背景:在COVID-19大流行期间的服务快速过渡期间,远程医疗在为患者提供精神病治疗方面发挥了至关重要的作用。此外,远程医疗的使用预计将在精神病学领域扩大。远程医疗的功效在科学文献中有很好的描述。然而,有必要进行全面的定量审查,分析和考虑不同的临床结局和精神病诊断.
目的:本文旨在评估精神科门诊治疗创伤后应激障碍的个体,情绪障碍,使用远程医疗的成人焦虑症相当于面对面治疗。
方法:本综述使用公认的数据库对随机对照试验进行了系统的检索。总的来说,评估了4个结果:治疗效果,患者满意度,工作联盟,和流失率。使用逆方差方法来总结每个结果的效应大小。
结果:总共确定了7414条记录,20项试验纳入系统评价和荟萃分析.这些试验包括创伤后应激障碍(9项试验),抑郁症(6项试验),不同疾病的混合(4项试验),和一般焦虑障碍(1项试验)。总的来说,分析得出的证据表明,远程医疗在治疗效果方面与面对面治疗具有可比性(标准化平均差-0.01,95%CI-0.12至0.09;P=.84;I2=19%,17次试验,n=1814),患者满意度平均差异(-0.66,95%CI-1.60至0.28;P=.17;I2=44%,6试验,n=591),和流失率(风险比1.07,95%CI0.94-1.21;P=.32;I2=0%,20次试验,n=2804)。结果还表明,远程医疗和面对面模式之间的工作联盟是可比的,但异质性是相当大的(平均差异0.95,95%CI-0.47至2.38;P=.19;I2=75%,6试验,n=539)。
结论:这项荟萃分析提供了有关个人远程医疗干预措施的新知识,这些干预措施被认为在疗效方面等同于当面治疗,患者满意度,工作联盟,和诊断的流失率。关于疗效的证据的确定性被评为中等。此外,需要高质量的随机对照试验来加强通过远程医疗在精神病学中提供治疗的证据基础,特别是针对人格障碍和一系列缺乏研究的焦虑症。个人患者数据荟萃分析建议用于未来的研究,以个性化远程医疗。
背景:PROSPERO国际系统评价前瞻性注册CRD42021256357;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=256357。
BACKGROUND: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative
review that analyzes and considers the different clinical outcomes and psychiatric diagnoses.
OBJECTIVE: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment.
METHODS: A systematic search of randomized controlled trials was conducted using recognized databases for this
review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome.
RESULTS: A total of 7414 records were identified, and 20 trials were included in the systematic
review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539).
CONCLUSIONS: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine.
BACKGROUND: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.