背景:儿童,青少年,患有慢性病的年轻人很难应对与疾病相关的压力源,精神健康问题并存,生活质量下降。COVID-19大流行导致了全球精神健康危机,远程医疗必然取代了亲自护理。然而,目前尚不清楚这种远程干预措施是否可行或有效.我们旨在填补这一研究实践空白。
目的:在本系统综述中,我们提供了一系列研究的综合研究,这些研究探讨了对年龄≤25岁的慢性病患者进行远程健康干预的可行性和有效性。
方法:PubMed,Embase,WebofScience,PsycInfo,从2008年到2020年,搜索了Cochrane系统评价数据库。我们包括实验性的,准实验,以及为儿童设计的远程健康干预措施的观察性研究,青少年,年龄≤25岁的年轻人患有慢性疾病,其中评估了可行性或疗效结局。仅包括同行评审期刊中的英语出版物。我们排除了针对护理人员或医疗保健提供者的干预措施的研究,心理健康问题不是在慢性疾病的背景下,疾病和药物管理,和健康个体的预防计划。
结果:我们筛选了2154篇独特的研究记录和109篇相关的全文文章。12项研究符合纳入标准,他们代表了七种独特的远程健康干预措施。其中5项研究包括可行性结果,7项研究包括疗效结果。除两项研究外,所有研究都是样本量相对较小的试点研究。大多数干预措施基于认知行为疗法和解决问题疗法。检查干预可行性的研究子集得出结论,远程健康干预是适当的,可接受,让病人和他们的父母满意。技术并没有在获得护理方面造成障碍。对于功效研究的子集,支持远程健康疗效的证据参差不齐.治疗类型的显著异质性,医学诊断,结果排除了荟萃分析。
结论:为患有慢性疾病的年轻人设计的远程健康干预措施的科学状态处于起步阶段。早期证据支持基于远程医疗的传统面对面干预措施的可行性。很少有研究评估疗效,目前的调查结果好坏参半。未来的研究应继续评估在COVID大流行后,远程健康是否可以作为面对面护理的可持续替代方案。
BACKGROUND: Children, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap.
OBJECTIVE: In this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ≤25 years with chronic illnesses.
METHODS: PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ≤25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals.
RESULTS: We screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis.
CONCLUSIONS: The state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic.