BACKGROUND: eHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking.
OBJECTIVE: We conducted a systematic review of systematic reviews and meta-analyses on the effectiveness/cost-effectiveness of eHealth interventions in patients with somatic diseases to analyze whether, and to what possible extent, the outcome of recent research supports or differs from previous conclusions.
METHODS: Literature searches were performed in PubMed, EMBASE, The Cochrane Library, and Scopus for systematic reviews and meta-analyses on eHealth interventions published between August 2009 and December 2012. Articles were screened for relevance based on preset inclusion and exclusion criteria. Citations of residual articles were screened for additional literature. Included papers were critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement before data were extracted. Based on conclusions drawn by the authors of the included articles, reviews and meta-analyses were divided into 1 of 3 groups: suitable, promising, or limited evidence on effectiveness/cost-effectiveness. Cases of uncertainty were resolved by consensus discussion. Effect sizes were extracted from papers that included a meta-analysis. To compare our results with previous findings, a trend analysis was performed.
RESULTS: Our literature searches yielded 31 eligible reviews, of which 20 (65%) reported on costs. Seven papers (23%) concluded that eHealth is effective/cost-effective, 13 (42%) underlined that evidence is promising, and others found limited or inconsistent proof. Methodological quality of the included reviews and meta-analyses was generally considered high. Trend analysis showed a considerable accumulation of literature on eHealth. However, a similar percentage of papers concluded that eHealth is effective/cost-effective or evidence is at least promising (65% vs 62%). Reviews focusing primarily on children or family caregivers still remained scarce. Although a pooled (subgroup) analysis of aggregate data from randomized studies was performed in a higher percentage of more recently published reviews (45% vs 27%), data on economic outcome measures were less frequently reported (65% vs 85%).
CONCLUSIONS: The number of reviews and meta-analyses on eHealth interventions in patients with somatic diseases has increased considerably in recent years. Most articles show eHealth is effective/cost-effective or at least suggest evidence is promising, which is consistent with previous findings. Although many researchers advocate larger, well-designed, controlled studies, we believe attention should be given to the development and evaluation of strategies to implement effective/cost-effective eHealth initiatives in daily practice, rather than to further strengthen current evidence.
BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.
DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.
RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.
CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.
BACKGROUND: Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases have increased over the past decade and become increasingly important to a wide range of clinicians, policy makers, and other health care stakeholders. While a few criticisms about their methodological rigor and synthesis approaches have recently appeared, no formal appraisal of their quality has been conducted yet.
OBJECTIVE: The primary aim of this critical review was to evaluate the methodology, quality, and reporting characteristics of prior reviews that have investigated the effects of home telemonitoring interventions in the context of chronic diseases.
METHODS: Ovid MEDLINE, the Database of Abstract of Reviews of Effects (DARE), and Health Technology Assessment Database (HTA) of the Cochrane Library were electronically searched to find relevant systematic reviews, published between January 1966 and December 2012. Potential reviews were screened and assessed for inclusion independently by three reviewers. Data pertaining to the methods used were extracted from each included review and examined for accuracy by two reviewers. A validated quality assessment instrument, R-AMSTAR, was used as a framework to guide the assessment process.
RESULTS: Twenty-four reviews, nine of which were meta-analyses, were identified from more than 200 citations. The bibliographic search revealed that the number of published reviews has increased substantially over the years in this area and although most reviews focus on studying the effects of home telemonitoring on patients with congestive heart failure, researcher interest has extended to other chronic diseases as well, such as diabetes, hypertension, chronic obstructive pulmonary disease, and asthma. Nevertheless, an important number of these reviews appear to lack optimal scientific rigor due to intrinsic methodological issues. Also, the overall quality of reviews does not appear to have improved over time. While several criteria were met satisfactorily by either all or nearly all reviews, such as the establishment of an a priori design with inclusion and exclusion criteria, use of electronic searches on multiple databases, and reporting of studies characteristics, there were other important areas that needed improvement. Duplicate data extraction, manual searches of highly relevant journals, inclusion of gray and non-English literature, assessment of the methodological quality of included studies and quality of evidence were key methodological procedures that were performed infrequently. Furthermore, certain methodological limitations identified in the synthesis of study results have affected the results and conclusions of some reviews.
CONCLUSIONS: Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring. Further efforts should be made to improve the design, conduct, reporting, and publication of systematic reviews and meta-analyses in this area.
DOELSTELLING: Een review van systematische reviews naar de effectiviteit en haalbaarheid van videoconferentie op basis van psychiatrische zorg op afstand diensten voor beperkte middelen omgevingen werd uitgevoerd. Specifiek met als doel het produceren van een evidence-based beoordeling van de effectiviteit en haalbaarheid van videoconferentie op basis van psychiatrische zorg op afstand diensten in beperkte middelen landen als Zuid-Afrika.
METHODEN: Acht belangrijke vragen over telepsychiatrie effectiviteit en haalbaarheid werden geïdentificeerd en inclusie en exclusie criteria zijn ontwikkeld. Herziening van citaten uit 2000-2011 van CINAHL, Medline, Pubmed, PsycInfo, EBSCOhost, Sabinet, Cochrane Database of Systematic Reviews (CCTR), Cochrane Controlled Trial Register (CCTR), Database of Abstracts van evaluaties van de doeltreffendheid (DARE), niet-gepubliceerde abstracts door NEXUS en internet zoekmachines (Google / Google scholar) werd uitgevoerd.
RESULTATEN: Tien systematische reviews werden voor beoordeling. Ondanks de methodologische beperkingen en de heterogeniteit van de systematische reviews, blijkt er goed bewijs van effectiviteit (betrouwbaarheid en betere resultaten) en haalbaarheid (gebruik, tevredenheid, aanvaardbaarheid en kosten) voor de videoconferentie op basis van psychiatrische zorg op afstand op internationaal niveau. De toepassing van dit bewijs in lagere middeninkomenslanden is afhankelijk van de integratie van de psychiatrische zorg op afstand in de lokale gezondheidszorg contexten.
CONCLUSIE: Op basis van het bewijs, beperkte middelen landen als Zuid-Afrika moeten worden aangemoedigd om telepsychiatrie programma's te ontwikkelen, samen met strenge evaluatie methoden.
TECHNOLOGIE: Real-time telehealth omvat het gebruik van informatie-en communicatietechnologieën (bijvoorbeeld een minimumpakket van videocamera's, computerschermen, en een beveiligde high-speed internet verbinding), zodat mensen live (of synchroon) communiceren over lange en korte afstanden. PROBLEEM: Hoewel real-time telezorg is gebruikt voor minstens 50 jaar over de hele wereld, een belemmering voor brede adoptie kan een gebrek aan betrouwbare gegevens als basis voor beleid, beheer en klinische beslissingen verschaffen. METHODEN EN RESULTATEN: Een systematische identificatie van studies over telezorg modaliteiten gepubliceerd in het Engels in peer-reviewed tijdschriften, het beoordelen van gezondheidseffecten, proces van de zorg, het gebruik van hulpbronnen, en de tevredenheid van gebruikers in de eerste lijn, leverde 31 publicaties. Twee onafhankelijke teams van beoordelaars gescreend en geëxtraheerd gegevens en uitgevoerde kwaliteitsbeoordelingen. Hoewel er geen formele economische analyse, werden alle gerelateerde economische resultaten uit klinische beoordelingen. De resultaten van hoge kwaliteit beoordelingen gaven aan dat real-time telezorg kan zo effectief zijn als in-persoon zorg bij patiënten met psychiatrische en neurologische problemen, en kan het aantal ziekenhuisopnames en sterfte te verminderen bij patiënten met chronische aandoeningen zoals congestief hartfalen .
eHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking.
OBJECTIVE:
We conducted a systematic review of systematic reviews and meta-analyses on the effectiveness/cost-effectiveness of eHealth interventions in patients with somatic diseases to analyze whether, and to what possible extent, the outcome of recent research supports or differs from previous conclusions.
METHODS:
Literature searches were performed in PubMed, EMBASE, The Cochrane Library, and Scopus for systematic reviews and meta-analyses on eHealth interventions published between August 2009 and December 2012. Articles were screened for relevance based on preset inclusion and exclusion criteria. Citations of residual articles were screened for additional literature. Included papers were critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement before data were extracted. Based on conclusions drawn by the authors of the included articles, reviews and meta-analyses were divided into 1 of 3 groups: suitable, promising, or limited evidence on effectiveness/cost-effectiveness. Cases of uncertainty were resolved by consensus discussion. Effect sizes were extracted from papers that included a meta-analysis. To compare our results with previous findings, a trend analysis was performed.
RESULTS:
Our literature searches yielded 31 eligible reviews, of which 20 (65%) reported on costs. Seven papers (23%) concluded that eHealth is effective/cost-effective, 13 (42%) underlined that evidence is promising, and others found limited or inconsistent proof. Methodological quality of the included reviews and meta-analyses was generally considered high. Trend analysis showed a considerable accumulation of literature on eHealth. However, a similar percentage of papers concluded that eHealth is effective/cost-effective or evidence is at least promising (65% vs 62%). Reviews focusing primarily on children or family caregivers still remained scarce. Although a pooled (subgroup) analysis of aggregate data from randomized studies was performed in a higher percentage of more recently published reviews (45% vs 27%), data on economic outcome measures were less frequently reported (65% vs 85%).
CONCLUSIONS:
The number of reviews and meta-analyses on eHealth interventions in patients with somatic diseases has increased considerably in recent years. Most articles show eHealth is effective/cost-effective or at least suggest evidence is promising, which is consistent with previous findings. Although many researchers advocate larger, well-designed, controlled studies, we believe attention should be given to the development and evaluation of strategies to implement effective/cost-effective eHealth initiatives in daily practice, rather than to further strengthen current evidence.
