背景:采用虚拟咨询,在COVID-19大流行的催化下,改变了初级保健服务的提供方式。由于它们在全球迅速扩散,有必要全面评估虚拟咨询对护理质量各个方面的影响。
目的:本研究旨在评估虚拟咨询对初级保健质量的影响。
方法:共检索6个数据库。评估虚拟咨询影响的研究,对于任何疾病,包括在内。标题和摘要筛选和全文筛选由2对研究者进行。使用混合方法评估工具评估偏倚风险。对结果进行了叙述性综合。
结果:总计,30项研究(5,469,333名参与者)纳入本综述。我们的研究结果表明,虚拟咨询对于某些疾病的管理与面对面护理同样有效或更有效,包括精神疾病,过度吸烟,和酒精消费。总的来说,4项研究表明对以患者为中心的某些方面有积极影响;然而,注意到对患者感知的自主性支持的负面影响(即,人们认为那些处于权威地位的人支持自治的程度)。虚拟咨询可以减少等待时间,降低患者成本,并降低二级和三级护理机构的随访率。对临床安全性影响的证据极为有限。关于公平的证据好坏参半。总的来说,看起来虚拟护理更有可能被年轻人使用,女性患者,其他亚组之间的差异取决于环境因素。
结论:我们的系统评价表明,虚拟咨询可能与面对面护理一样有效,并且对护理的效率和及时性有潜在的积极影响;然而,对患者安全的影响相当缺乏证据,股本,以病人为中心,强调未来研究工作应该投入的领域。利用真实世界的数据,以及临床试验,对于确保虚拟咨询的使用根据患者需求量身定制,并涵盖预期的最终用户至关重要。根据初级保健背景定制并考虑患者特征的数据收集方法对于生成更强大的证据基础以告知未来的虚拟护理策略是必要的。
The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.
This study aims to evaluate the impact of virtual consultations on the quality of primary care.
A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.
In total, 30 studies (5,469,333 participants) were included in this
review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients\' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors.
Our systematic
review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.