JMIR Publications

ABSTRACT

Background:

The digital age, with digital sensors, IoT, and big data tools, has opened new opportunities for improving the delivery of healthcare services, with remote monitor systems playing a crucial role, improving the access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health Remote Monitoring Systems (HRMS) present various advantages such as the reduction of patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, the elderly and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection.

Objective:

This paper aims at performing a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the health processes digitalization, the remote data acquisition and interaction process between healthcare personnel and patients.

Methods:

A systematic literature review was conducted, using PRISMA guidelines, to identify articles that explore interventions with HRMS in patients with chronic diseases in the PHC setting. The search was conducted in Scopus and Web of Science Core Collection. The studies considered to this study included (1) continuous electronic recording of patient indicators (sensors or wearables) linked to a computer system integrated into PHC, (2) patient input devices linked to a computer system allowing real-time data visualization for analysis by PHC professionals or (3) collection of electronic health data transmitted for analysis by a remote PHC professional.

Results:

The literature review yielded 123 publications, 18 of those met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (34.6%) and cardiovascular diseases (26.9%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of the information in the already existing systems into the PHC infrastructures and in changing working processes of the PHC’s Professionals (83.4%).

Conclusions:

The PHC context integrates multidisciplinary teams and patients with often complex chronic pathologies. Despite all the theoretical framework, objective identification of problems and the involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale-up. Despite the inherent limitations of conducting a systematic literature review (databases used, exclusion criteria, and the time between collection and analysis of results), the small number of studies in the PHC context is a relevant limitation. This study aimed at demonstrating the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way.