%0期刊文章%@ 1438- 8871% I JMIR出版物%V 24卡塔尔世界杯8强波胆分析% N 10% P 37436% T了解在线咨询的设计和实施如何影响初级保健质量:对设计人员、提供者和研究人员的建议的证据系统回顾%A Darley,Sarah %A Coulson,Tessa %A Peek,Niels %A Moschogianis,Susan %A van der Veer,Sabine N %A Wong,David C %A Brown,Benjamin C %+人口健康部，卫生服务研究和初级保健，曼彻斯特大学，牛津路，M13 9PL，英国，44 7919103175，Benjamin.brown@manchester.ac.uk %K全科医生%K系统回顾%K远程会诊%K OC %K分诊%K初级卫生保健%K护理提供者%K卫生保健专业人员%K劳动力%K远程医疗%K COVID-19 %K大流行%K初级保健%K健康结果%K患者护理%D 2022 %7 24.10.2022 %9回顾%J J医学互联网Res %G英语%X背景:在线会诊(OCs)允许患者在网上联系他们的护理提供者。在世界范围内，由于政策举措和COVID-19，初级保健中心已迅速推出。目前缺乏关于OC设计和实施如何影响护理质量的证据。目的:我们旨在综合研究OCs对初级保健质量的影响，以及系统设计和实施对这些影响的影响。方法:检索2010年1月至2022年2月的数据库。我们纳入了对初级保健中真实世界OC使用的定量和定性研究。定量数据转化为定性主题。我们使用了医学研究所卫生保健质量领域提供的专题综合，以及由不采用、放弃、扩大、传播和可持续性框架提供的框架分析。 Strength of evidence was judged using the GRADE-CERQual approach. Results: We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients’ queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. Conclusions: This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). Trial Registration: PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy %M 36279172 %R 10.2196/37436 %U //www.mybigtv.com/2022/10/e37436 %U https://doi.org/10.2196/37436 %U http://www.ncbi.nlm.nih.gov/pubmed/36279172