探討應用遠距醫療協助少數族群高血壓管控之成效——系統性文獻回顧

The Use of Telemedicine Interventions to Improve Hypertension Management Among Racial Ethnic Minorities: A Systematic Review

背景：台灣少數族群是高血壓人數快速成長的族群之一。近年來， 健康照護單位運用遠距醫療（telemedicine）作為居家血壓監控已逐漸盛行，但大多數集中在主流族群，鮮少關注少數族群，如：原住民族與移民族裔，以及缺乏系統性文獻回顧探討遠距醫療之成效。目的：本文透過系統性文獻回顧，探討應用遠距醫療協助成年少數族群高血壓管控之成效。方法：利用國內外相關資料庫包括：PubMed、Web of Science、CINAHL（Cumulative Index to Nursing &Allied Health Literature）、PsycINFO、Science Direct、ProQuest、MEDLINE、Cochrane Library、airiti Library華藝線上圖書館等資料庫，針對2000年1月至2015年12月之間發表的全文文章進行廣泛性文獻查證。單獨或合併使用關鍵字：高血壓（hypertension）、血壓（blood pressure）、管控（management）、遠距醫療（telemedicine）、電子健康（telehealth）、e化健康（ehealth）、以及數位化健康（digital health）進行檢索，選出研究族群為少數族群的文獻。以Preferred Reporting Items forSystematic reviews and Meta-Analyses（PRISMA）建議步驟評定文獻品質，最後篩選出六篇納入分析。結果：本系統性文獻回顧結果發現，以遠距醫療為基礎的護理措施，能顯著改善少數族群血壓，尤以合併居家遠距監控和具文化能力（culturally competent）護理師諮詢電話的整合性介入方式更具成效，且多種成效指標應同時進行測量。但目前文獻多侷限於非裔美國人之研究，結果是否可適用於台灣少數族群，還需待更多研究進行探討。結論／實務應用：未來宜針對台灣少數族群，進一步發展具文化適切性遠距醫療血壓管理，並嚴謹地以長期追蹤研究設計、盲化、大規模的隨機控制試驗，驗證並更新此實證結果。

Background: Racial ethnic minorities are one of the fastest growing populations in Taiwan. In recent years, there has been an increase in literature addressing the efficacy of home blood-pressure (BP) management that uses telemedicine interventions in general healthcare and community settings. However, no study or systematic literature review has yet assessed the effectiveness of using telemedicine HTN interventions in Taiwan's indigenous, new-immigrant, and other minority populations. Purpose: The purpose of the present paper is to review the current literature on the use of telemedicine interventions to assist HTN management among racial ethnic minorities. Methods: A comprehensive literature search was conducted for full-text articles that were published between January 2000 and December 2015 using the following databases: PubMed, WEB of Science, CINAHL (Cumulative Index to Nursing & Allied Health Literature), PsycINFO, Science Direct, ProQuest, Medline, Cochrane Library, National Dissertations and Theses, and airiti Library. The search used the following key search terms both alone and in combination: hypertension, blood pressure, management, telemedicine, telehealth, ehealth, and digital health. The studies were thoroughly assessed under the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 6 articles met the criteria for using keywords related to racial ethnic minority populations and were used in the present review. Results: Findings of this systematic review show that telemedicine interventions significantly improve HTN management. The intervention that combined home telemonitoring with culturally competent nurse counseling calls was identified as the best intervention for reducing BP. As the current literature on this topic is limited to African-Americans, more research is necessary to validate our findings. Conclusions / Implications for Practice: Future studies should target racial ethnic minorities in Taiwan in order to better understand how to provide culturally appropriate, telemedicine-based HTN management to Taiwan's minority populations. Further studies with a long-term follow-up plan, randomized controlled trials, and larger sample sizes are required to support these results.