ABSTRACT
[This corrects the article DOI: 10.2196/27990.].
ABSTRACT
BACKGROUND: Due to an increase in life expectancy, the prevalence of chronic diseases is also on the rise. Clinical practice guidelines (CPGs) provide recommendations for suitable interventions regarding different chronic diseases, but a deficiency in the implementation of these CPGs has been identified. The PITeS-TiiSS (Telemedicine and eHealth Innovation Platform: Information Communications Technology for Research and Information Challenges in Health Services) tool, a personalized ontology-based clinical decision support system (CDSS), aims to reduce variability, prevent errors, and consider interactions between different CPG recommendations, among other benefits. OBJECTIVE: The aim of this study is to design, develop, and validate an ontology-based CDSS that provides personalized recommendations related to drug prescription. The target population is older adult patients with chronic diseases and polypharmacy, and the goal is to reduce complications related to these types of conditions while offering integrated care. METHODS: A study scenario about atrial fibrillation and treatment with anticoagulants was selected to validate the tool. After this, a series of knowledge sources were identified, including CPGs, PROFUND index, LESS/CHRON criteria, and STOPP/START criteria, to extract the information. Modeling was carried out using an ontology, and mapping was done with Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT; International Health Terminology Standards Development Organisation). Once the CDSS was developed, validation was carried out by using a retrospective case study. RESULTS: This project was funded in January 2015 and approved by the Virgen del Rocio University Hospital ethics committee on November 24, 2015. Two different tasks were carried out to test the functioning of the tool. First, retrospective data from a real patient who met the inclusion criteria were used. Second, the analysis of an adoption model was performed through the study of the requirements and characteristics that a CDSS must meet in order to be well accepted and used by health professionals. The results are favorable and allow the proposed research to continue to the next phase. CONCLUSIONS: An ontology-based CDSS was successfully designed, developed, and validated. However, in future work, validation in a real environment should be performed to ensure the tool is usable and reliable.
ABSTRACT
OBJETIVO: Evaluar la efectividad de intervenciones basadas en telemedicina para mejorar resultados en salud en pacientes con multimorbilidad en atención primaria. DISEÑO: Revisión sistemática. Fuentes de datos: INAHTA, Guía Salud, NICE, Cochrane Library, Medline/PubMed y EMBASE hasta abril de 2018. Selección de estudios: CRITERIOS DE INCLUSIÓN: pacientes (adultos con 2 o más enfermedades crónicas o índice de Charlson mayor de 3); intervención (programa de telemedicina desarrollada en atención primaria); comparador (práctica habitual); resultados (mortalidad, ingresos hospitalarios, consultas a urgencias, calidad de vida relacionada con la salud y satisfacción); diseño (guía de práctica clínica, revisión sistemática, metaanálisis, ensayo clínico controlado aleatorizado o cuasiexperimental). Publicación en inglés o español. Se localizaron 236 referencias. Extracción de datos: Exclusión de duplicados; valoración de criterios de selección sobre título, resumen y texto completo; valoración crítica; extracción y análisis cualitativo. Dos revisores y un tercero para discrepancias. RESULTADOS: Se incluyeron 5 artículos de 3 estudios, 2 ensayos clínicos controlados aleatorizados y en cuasiexperimental. No se observaron resultados significativos en la reducción de la mortalidad o mejora de la calidad de vida relacionada con la salud. La efectividad de la telemedicina sobre el número de ingresos hospitalarios o consultas a urgencias mostró resultados contradictorios. La satisfacción no fue medida en los estudios incluidos. CONCLUSIONES: El escaso número de estudios, la relativa heterogeneidad y limitaciones metodológicas no permiten confirmar la efectividad de las intervenciones basadas en telemedicina en pacientes con multimorbilidad en atención primaria, sobre la mejora de la mortalidad, el número de ingresos hospitalarios o consultas a urgencias y calidad de vida relacionada con la salud, respecto a la práctica habitual
OBJECTIVE: To evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care. DESIGN: A systematic review. Data sources: INAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018. Study selection: Inclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located. Data extraction: Duplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis. RESULTS: Five articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included. CONCLUSIONS: The relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care
Subject(s)
Humans , Male , Female , Telemedicine/methods , Multimorbidity , Primary Health Care/methods , Multiple Chronic Conditions/therapy , Treatment Outcome , Quality of Life , Patient Outcome AssessmentABSTRACT
OBJECTIVE: To evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care. DESIGN: A systematic review. DATA SOURCES: INAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018. STUDY SELECTION: Inclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located. DATA EXTRACTION: Duplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis. RESULTS: Five articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included. CONCLUSIONS: The relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care.
