The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview

BackgroundTelehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare.Methods and FindingsTwo reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (ConclusionsPolicymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.背景：远程医疗（telehealthcare）指依托信息与通信技术开展远距离医疗服务，并通过远程监测与个性化反馈支持患者自我管理。当前，对远程医疗的收益、风险与成本相关证据进行系统性审视恰逢其时。方法与结果：两名检索员检索了1997年1月至2011年11月期间发表于《考克兰图书馆》（The Cochrane Library）、MEDLINE、EMBASE、LILACS、IndMed及PakMed的相关系统评价。检索员采用《关键评价技能项目》（Critical Appraisal Skills Programme, CASP）系统评价质量评估工具，独立完成所纳入研究的质量评价。本次检索共识别出1782篇综述文献，最终筛选纳入80篇系统评价，其覆盖了涵盖医患间同步（实时）与异步（存储转发）交互的多种远程医疗模式。多数研究显示，远程医疗与常规诊疗的结局并无显著差异。多篇评价指出，短期相关研究数量颇为可观。结论：政策制定者与医疗规划者需明确，对远程医疗的投入并非必然能带来临床或经济效益。对于预后风险最高的患者群体，或可实现最显著的收益提升。当前亟需开展长期研究，以明确限时临床试验中观察到的收益是否能够持续。