TY - JOUR AU - Darley, Sarah AU - Coulson, Tessa AU - Peek, Niels AU - Moschogianis, Susan AU - van der Veer, Sabine N AU - Wong, David C AU - Brown, Benjamin C PY - 2022 DA - 2022/10/24 TI -了解在线咨询的设计和实施如何影响初级保健质量:系统评价的证据建议设计师、供应商,和研究人员JO - J地中海互联网Res SP - e37436六世24 - 10 KW -惯例千瓦系统回顾KW -远程咨询KW - OC KW -分流KW -初级卫生保健KW -保健提供者KW -医疗保健专业KW -劳动力KW -远程医疗KW - COVID-19 KW -流行千瓦初级保健KW -健康结果KW -病人护理AB -背景:在线咨询(OCs)允许患者在网络上联系他们的护理提供者。在全球范围内，由于政策举措和2019冠状病毒病，OCs已在初级保健中迅速推广。关于OC的设计和实施如何影响护理质量，缺乏证据。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。我们纳入了在初级保健中对现实世界中口服药物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提供的卫生保健质量领域的专题综合，以及根据不采用、放弃、扩大规模、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 SN - 1438-8871 UR - //www.mybigtv.com/2022/10/e37436 UR - https://doi.org/10.2196/37436 UR - http://www.ncbi.nlm.nih.gov/pubmed/36279172 DO - 10.2196/37436 ID - info:doi/10.2196/37436 ER -