systems. TRIAL REGISTRATION: PROSPERO CRD42024586285; www.crd.york.ac.uk/PROSPERO/view/CRD42024586285.
背景:医疗保健提供者处于低收入和中低收入国家(LLMICs)正在进行的数字健康转型的前沿。数字健康创新(DHIs)有望实现更高效、更公平的医疗保健服务。然而,它们的实施往往超过了支持其有效性的证据的产生,导致项目零散,与当地系统需求的契合度不佳。认识到数字健康创新的多种使用方式,世界卫生组织在2023年推出了修订后的数字健康干预分类,确定了4个主要用户群体,包括医疗保健提供者。 目的:本研究旨在综合当前关于LLMICs中医疗保健提供者使用数字健康创新及其影响的证据。 方法:我们对2010年至2024年发表的文章进行了伞状综述。文章来源为PubMed、Embase、Scopus和Web of Science。搜索策略将关键词与布尔运算符相结合。要纳入研究,文章必须是作为系统综述、专题综述或范围综述发表的原创研究,并且必须使用系统的数据识别和提取过程。它们需要与至少一个LLMIC中实施的数字健康创新相关,并且为英文。使用世界银行国家分类来定义LLMICs。根据2023年世界卫生组织数字健康干预分类中概述的11项卫生系统功能,对提取的数据进行演绎编码和主题分析。 结果:总体而言,纳入了88篇综述。远程医疗是研究最频繁的数字健康创新(60/88,68%),有证据表明它改善了提供者(如医院和私人提供者)之间的信息共享,并提高了服务效率,特别是在获取有限的环境中。在远程医疗之外,其他数字健康创新类别的证据仍然薄弱且不均衡。虽然数字健康创新似乎有助于提供者与客户、系统以及彼此之间更有效地互动,但许多干预措施仍然是短期的、规模有限的,或者在背景上不匹配。医疗保健提供者使用个人移动设备成为提供数字健康创新的常见且实用的平台,凸显了成本节约和快速采用的潜力。基础设施不足、设置成本高和劳动力能力有限等持续挑战仍然是可持续扩大规模的关键障碍。 结论:一些证据表明,数字健康创新正在改变LLMICs的医疗保健服务,并有助于实现更广泛的健康目标;然而,缺乏关于数字健康创新对健康结果、成本效益和长期可持续性影响的有力和确凿证据。在引入可能与潜在系统限制不匹配的数字健康创新时应谨慎。鼓励政策制定者和发展伙伴支持实施研究,以建立更连贯的全球证据基础。数字健康创新不应被视为独立的解决方案,而应被视为加强卫生系统的补充工具。 试验注册:PROSPERO CRD42024586285;www.crd.york.ac.uk/PROSPERO/view/CRD42024586285 。
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