后流行病世界中被忽视热带病的远程医疗和临床护理:我们在缓解全球不平等现象的道路上何去何从?范围审查

Fernanda Goncalves Ferreira Salvador, Claudia C J Duarte, Mayumi D Wakimoto, Luis V Lapão, Henrique M C Silveira, Claudia Maria Valete
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引用次数: 0

摘要

背景 被忽视的热带病(NTDs)是一个全球性的公共卫生问题,对社会经济影响巨大。利用数字医疗技术远程提供医疗服务是减少医疗服务不平等的重要策略,但在中低收入环境和地理位置偏僻的地区却具有挑战性。本次综述的目的是根据范围界定综述协议,确定并总结世界各地利用远程医疗为 NTD 患者提供临床护理的国际证据。方法/主要研究结果 从 MEDLINE/PubMed、Web of Science 和 Scopus 数据库中共提取了 422 篇文章,在删除了 129 篇重复文章后,有 285 篇研究因不符合至少一项资格标准而被排除。共有 8 篇文章被纳入数据收集范围,这些文章发表于 2006 年至 2023 年之间,其中一半发表于 2021 年之后(4 篇)。50%的研究(4 篇)集中于皮肤病,如麻风病和利什曼病,其他疾病包括登革热(2 篇)、沙眼(1 篇)和囊尾蚴病(1 篇)。对 NTD 的远程医疗干预大多发生在南美洲(5 项),重点是巴西(2 项)。对远程诊断准确性进行评估的研究表明,远程诊断对麻风病、沙眼和神经囊尾蚴病并发症的治疗效果良好。在登革热和一些皮肤科非传染性疾病的治疗中,远程医疗大大减少了对专业面诊的需求;利用移动医疗提高了对皮肤利什曼病的临床监测质量。结论/意义 本次范围界定审查对应用于 NTD 临床护理的远程医疗的现有证据进行了摸底。尽管我们观察到,在 COVID-19 大流行之后,有关这一主题的学术研究近期略有增加,但通过远程医疗对 NTD 进行临床管理的建议仍存在差距,尤其是同步方法,这表明这一资源在很大程度上仍未得到充分利用。
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Telemedicine and clinical care for Neglected Tropical Diseases in a post-pandemic world: where are we on the way to mitigate global inequities? A scoping review
Background Neglected Tropical Diseases (NTDs) represent a global public health problem with great socioeconomic impact. Using digital health technologies to provide medical care remotely can be an important strategy for reducing inequalities in access but is challenging in low-and middle-income settings and geographically isolated areas. The objective of the current review was to identify and summarize international evidence on the use of telemedicine for clinical care of patients with NTD around the world based on a scoping review protocol. Methodology/Principal Findings A total of 422 articles were extracted from the databases MEDLINE/PubMed, Web of Science and Scopus, and after remove 129 duplicates, 285 studies were excluded because they did not meet at least one of the eligibility criteria. A total of 8 articles were included for data collection, published between 2006 and 2023, half of them after 2021 (n=4). Fifty percent of the studies (n=4) were focused on dermatological diseases, like leprosy and leishmaniosis, and the other diseases found were dengue (n=2), trachoma (n=1) and cysticercosis (n=1). Most of telemedicine interventions in NTD took place in South America (n=5), with emphasis on Brazil (n=2). Studies that evaluated the accuracy of remote diagnosis demonstrated good effectiveness for leprosy, trachoma and complications of neurocysticercosis. There was a significant reduction in the need for specialized in-person medical consultations with telemedicine for the care of dengue fever and some dermatological NTDs; and an improvement in the quality of clinical monitoring of cutaneous leishmaniasis using mobile health was related. Conclusions/Significance This scoping review mapped the existing evidence on telemedicine applied at clinical care for NTD. Although we observed a small recent increase in academic research on the theme after COVID-19 pandemic, there is a gap in recommendations for the clinical management of NTDs through telemedicine, especially for synchronous approaches, revealing that this resource is still largely underutilized.
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