Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?
Identifieur interne : 001E02 ( Pmc/Checkpoint ); précédent : 001E01; suivant : 001E03Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?
Auteurs : John D. Piette ; Kc Lun [Singapour] ; Lincoln A. Moura [Brésil] ; Hamish Sf Fraser [États-Unis] ; Patricia N. Mechael [États-Unis] ; John Powell ; Shariq R. Khoja [Kenya]Source :
- Bulletin of the World Health Organization [ 0042-9686 ] ; 2012.
Abstract
E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients’ self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.
Url:
DOI: 10.2471/BLT.11.099069
PubMed: 22589570
PubMed Central: 3341688
Affiliations:
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p>E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients’ self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.</p>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Bull World Health Organ</journal-id>
<journal-id journal-id-type="iso-abbrev">Bull. World Health Organ</journal-id>
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<article-categories><subj-group subj-group-type="heading"><subject>Policy & Practice</subject>
</subj-group>
<subj-group subj-group-type="article-subtype"><subject>Theme Issue</subject>
</subj-group>
</article-categories>
<title-group><article-title>Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?</article-title>
<trans-title-group xml:lang="fr"><trans-title xml:lang="fr">Impacts de la télésanté sur les résultats sanitaires dans les pays à revenu faible et moyen: quelle direction prendre?</trans-title>
</trans-title-group>
<trans-title-group xml:lang="es"><trans-title xml:lang="es">El impacto de la cibersalud en los resultados de la asistencia en países con ingresos bajos y medios: ¿cómo actuar a partir de ahora?</trans-title>
</trans-title-group>
<trans-title-group xml:lang="ar"><trans-title xml:lang="ar">آثار الصحة الإلكترونية على حصائل الرعاية في البلدان منخفضة ومتوسطة الدخل: ما الذي يتعين علينا فعله تاليًا؟ </trans-title>
</trans-title-group>
<trans-title-group xml:lang="zh"><trans-title xml:lang="zh">电子卫生对中低收入国家医疗护理结果的影响:何去何从?</trans-title>
</trans-title-group>
<trans-title-group xml:lang="ru"><trans-title xml:lang="ru">Влияние "электронного" здравоохранения на результаты лечения в странах с низким и средним уровнем дохода: куда мы движемся?</trans-title>
</trans-title-group>
<alt-title alt-title-type="author-running-head">John D Piette et al.</alt-title>
<alt-title alt-title-type="title-running-head">Impacts of e-health on health outcomes</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Piette</surname>
<given-names>John D</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lun</surname>
<given-names>KC</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>b</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Moura</surname>
<given-names>Lincoln A</given-names>
<suffix>Jr</suffix>
</name>
<xref ref-type="aff" rid="aff3"><sup>c</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fraser</surname>
<given-names>Hamish SF</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>d</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mechael</surname>
<given-names>Patricia N</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>e</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Powell</surname>
<given-names>John</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>f</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Khoja</surname>
<given-names>Shariq R</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>g</sup>
</xref>
</contrib>
<aff id="aff1"><label>a</label>
Veteran Affairs Ann Arbor Center for Clinical Management Research, Health Services Research and Development Center of Excellence, PO Box 130170, Ann Arbor, MI, 48113-0170, United States of America (USA).</aff>
<aff id="aff2"><label>b</label>
School of Computing, National University of Singapore,<country>Singapore</country>
.</aff>
<aff id="aff3"><label>c</label>
Assis Moura eHealth, São Paulo,<country>Brazil</country>
.</aff>
<aff id="aff4"><label>d</label>
Harvard Medical School, Boston,<country>USA</country>
.</aff>
<aff id="aff5"><label>e</label>
Earth Institute, Columbia University, New York,<country>USA</country>
.</aff>
<aff id="aff6"><label>f</label>
Division of Health Sciences, University of Warwick, Coventry,<country>England</country>
.</aff>
<aff id="aff7"><label>g</label>
eHealth Resource Centre, The Aga Khan University, Nairobi,<country>Kenya</country>
.</aff>
</contrib-group>
<author-notes><corresp id="cor1">Correspondence to John D Piette (e-mail: <email xlink:href="jpiette@umich.edu">jpiette@umich.edu</email>
).</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>01</day>
<month>5</month>
<year>2012</year>
</pub-date>
<volume>90</volume>
<issue>5</issue>
<fpage>365</fpage>
<lpage>372</lpage>
<history><date date-type="received"><day>18</day>
<month>11</month>
<year>2011</year>
</date>
<date date-type="rev-recd"><day>27</day>
<month>1</month>
<year>2012</year>
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<date date-type="accepted"><day>31</day>
<month>1</month>
<year>2012</year>
</date>
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<permissions><copyright-statement>(c) World Health Organization (WHO) 2012. All rights reserved.</copyright-statement>
<copyright-year>2012</copyright-year>
</permissions>
<abstract><title>Abstract</title>
<p>E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients’ self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.</p>
</abstract>
<trans-abstract xml:lang="fr"><title>Résumé</title>
<p>La télésanté couvre un ensemble diversifié d'outils informatiques conçus pour améliorer la santé publique et les soins de santé. Peu d'informations sont disponibles sur les impacts des programmes de télésanté, en particulier dans les pays à revenu faible et moyen. Nous avons donc effectué une étude exploratoire de la documentation publiée et non publiée pour identifier les données relatives aux effets de la télésanté sur les résultats et les coûts sanitaires. L'accent a été mis sur l'identification des questions sans réponse pour la recherche future, en particulier sur des sujets pertinents pour les pays à revenu faible et moyen. Bien que la pénétration des outils de télésanté assistant la pratique clinique progresse au niveau mondial, on dispose de plus de preuves des avantages procurés par les outils assistant les décisions cliniques et les systèmes d'information de laboratoire que de ceux assistant l'archivage d'image et les systèmes de communication. La mise en œuvre de systèmes d'information communautaires pour la surveillance des maladies a été réalisée avec succès dans plusieurs pays à revenu faible et moyen. Bien que les informations relatives aux résultats fassent en général défaut, un grand projet au Brésil a exposé de manière documentée les impacts notables sur l'efficacité du système sanitaire. Des méta-analyses et des essais rigoureux ont exposé de manière documentée les avantages de la messagerie texte pour l'amélioration des résultats, comme ceux des soins auto-administrés. Il a été démontré que le suivi téléphonique automatisé et les appels d'assistance aux soins auto-administrés amélioraient certains résultats de la gestion des maladies chroniques, comme le contrôle de la glycémie et de la tension artérielle dans les pays à revenu faible et moyen. Bien que de grands programmes de mise en œuvre et de recherche en termes de télésanté soient menés dans de nombreux pays à revenu faible et moyen, on a besoin de plus d'informations sur les impacts de la télésanté en termes de résultats et de coûts dans ce contexte.</p>
</trans-abstract>
<trans-abstract xml:lang="es"><title>Resumen</title>
<p>La cibersalud abarca un conjunto diverso de herramientas informáticas diseñadas para mejorar la sanidad pública y la asistencia sanitaria. Se dispone de poca información acerca del impacto de los programas de cibersalud, especialmente, en países con ingresos bajos y medios. Por ello, llevamos a cabo una revisión sistemática exploratoria de la literatura publicada y no publicada para identificar datos sobre los efectos de la cibersalud en los resultados y en los costes sanitarios. Se puso énfasis en la identificación de preguntas no respondidas para futuras investigaciones, en especial, sobre temas relacionados con países de ingresos bajos y medios. Aunque las herramientas de cibersalud que apoyan la práctica clínica se han implementado globalmente y en creciente medida, únicamente hay evidencias sobre los beneficios de las que apoyan los archivos de imágenes y los sistemas de comunicación, pero de las herramientas que apoyan decisiones clínicas y sistemas de información de laboratorio. Los sistemas de información comunitarios para la vigilancia de enfermedades se han implementado satisfactoriamente en diversos países con ingresos bajos y medios. Aunque, por lo general, falta información relativa a los resultados, un proyecto de gran amplitud en Brasil ha documentado impactos notables en el sistema sanitario. Los metanálisis y los ensayos rigurosos han documentado los beneficios de los mensajes de texto en la mejora de resultados tales como la autoasistencia de los pacientes. El control por teléfono automatizado y las llamadas de autoasistencia de apoyo han demostrado que mejoran algunos resultados de gestión de enfermedades crónicas, como el control glucémico y de la presión sanguínea, en países con ingresos bajos y medios. Aunque se han llevado a cabo amplios programas para la implementación e investigación de la cibersalud en muchos países con ingresos bajos y medios, se necesita más información sobre los impactos de la cibersalud y sobre los costes en estos lugares.</p>
</trans-abstract>
<trans-abstract xml:lang="ar"><title>ملخص </title>
<p>تضم الصحة الإلكترونية مجموعة متنوعة من أدوات المعلوماتية التي تم تصميمها لتحسين الصحة العمومية والرعاية الصحية. ولا تتوفر سوى معلومات قليلة عن آثار برامج الصحة الإلكترونية، وبالأخص في البلدان منخفضة ومتوسطة الدخل. ولذلك، أجرينا استعراضًا دقيقًا للأبحاث المنشورة وغير المنشورة بغية التعرف على البيانات الخاصة بتأثيرات الصحة الإلكترونية على الحصائل الصحية وتكاليفها. وانصب التركيز على تحديد الأسئلة التي يتم الإجابة عنها لإجراء بحوث بشأنها في المستقبل، وبالأخص حول المواضيع ذات الصلة بالبلدان منخفضة ومتوسطة الدخل. وبرغم ما تحظى به أدوات الصحة الإلكترونية الداعمة للممارسات السريرية من اختراق متنام على الصعيد العالمي، يتوفر المزيد من البينّات حول فوائد الأدوات التي تدعم القرارات السريرية ونظم المعلومات المختبرية مقارنة بتلك التي تدعم أنظمة الأرشفة بالصور والاتصالات. وتم بنجاح تنفيذ نظم المعلومات المجتمعية لترصد الأمراض في العديد من البلدان منخفضة ومتوسطة الدخل. وبرغم النقص في المعلومات الخاصة بالحصائل بشكل عام، وثق أحد المشروعات الضخمة في البرازيل آثارًا ملحوظة على كفاءة النظام الصحي. كما وثقت استعراضات التحاليل والتجارب الصارمة فوائد الرسائل النصية في تحسين حصائل مثل الرعاية الذاتية للمرضى. واتضح أن الرصد الآلي للهواتف ومكالمات دعم الرعاية الذاتية تؤدي إلى تحسين بعض حصائل إدارة الأمراض المزمنة مثل سكر الدم والتحكم في ضغط الدم في البلدان منخفضة ومتوسطة الدخل. وعلى الرغم من إدارة برامج ضخمة لتنفيذ الصحة الإلكترونية وأبحاثها في العديد من البلدان منخفضة ومتوسطة الدخل، لا تزال هناك حاجة إلى مزيد من المعلومات عن آثار الصحة الإلكترونية على حصائل هذه المواقع وتكاليفها. </p>
</trans-abstract>
<trans-abstract xml:lang="zh"><title>摘要</title>
<p>电子卫生涵盖各种各样设计用以提高公众健康和卫生保健的信息学工具。有关电子卫生方案的影响的可用信息很少,尤其是在中低收入国家。因此,我们审查一定范围的发表和未发表的文献,确定电子卫生对健康状况和成本的影响数据。重点在于确定未来研究的悬而未决的问题,特别是中低收入国家的相关主题。虽然支持临床实践的电子卫生工具已经日益在全球渗透,但是支持临床决策和实验室信息系统的工具的好处得到的证据比支持图片存档和通信系统的工具更多。社区疾病监测信息系统已成功地在一些中低收入国家实施。虽然普遍缺乏效果信息,巴西的一个大型项目对医疗系统效率的显著影响却是有据可查。Meta 分析和严格的试验记录了短信息在改善医疗效果方面的益处,如病人的自理。电话自动监测和自理支持电话显示其有助于改善中低收入国家一些慢性疾病管理的成果,如血糖和血压控制。虽然许多中低收入国家正在开展电子卫生实施和研究的大型方案,仍然需要更多有关电子卫生在这些情况下成果和成本影响方面的信息。</p>
</trans-abstract>
<trans-abstract xml:lang="ru"><title>Резюме</title>
<p>"Электронное" здравоохранение включает в себя набор разнообразных информационных инструментов, созданных для повышения уровня общественного здравоохранения и медицинского обслуживания. Имеющейся информации о воздействии программ "электронного" здравоохранения, особенно в странах с низким и средним уровнем дохода, недостаточно. В связи с этим мы провели обзорное исследование как изданной, так и неиздающейся литературы, чтобы установить влияние "электронного" здравоохранения на результаты и стоимость лечения. Акцент был сделан на выявлении нерешенных вопросов для будущих исследований, особенно касающихся стран с низким и средним уровнем дохода. Хотя внедрение поддерживающих клиническую практику инструментов "электронного" здравоохранения растет в глобальных масштабах, согласно полученным данным, большей эффективности позволяют добиться тех из них, которые применяются для оказания поддержки при принятии клинических решений и в использовании лабораторных информационных систем, в сравнении с применяемыми для архивирования изображений и организации систем связи. В ряде стран с низким и средним уровнем дохода успешно реализованы общественные информационные системы наблюдения за распространением заболеваний. Несмотря на то, что информации о результатах, как правило, недостаточно, заметное влияние на эффективность системы здравоохранения было зафиксировано в ходе реализации крупного проекта в Бразилии. Мета-анализ и тщательные исследования зафиксировали эффективность применения текстовых сообщений для улучшения таких результатов, как самообслуживание пациентов. В странах с низким и средним уровнем дохода улучшение результатов ведения хронических больных, в частности, контроля за артериальным давлением и содержанием сахара в крови, показали автоматизированный телефонный мониторинг и звонки для поддержки самообслуживания. Хотя во многих странах с низким и средним уровнем дохода осуществляются масштабные программы по внедрению и исследованию систем "электронного" здравоохранения, необходимость в дополнительной информации об их влиянии на результаты и стоимость лечения в подобных условиях по-прежнему сохраняется.</p>
</trans-abstract>
</article-meta>
</front>
</pmc>
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<li>Singapour</li>
<li>États-Unis</li>
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