电子健康档案联合新媒介载体对社区居民健康促进效果的范围综述

郑映微; 黄斌; 范冠华

doi:10.16766/j.cnki.issn.1674-4152.003046

电子健康档案联合新媒介载体对社区居民健康促进效果的范围综述

doi: 10.16766/j.cnki.issn.1674-4152.003046

汕头大学医学院，广东汕头 515041

基金项目:

广东省自然科学基金面上项目 2017A030313434

广东省自然科学基金面上项目 2022A1515012192

广东省医学科研基金项目 A2021500

广东省医学科研基金项目 A2022535

广东省哲学社会科学“十四五”规划2022年度学科共建项目 GD22XXW10

汕头大学医学院PSBH课题 2019汕大医PSBH07

汕头市科技计划医疗卫生类别项目 190716185262435

详细信息

通讯作者:
范冠华, E-mail: fangh@stu.edu.cn

中图分类号: R197.323.1 R197.61
计量
- 文章访问数: 249
- HTML全文浏览量: 78
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-08
- 网络出版日期: 2023-08-26

Actual effect of electronic health records combined with new media carriers on health promotion of community residents: a scoping review

Shantou University Medical College, Shantou, Guangdong 515041, China

摘要

摘要: 目的立足于应用电子健康档案干预改善社区居民健康素养的相关文献调研现状，系统分析电子健康档案联合新媒介载体对社区居民的健康促进效果，以及电子健康档案的信息利用现状，明确电子健康档案在临床活动中的应用进展。方法基于Arksey和O’Mallry概况性评价框架方法，检索PubMed、中国知网(CNKI)数据库中有关电子健康档案的应用途径与其效果的国内外文献。用描述性分析、数据汇总展示所纳入研究的分布情况，并依据与研究问题和目标相关的研究及主要发现撰写范围综述(scoping review)，并提出建议。结果共检索到1 167篇相关文献，通过排序筛选、浏览标题、阅读摘要、全文分析后，最终有9篇核心文献纳入概况性评价，根据研究途径进行分类，可分为APP和(或)可穿戴设备、微信、疾病健康相关网站(或系统)三大类，这些新媒介载体联合电子健康档案的模式能促进慢性病患者的自我健康管理。结论电子健康档案可提高患者健康素养，但其推广与应用受获取途径、信息安全、用户年龄等影响，在国内仍有诸多待改进之处。积极鼓励和引导居民了解并主动应用电子健康档案，完善相关法律体系是当前阶段推广电子健康档案的必然要求。
- 电子健康档案 /
- 健康风险行为 /
- 范围综述
Abstract: Objective Based on the present situation of literature research on the application of electronic health records to improve community residents ' health literacy, this paper systematically analyses the effects of electronic health records combined with new media carriers on the health promotion of community residents, as well as the information utilization situation of electronic health records, and clarifies the progress of the application of electronic health records in clinical activities. Methods Based on the general evaluation framework method of Arksey and O ' Mallry, the domestic and foreign literature about the application ways and effects of electronic health records in PubMed and China National Knowledge Infrastructure (CNKI) database were searched. Descriptive analysis and data collection were used to show the distribution of the included studies, and suggestions were put forward based on the scoping review. Results A total of 1 167 literature related to the research topic were retrieved, and 9 core literature were finally included in the overview evaluation after the selection of titles, abstracts, and full text reading. According to the research methods, it could be divided into three categories: APP and (or) wearable devices, Wechat, and disease and health related websites (or systems). The mode of these new media carriers and electronic health records could promote the self-health management of patients with chronic diseases. Conclusions Electronic health records can improve patients ' health literacy, but its promotion and application are affected by accesses, information security, user ages. It still has a lot to be improved in China. At the current stage, the inevitable requirements of promoting electronic health records are actively encouraging and guiding residents to understand and actively apply electronic health records, improving the relevant legal system.
- Electronic health records /
- Health risk behaviors /
- Scoping review

HTML全文

图 1 文献检索流程

Figure 1. Document retrieval process

下载: 全尺寸图片幻灯片

表 1 纳入文献的基本特征

Table 1. Basic features of the included literature

文献作者	新媒介载体类型	国家	中文/英文	样本量	干预持续时间	研究对象	研究设计	研究类型
YANG Y等^[8]	手机健康APP	韩国	英文	239	3个月	糖尿病患者	集群随机对照	定量研究
汤洪秀等^[9]	手机健康APP	中国	中文	300	12个月	糖尿病患者	随机对照	定量研究
任庭苇^[10]	手机健康APP+可穿戴设备	中国	中文	188	1个月	高血压或糖尿病患者	随机对照	定量研究
KIM J W等^[11]	手机健康APP+可穿戴设备	韩国	英文	43	2个月	阻塞性睡眠呼吸暂停患者	随机对照	定量研究
RYU B等^[12]	手机健康APP+可穿戴设备	韩国	英文	68	2个月	门诊患者BMI＞23	随机对照	定量研究
NAZI K M等^[13]	网站	美国	英文	688	10个月	退伍军人	描述性研究	定量研究
LOPEZ P M等^[14]	网站	美国	英文	6 974+16	12个月	高血压患者	准实验研究	混合研究
孙蕊^[15]	微信	中国	中文	80	3年	妊娠期高血压孕妇	随机对照	定量研究
KARLSSON L O等^[16]	临床决策支持系统	瑞典	英文	14 800	12个月	房颤患者	集群随机试验	定量研究

下载: 导出CSV

表 2 电子健康档案联合新媒介载体效果研究

Table 2. Study on the effect of electronic health records combined with new media carriers

文献作者	类型	研究对象	研究设计	监测指标	研究结果
YANG Y等^[8]	APP	糖尿病患者	随机对照；问卷调查	糖化血红蛋白	干预组糖化血红蛋白、血糖控制效果较对照组好，差异有统计学意义；干预组治疗满意度和药物依从性的得分更高
汤洪秀等^[9]	APP	糖尿病患者	随机对照；问卷调查	糖尿病综合知识知晓率；糖化血红蛋白	干预组糖尿病综合知识知晓率(76.50%)高于干预前(52.50%)，合理膳食、血糖监测、血压监测的患者所占比例高于干预前，差异有统计学意义
任庭苇^[10]	APP+可穿戴设备	高血压或糖尿病患者	随机对照；问卷调查	血压；体重指数BMI；糖化血红蛋白	干预组舒张压和体重控制效果更好，与对照组相比差异有统计学意义
KIM J W等^[11]	APP+可穿戴设备	阻塞性睡眠呼吸暂停低通气综合征患者	3组随机对照；问卷调查	BMI；阻塞性睡眠呼吸暂停低通气综合征相关呼吸参数的变化	干预组的体重减轻有显著变化，比对照组体重减轻更多(P=0.01)，与睡眠相关的健康结果无显著变化；2组的依从性患者百分比分别为63.64%和36.36%
RYU B等^[12]	APP+可穿戴设备	门诊患者BMI＞23	干预、纸质调查、意见访谈	BMI；胆固醇、甘油三酯等	干预组在最后一周的体重减轻率明显高于对照组；研究期结束时，甘油三酯水平明显较低(平均2.59 mmol/L，P=0.002)
NAZI K M等^[13]	网站	退伍军人	网络匿名问卷调查	频率、时间；网站有用性、易用性和影响因素	64%的受访者使用该网站查找了有关疾病、治疗的信息；48%的人认为健康提醒帮助他们采取行动；80%的人同意网站保护个人健康数据的隐私
LOPEZ P M等^[14]	网站	高血压患者医生	干预；半结构化访谈	血压；患者依从性	对时间、年龄和性别进行调整后，干预组平均收缩压、舒张压分别下降了1.71 mmHg和1.13 mmHg(P＜0.05)；医生与患者相互之间的态度(满意度、依从性等)有所改善
孙蕊^[15]	微信	妊娠期高血压孕妇	随机对照试验	血压；患者依从性	干预组有效提高妊娠期孕妇医嘱的依从性(科学饮食、适当运动、血压监测、遵医用药)，使妊娠期妇女血压值维持在正常水平，并降低剖宫产和不良妊娠的可能性
KARLSSON L O等^[16]	临床决策支持系统	42家诊所房颤患者	集群随机对照试验	中风、血栓、大量出血发生率	干预组的指南依从性(73.0%)显著提高、出血发生率显著降低
注：1 mmHg=0.133 kPa。

下载: 导出CSV

参考文献(32)

[1]	ONC. What is an electronic health record (EHR) [EB/OL]. (2019-09-10)[2022-01-13]. https://www.healthit.gov/faq/what-electronic-health-record-ehr.
[2]	董钰源, 吴冬梅, 刘冰. "健康中国2030"医疗相关指标体系研究[J]. 中国临床研究, 2021, 34(5): 717-720. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202105034.htm DONG Y Y, WU D M, LIU B. Research on "Healthy China 2030" medical-related index system[J]. Chinese Journal of Clinical Research, 2021, 34(5): 717-720. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202105034.htm
[3]	ZANABONI P, KUMMERVOLD P E, SØRENSEN T, et al. Patient use and experience with online access to electronic health records in Norway: results from an online survey[J]. J Med Internet Res, 2020, 22(2): e16144. DOI: 10.2196/16144.
[4]	许薇娜. 电子健康档案对慢性病目标管理的意义[J]. 黑龙江档案, 2021(4): 226-227. doi: 10.3969/j.issn.1673-9116.2021.04.117 XU W N. Significance of electronic health records for target management of chronic diseases[J]. Heilongjiang Archives, 2021(4): 226-227. doi: 10.3969/j.issn.1673-9116.2021.04.117
[5]	贾东月. 健康中国行动视域下电子健康档案的应用研究[J]. 办公室业务, 2020(23): 186-188. doi: 10.3969/j.issn.1004-647X.2020.23.091 JIA D Y. Application of Electronic Health Archives in Health China[J]. Office Operations, 2020(23): 186-188. doi: 10.3969/j.issn.1004-647X.2020.23.091
[6]	王存库, 汤学军, 包培文, 等. 电子健康档案建设现状及开放便民应用技术路径研究[J]. 中国卫生信息管理杂志, 2020, 17(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGL202001003.htm WANG C K, TANG X J, BAO P W, et al. Research on the Construction Status of Electronic Health Records and the Approach Towards the Convenient Application with New Technology[J]. Chinese Journal of Health Informatics and Management, 2020, 17(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGL202001003.htm
[7]	MAGGIO L A, LARSEN K, THOMAS A, et al. Scoping reviews in medical education: a scoping review[J]. Med Educ, 2021, 55(6): 689-700. doi: 10.1111/medu.14431
[8]	YANG Y, LEE E Y, KIM H S, et al. Effect of a mobile phone-based glucose-monitoring and feedback system for type 2 diabetes management in multiple primary care clinic settings: cluster randomized controlled trial[J]. JMIR Mhealth Uhealth, 2020, 8(2): e16266. DOI: 10.2196/16266.
[9]	汤洪秀, 彭焱, 曾艺, 等. "互联网+家庭医生工作室"健康管理模式对糖尿病患者干预效果分析[J]. 中国慢性病预防与控制, 2019, 27(9): 694-697. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201909017.htm TANG H X, PENG Y, ZENG Y, et al. Analysis of the intervention effect of the "Internet + Family doctor studio" health management model in patients with diabetes mellitus[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2019, 27(9): 694-697. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201909017.htm
[10]	任庭苇. 基于可穿戴设备的移动医疗慢病管理系统对社区中老年高血压与糖尿病患者的管理效果评估[D]. 重庆: 重庆医科大学, 2019. REN T W. Evaluation of the management effect of hypertension and diabetes patients in community elderly patients by mobile medical chronic disease management system based on wearable devices[D]. Chongqing: Chongqing Medical University, 2019.
[11]	KIM J W, RYU B, CHO S, et al. Impact of personal health records and wearables on health outcomes and patient response: three-arm randomized controlled trial[J]. JMIR MHealth UHealth, 2019, 7(1): e12070. DOI: 10.2196/12070.
[12]	RYU B, KIM N, HEO E, et al. Impact of an electronic health record-integrated personal health record on patient participation in health care: development and randomized controlled trial of MyHealthKeeper[J]. J Med Internet Res, 2017, 19(12): e401. DOI: 10.2196/jmir.8867.
[13]	NAZI K M, HOGAN T P, MCINNES D K, et al. Evaluating patient access to electronic health records: results from a survey of veterans[J]. Med Care, 2013, 51(3 Suppl 1): S52-56.
[14]	LOPEZ P M, DIVNEY A, GOLDFELD K, et al. Feasibility and outcomes of an electronic health record intervention to improve hypertension management in immigrant-serving primary care practices[J]. Med Care, 2019: S164-S171. DOI: 10.1097/MLR.0000000000000994.
[15]	孙蕊. 电子健康档案联合微信群模式下的延伸护理服务在妊娠期高血压疾病患者中的应用观察[J]. 黑龙江医学, 2020, 44(10): 1448-1450. doi: 10.3969/j.issn.1004-5775.2020.10.049 SUN R. Observation on the Application of Extended Nursing Services Under the Combination of Electronic Health Records and WeChat Group in Patients with Pregnancy-induced Hypertension[J]. Heilong Medical Jouranl, 2020, 44(10): 1448-1450. doi: 10.3969/j.issn.1004-5775.2020.10.049
[16]	KARLSSON L O, NILSSON S, BÅNG M, et al. A clinical decision support tool for improving adherence to guidelines on anticoagulant therapy in patients with atrial fibrillation at risk of stroke: a cluster-randomized trial in a Swedish primary care setting (the CDS-AF study)[J]. PLoS Med, 2018, 15(3): e1002528. DOI: 10.1371/journal.pmed.1002528.
[17]	BAILEY S C, WALLIA A, WRIGHT S, et al. Electronic health record-based strategy to promote medication adherence among patients with diabetes: longitudinal observational study[J]. J Med Internet Res, 2019, 21(10): e13499. DOI: 10.2196/13499.
[18]	BREWER C F, IP D, DRASAR E, et al. Reducing inappropriately suspended VTE prophylaxis through a multidisciplinary shared learning programme and electronic prompting[J]. BMJ Open Qual, 2019, 8(1): e000474. DOI: 10.1136/bmjoq-2018-000474.
[19]	LEWKOWICZ D, WOHLBRANDT A, BOETTINGER E. Economic impact of clinical decision support interventions based on electronic health records[J]. BMC Health Serv Res, 2020, 20(1): 871. doi: 10.1186/s12913-020-05688-3
[20]	张雪. 国外电子健康档案发展概况及启示[J]. 医学信息学杂志, 2020, 41(9): 2-10. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQB202009003.htm ZHANG X. Development Situation of Electronic Health Records in Foreign Countries and Its Enlightenment[J]. Journal of Medical Informatics, 2020, 41(9): 2-10. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQB202009003.htm
[21]	COLICCHIO T K, CIMINO J J, DEL FIOL G. Unintended consequences of nationwide electronic health record adoption: challenges and opportunities in the post-meaningful use era[J]. J Med Internet Res, 2019, 21(6): e13313. DOI: 10.2196/13313.
[22]	林蕙, 李世娟, 张鹏翼. 社交平台中癌症患者及家属健康信息自我表露研究: 以新浪微博肺癌超话为例[J]. 情报科学, 2022, 40(3): 72-81, 108. https://www.cnki.com.cn/Article/CJFDTOTAL-QBKX202203023.htm LIN H, LI S J, ZHANG P Y. Self-Disclosure of Health Information of Cancer Patients and Their Families on Social Platforms: Take Sina Weibo Lung Cancer Super Talk as an Example[J]. Information Science, 2022, 40(3): 72-81, 108. https://www.cnki.com.cn/Article/CJFDTOTAL-QBKX202203023.htm
[23]	GUO Y, XU Z M, QIAO J Y, et al. Development and feasibility testing of an mHealth (Text Message and WeChat) intervention to improve the medication adherence and quality of life of people living with HIV in China: pilot randomized controlled trial[J]. JMIR Mhealth Uhealth, 2018, 6(9): e10274. DOI: 10.2196/10274.
[24]	ENTZERIDOU E, MARKOPOULOU E, MOLLAKI V. Public and physician's expectations and ethical concerns about electronic health record: benefits outweigh risks except for information security[J]. Int J Med Inform, 2018, 110: 98-107. doi: 10.1016/j.ijmedinf.2017.12.004
[25]	中华人民共和国国家卫生健康委员会.卫生部关于印发《电子病历基本规范(试行)》的通知[EB/OL].(2010-02-22)[2022-01-13].http://www.nhc.gov.cn/wjw/gfxwj/201304/a99a0bae95be4a27a8b7d883cd0bc3aa.shtml. The National Health Commission, PRC. Notice of the Ministry of Health on the Issuance of the Basic Standards for Electronic Medical Records (Trial)[EB/OL].(2010-02-22)[2022-01-13].http://www.nhc.gov.cn/wjw/gfxwj/201304/a99a0bae95be4a27a8b7d883cd0bc3aa.shtml.
[26]	李成波, 陈静凌. 健康信息获取渠道对城市老年人健康信息素养的影响: 基于我国西部地区三省市的问卷调查分析[J]. 人口与发展, 2020, 26(2): 49-59. https://www.cnki.com.cn/Article/CJFDTOTAL-SCRK202002005.htm LI C B, CHEN J L. The Influence of Health Information Acquisition Channels on Older Urban Adults'Health Information Literacy: Evidence from Questionnaires of Three Cities in Western China[J]. Population and Development, 2020, 26(2): 49-59. https://www.cnki.com.cn/Article/CJFDTOTAL-SCRK202002005.htm
[27]	马凤新. 发展"互联网+医疗健康"的实践与思考[J]. 健康中国观察, 2022(1): 75-77. https://www.cnki.com.cn/Article/CJFDTOTAL-JZCG202201028.htm MA F X. Practice and thinking of developing "Internet + health care"[J]. Healthy China Observation, 2022(1): 75-77. https://www.cnki.com.cn/Article/CJFDTOTAL-JZCG202201028.htm
[28]	JANETT R S, YERACARIS P P. Electronic medical records in the American health system: challenges and lessons learned[J]. Cien Saude Colet, 2020, 25(4): 1293-1304. doi: 10.1590/1413-81232020254.28922019
[29]	彭德荣, 陈晨, 石建伟, 等. 基于居民健康档案的新型社区卫生信息化整合平台构建与应用[J]. 中华全科医学, 2020, 18(4): 523-526, 541. doi: 10.16766/j.cnki.issn.1674-4152.001289 PENG D R, CHEN C, SHI J W, et al. Construction and application of residents' health records based new community health information integration platform[J]. Chinese Journal of General Practice, 2020, 18(4): 523-526, 541. doi: 10.16766/j.cnki.issn.1674-4152.001289
[30]	尹勤, 徐千里. 流动人口健康档案建立现状及影响因素分析[J]. 中国公共卫生, 2018, 34(10): 1351-1355. doi: 10.11847/zgggws1117567 YIN Q, XU Q L. Establishment of health records and its influencing factors among migrant populations[J]. Chinese Journal of Public Health, 2018, 34(10): 1351-1355. doi: 10.11847/zgggws1117567
[31]	汤怡. 电子健康档案在推广过程中的隐私保护问题考量[J]. 区域治理, 2019(38): 233-235. https://www.cnki.com.cn/Article/CJFDTOTAL-QYZL201938081.htm TANG Y. Privacy protection in the process of electronic health recor[J]. Regional Governance, 2019(38): 233-235. https://www.cnki.com.cn/Article/CJFDTOTAL-QYZL201938081.htm
[32]	代华, 邓宏宇, 袁波, 等. "互联网+"社区赋能的现状及前景展望[J]. 中华全科医学, 2022, 20(2): 175-178. doi: 10.16766/j.cnki.issn.1674-4152.002306 DAI H, DENG H Y, YONG B, et al. The status quo and prospect of"Internet Plus"community empowerment[J]. Chinese Journal of General Practice, 2022, 20(2): 175-178. doi: 10.16766/j.cnki.issn.1674-4152.002306