Effect of Telemedicine on Quality of Care in Patients with Coexisting Hypertension and Diabetes: A Systematic Review and Meta-Analysis
Background: With the development of technology and the need for individualized and continuous support for patients with chronic conditions, telemedicine has been widely used. Despite the potential benefits of telemedicine, little is known about its effect on the quality of care (QoC) in people with hypertension and comorbid diabetes, who face more challenges in disease management than those with hypertension or diabetes alone. This study aimed to examine the effect of telemedicine on QoC for patients with hypertension and comorbid diabetes by synthesizing findings from clinical trials.
Methods: This systematic review and meta-analysis were developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four major electronic databases from inception to March 2020 were searched. Studies were screened using predetermined criteria. Data were extracted and tabulated into tables. The primary outcomes were QoC indicators, including outcomes (e.g., blood pressure [BP] and glycemic control), process, and experience of care. Quantitative data were pooled and presented in forest plots. Qualitative narratives were also used.
Results: Five studies from four clinical trials were included in this review, with intervention durations ranging from 3 to 6 months. Telemedicine significantly decreased BP by 10.4/4.8 mm/Hg, but its effect on glycemic control was inconsistent. Telemedicine also improved experience of care (e.g., patient perception and engagement). Various indicators for process of care were assessed, including medication adherence, BP monitoring, and self-efficacy, with mixed findings.
Conclusions: Telemedicine has great potential to improve the QoC, particularly outcomes of care, for patients with hypertension and comorbid diabetes. Health care professionals may consider using available telemedicine to facilitate communication and interaction with their patients, thereby helping them with disease management. Long-term, large-scale studies are needed to test the generalizability and sustainability of the telemedicine programs.