Hu Cuirong, Liao Xinqi, Fang Yi, Zhu Shu, Lan Xia, Cheng Guilan
Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, No.37, Guoxue Lane, Wuhou District, Chengdu, 610041, China, 86 18980602084.
J Med Internet Res. 2025 Jul 8;27:e73010. doi: 10.2196/73010.
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder frequently requiring oxygen therapy to relieve symptoms and improve survival. In recent years, telehealth-supported interventions have emerged as promising strategies to optimize home oxygen therapy by promoting adherence, reducing hospitalizations, and enhancing health-related quality of life. However, evidence regarding their effectiveness remains inconsistent and equivocal, underscoring the need for further rigorous evaluation.
This study aimed to evaluate the clinical and cost-effectiveness of telehealth-supported home oxygen therapy on adherence, hospital readmission, and health-related quality of life in patients with COPD.
A comprehensive search was conducted across 6 databases (PubMed, Cochrane Central, Embase, Web of Science, PsycINFO, and CINAHL) up to October 1, 2024, and updated on April 28, 2025. Randomized controlled trials involving patients with COPD comparing telehealth-supported home oxygen therapy with usual care, and reporting outcomes on adherence, hospital readmissions, or health-related quality of life, were included. In addition, 2 reviewers independently screened the studies, extracted data, assessed the risk of bias using the Cochrane Risk of Bias 2 tool, and evaluated the certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analyses and heterogeneity assessments were conducted using R software (R Core Team). Standardized mean differences with 95% CIs were calculated to evaluate the intervention effects under a random-effects model.
In total, 8 studies comprising 1275 patients were included in the review. Telehealth-supported home oxygen therapy significantly reduced hospital readmissions (standardized mean difference [SMD]=-0.40, 95% CI -0.60 to -0.21) and improved health-related quality of life (SMD=0.49, 95% CI 0.25-0.73). No significant effect was observed on therapy adherence (SMD=0.19, 95% CI -0.76 to 1.14). Furthermore, 3 economic evaluations suggested that although telehealth interventions may incur higher initial costs, they are likely to result in long-term savings by reducing hospital admissions. Sensitivity analyses confirmed the robustness of the findings for hospital readmissions and health-related quality of life, for which the quality of evidence was rated as high, whereas the evidence for therapy adherence was rated as low.
Telehealth-supported home oxygen therapy significantly reduces hospital admissions and improves health-related quality of life in patients with COPD, but does not significantly improve therapy adherence. Tailored interventions that consider patient demographics, combined with supportive policies, may further enhance clinical outcomes. Future research should incorporate economic evaluations to better inform policy decisions regarding the implementation of telehealth-supported home oxygen therapy. However, the overall certainty of evidence is limited by study-level risk of bias, variability in intervention designs, and imprecision of effect estimates, highlighting the need for further high-quality, standardized trials.
慢性阻塞性肺疾病（COPD）是一种常见的呼吸系统疾病，常常需要氧疗来缓解症状并提高生存率。近年来，远程医疗支持的干预措施已成为优化家庭氧疗的有前景的策略，可通过促进依从性、减少住院次数以及提高与健康相关的生活质量来实现。然而，关于其有效性的证据仍然不一致且不明确，这凸显了进一步进行严格评估的必要性。
本研究旨在评估远程医疗支持的家庭氧疗对COPD患者的依从性、再次入院率以及与健康相关的生活质量的临床效果和成本效益。
截至2024年10月1日，对6个数据库（PubMed、Cochrane Central、Embase、Web of Science、PsycINFO和CINAHL）进行了全面检索，并于2025年4月28日更新。纳入了涉及COPD患者且将远程医疗支持的家庭氧疗与常规护理进行比较，并报告依从性、再次入院率或与健康相关的生活质量结果的随机对照试验。此外，两名 reviewers 独立筛选研究、提取数据、使用Cochrane偏倚风险2工具评估偏倚风险，并采用推荐分级评估、制定和评价方法评估证据的确定性。使用R软件（R核心团队）进行荟萃分析和异质性评估。计算具有95%置信区间的标准化均值差，以在随机效应模型下评估干预效果。
该综述共纳入了8项研究，涉及1275名患者。远程医疗支持的家庭氧疗显著降低了再次入院率（标准化均值差[SMD]= -0.40，95%置信区间 -0.60至 -0.21），并改善了与健康相关的生活质量（SMD = 0.49，95%置信区间0.25 - 0.73）。未观察到对治疗依从性有显著影响（SMD = 0.19，95%置信区间 -0.76至1.14）。此外，3项经济评估表明，尽管远程医疗干预可能会产生更高的初始成本，但它们可能通过减少住院次数带来长期节省。敏感性分析证实了关于再次入院率和与健康相关的生活质量的研究结果的稳健性，其证据质量被评为高，而治疗依从性的证据质量被评为低。
远程医疗支持的家庭氧疗显著降低了COPD患者的住院次数，并改善了与健康相关的生活质量，但并未显著提高治疗依从性。考虑患者人口统计学特征的定制干预措施，结合支持性政策，可能会进一步改善临床结果。未来的研究应纳入经济评估，以更好地为关于实施远程医疗支持的家庭氧疗的政策决策提供信息。然而，证据的总体确定性受到研究水平的偏倚风险、干预设计的变异性以及效应估计的不精确性的限制，这突出了进一步开展高质量、标准化试验的必要性。
