JMIR Publications

ABSTRACT

Background:

Multimorbidity, the existence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies (ICTs) that have been used to reduce the complexity of patient management. However, the way to properly integrate CDSS into telemedicine services is still unspecified.

Objective:

i) to broadly review a system design of CDSS that has been integrated into each function of telemedicine for multimorbid patients in primary care, ii) to summarize the effectiveness of the interventions, and iii) to identify gaps in the literature.

Methods:

The online electronic search for literature was conducted up to Nov 2021 based on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference list was done to find potential studies. The inclusion criteria were based on three main study characteristics: multimorbidity, CDSS, and telemedicine.

Results:

Seven experimental studies were included in this review: 3 RCTs and four non-RCTs. The interventions were designed to manage patients with diabetes mellitus (DM), hypertension (HT), polypharmacy, and gestational diabetes mellitus (GDM). CDSS can be used in various tasks relating to telemedicine functions: telemonitoring (e.g., feedback), teleconsultation (e.g., guideline suggestion, advisory material provision, and response to simple queries), tele-case management (e.g., sharing information across facilities and teams), and tele-education (e.g., patient self-management). However, the structure of CDSS (such as data input, task, output, and intended users/decision makers) varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions.

Conclusions:

There is a role of telemedicine and CDSS in supporting patients with multimorbidity. CDSS can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined, examining tasks of CDSS, particularly for screening and diagnosis of multiple conditions, and exploring the role of the patient as the direct user of the CDSS. Clinical Trial: A review protocol was registered on PROSPERO, register number CRD42021293444.