Telemedicine versus face to face patient care: effects on professional practice and health care outcomes

 

Abstract

Background

Telemedicine is the use of telecommunications technology for medical diagnosis and patient care. From its beginnings telemedicine has been used in a variety of health care fields, although widespread interest among healthcare providers has only now become apparent with the development of more sophisticated technology.

Objectives

To assess the effects of telemedicine as an alternative to face-to-face patient care.

Search methods

We searched the Effective Practice and Organisation of Care Group's specialised register, The Cochrane Library, MEDLINE (1966-August 1999), EMBASE (to 1996), CINAHL (to August 1999), Inspec (to August 1996), Healthstar (1983-1996), OCLC, Sigle (to 1999), Assia, SCI (1981-1997), SSCI (1981-1997), DHSS-Data.

We handsearched the Journal of Telemedicine and Telecare (1995-1999), Telemedicine Journal (1995-1999) and reference lists of articles. We also handsearched conference proceedings and contacted experts in countries identified as having an interest in telemedicine.

Selection criteria

Randomised trials, controlled before and after studies and interrupted time series comparing telemedicine with face-to-face patient care. The participants were qualified health professionals and patients receiving care through telemedicine.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

Seven trials involving more than 800 people were included. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits and the findings did not constitute evidence of the safety of telemedicine. None of the studies included formal economic analysis. All the technological aspects of the interventions appear to have been reliable, and to have been well accepted by patients.

Authors' conclusions

Establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research and the fact that it is feasible to carry out randomised trials of telemedicine applications. Policy makers should be cautious about recommending increased use and investment in unevaluated technologies.

 

Plain language summary

Telemedicine versus face to face patient care: effects on professional practice and health care outcomes

Telemedicine is using telecommunications technology for medical diagnosis and health care. It includes transmitting test results down phone lines, using video technology for long distance consultations or education, and many other uses. The review found studies showing various forms of telemedicine are feasible, but there is not yet enough evidence to show the effects on health outcomes or costs of many expensive uses of technology. Overall, people self-monitoring at home or having video consultations were satisfied with their experience. More research is needed to assess the effects of the range of telemedicine techniques.

 

摘要

背景

遠端醫療對照於面對面的病患照護：對於專家作法及健康照護結果的影響

遠端醫療是利用通訊技術進行醫療診斷及病患照顧。從一開始遠端醫療就已被用在各種健康照護領域，雖然健康照護提供者對於發展更精密技術的廣泛興趣現在才變得明顯。

目標

評估遠端醫療作為一種替代面對面病患照護的效果。

搜尋策略

我們檢索the Effective Practice and Organisation of Care Group的專科登記資料庫，The Cochrane Library，MEDLINE (1966年至1999年8月)，EMBASE (至1996年)，Cinahl (至1999年8月)，Inspec (至1996年8月)，Healthstar (1983至1996年)，OCLC，Sigle (至1999年)，Assia，SCI (1981至1997年)，SSCI (1981至1997年)，DHSSData。我們人工檢索the Journal of Telemedicine and Telecare (1995至1999年)， Telemedicine Journal (1995至1999年)及文章的參考文獻。我們也人工檢索會議記錄並聯絡對遠端醫療有興趣之國家的專家。

選擇標準

比較遠端醫療與面對面病患照護的隨機試驗，前後對照研究及間斷時間序列分析。研究對象為合格的健康專家及接受遠端醫療照護的病患。

資料收集與分析

兩名審查者分別評估試驗品質並摘錄資料。

主要結論

納入7篇試驗共包含超過800名的研究對象。一篇試驗關於急診部門的遠端醫療，一篇有關基層健康照護與醫院門診部門的視訊會診，而其餘的則有關提供居家照護或慢性疾病患者的自我監測。這些研究似乎進行順利，雖然病患數量不多，除了一篇。雖然沒有研究顯示介入措施有任何不利的影響，但它們也沒有顯示明確的好處且結果並未建立遠端醫療安全性的證據。沒有研究包含正式的經濟學分析。所有介入措施的技術面向似乎是可靠的，且已被病患廣泛地接受。

作者結論

建立系統以使用通訊技術進行病患照護是可行的，但幾乎沒有臨床效益的證據。對於其他結果，研究提供各種且未定論的結果如精神測量，且沒有可分析遠端醫療系統成本效果的資料。這篇回顧證明了需要更進一步的研究，以及完成遠端醫療應用的隨機試驗是可行的。政策決定者在建議增加使用及評估未評估過的技術時應謹慎。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

尚未有關於遠端醫療可能服務範圍的足夠證據，但所有人對於居家自我監測及視訊會診是滿意的。遠端醫療是利用通訊技術進行醫療診斷及健康照護。它包括傳遞測試結果的電話線，遠距會議或教育所使用的視訊技術，及其他許多的應用。這篇回顧發現，研究顯示各種形式的遠端醫療是可行的，但尚未有充分的證據顯示其對於健康結果或使用許多昂貴技術的成本的效果。總而言之，民眾對於居家自我監測或有視訊會診的經驗是滿意的。需要更多的研究以評估遠端醫療技術範圍的效果。