J Telemed Telecare - Policy expectations and reality of telemedicine - a critical analysis of health care outcomes, costs and acceptance for congestive heart failure.

Tópicos

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Resumo

A critical review of evidence was carried out to discover whether the actual performance of telemedicine fulfils the expectations of German policy-makers. The analysis was conducted using the example of telemedicine for congestive heart failure (CHF). It was based on both German and international evidence. The PubMed, MEDLINE, Google Scholar and Cochrane Library databases were searched, as well as public sources from the German Federal Ministry of Health. Forty-five studies reporting patient outcomes, costs or acceptance of telemedicine for CHF were included in the review, of which 28 were interventional. The policy expectations of telemedicine generally are: high technology acceptance and improved patient outcomes at lower costs. However, in the field of CHF, policy-makers underestimate the complexity of telemedicine and the technology has not yet lived up to its expectations. Although some studies show improvements in all-cause mortality and CHF-related hospitalisations, there is excessive study heterogeneity and vagueness in the areas of costs and acceptance. Methodological insufficiencies as well as the scarcity of evidence in the German context do not allow definite conclusions to be drawn. Policy-makers and other stakeholders should increase their efforts to consolidate isolated telemedicine projects, establish guidelines for clinical treatment procedures and economic evaluations, and define industry/technical device standards to enhance the comparability of interventions. Imposing the use of telemedicine on patients and physicians is not likely to be fruitful. A successful adaptation requires an analysis of needs and continuous education on both sides.

Resumo Limpo

critic review evid carri discov whether actual perform telemedicin fulfil expect german policymak analysi conduct use exampl telemedicin congest heart failur chf base german intern evid pubm medlin googl scholar cochran librari databas search well public sourc german feder ministri health fortyf studi report patient outcom cost accept telemedicin chf includ review intervent polici expect telemedicin general high technolog accept improv patient outcom lower cost howev field chf policymak underestim complex telemedicin technolog yet live expect although studi show improv allcaus mortal chfrelat hospitalis excess studi heterogen vagu area cost accept methodolog insuffici well scarciti evid german context allow definit conclus drawn policymak stakehold increas effort consolid isol telemedicin project establish guidelin clinic treatment procedur econom evalu defin industrytechn devic standard enhanc compar intervent impos use telemedicin patient physician like fruit success adapt requir analysi need continu educ side

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