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

10.6224/JN.63.4.25

李文文(Wen-Wen Li)；賴維淑(Wei-Shu Lai)

遠距醫療 ； 高血壓 ； 少數族群 ； 系統性文獻回顧 ； 文化適切性處置 ； telemedicine ； hypertension ； racial ethnic minorities ； systematic review ； culturally appropriate intervention

護理雜誌

63卷4期（2016 / 08 / 01）

25 - 34

繁體中文

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.

1. 蔡國權、洪彰岑、黃錦源、甘能斌(2015)。遠距監測與不同身體活動量對中高齡女性高血壓防治的評估。大專體育學刊，17(3)，353-363。
   連結：
2. American Telemedicine Association. (n.d.). What is telemedicine? Retrieved from http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.V4XRqMtf03t
3. National Institutes of Health. (2015, September 10). Description of high blood pressure. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/hbp
4. 衛生福利部國民健康署（2016）．愛媽媽的「心」與媽媽一起量血壓． 取自http://www.hpa.gov.tw/Bhpnet/Web/News/News.aspx?No=201505120001 [Health Promotion Administration, Ministry of Health and Welfare, Taiwan, ROC. (2016). Show your love for mom: Monitor your blood pressures together. Retrieved from http://www.hpa.gov.tw/Bhpnet/Web/News/News.aspx?No=201505120001]
5. 內政部移民署（2015）．外籍配偶人數與大陸( 含港澳) 配偶人數．取自http://www.immigration.gov.tw/ct.asp?xItem=1313198&ctNode=29699&mp=1 [National Immigration Agency. (2015). Population statistics: Foreign and mainland Chinese (including Hong Kong and Macau) spouses. Retrieved from http://www.immigration.gov.tw/ct.asp?xItem=1313198&ctNode=29699&mp=1]
6. 原住民族委員會（2016）．101 年原住民族人口及健康統計年報． 取自http://www.apc.gov.tw/portal/docList.html?CID=217054CAE51A3B1 [Council of Indigenous Peoples. (2015). Indigenous population and health statistics annual report, 2012. Retrieved from http://www.apc.gov.tw/portal/docList.html?CID=217054CAE51A3B1]
7. Agarwal, R.,Bills, J. E.,Hecht, T. J. W.,Light, R. P.(2011).Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: A systematic review and meta-analysis.Hypertension,57,29-38.
8. Anonymous(1997).Effects of weight loss and sodium retention intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure: The trials of hypertension prevention, phase II.Archives of Internal Medicine,157(6),657-667.
9. Appel, L. J.,Moore, T. J.,Obarzanek, E.,Vollmer, W. M.,Svetkey, L. P.,Sacks, F. M.,Karanja, N.(1997).A clinical trial of the effects of dietary patterns on blood pressure.The New England Journal of Medicine,336(16),1117-1124.
10. Artinian, N. T.,Flack, J. M.,Norstrom, C. K.,Hockman, E. M.,Washington, O. G. M.,Jen, K. L. C.,Fathy, M.(2007).Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans.Nursing Research,56(5),312-322.
11. Artinian, N. T.,Washington, O. G. M.,Templin, T. N.(2001).Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: A pilot study.Heart & Lung: The Journal of Acute and Critical Care,30(3),191-199.
12. Bondmass, M.,Bolger, N.,Castro, G.,Avitall, B.(2004).The effect of home monitoring and telemanagement on blood pressure control among African Americans.Telemedicine Journal,6(1),15-23.
13. Brennan, T.,Spettell, C.,Villagra, V.,Ofili, E.,Mcmahill-Walraven, C.,Lowy, E. J.,Mayberry, R.(2010).Disease management to promote blood pressure control among African Americans.Population Health Management,13(2),65-72.
14. Chen, M. L.,Hu, J.(2014).Health disparities in Chinese Americans with hypertension: A review.International Journal of Nursing Sciences,1(3),318-322.
15. Houston, T. K.,Allison, J. J.,Sussman, M.,Horn, W.,Holt, C. L.,Trobaugh, J.,Hullett, S.(2011).Culturally appropriate storytelling to improve blood pressure: A randomized trial.Annals of Internal Medicine,154(2),77-84.
16. Margolis, K. L.,Asche, S. E.,Bergdall, A. R.,Dehmer, S. P.,Groen, S. E.,Kadrmas, H. M.,Trower, N. K.(2013).Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial.JAMA: Journal of the American Medical Association,310(1),45-56.
17. McManus, R. J.,Mant, J.,Bray, E. P.,Holder, R.,Jones, M. I.,Greenfield, S.,Hobbs, F. D. R.(2010).Telemonitoring and self-management in the control of hypertension (TASMINH2): A randomized controlled trial.The Lancet,376(9736),163-172.
18. Migneault, J. P.,Didier, J. J.,Wright, J. A.,Heeren, T.,Campbell, M. K.,Morisky, D. E.,Friedman, R. H.(2012).A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: A randomized controlled trial.Annals of Behavioral Medicine,43(1),62-73.
19. Moher, D.,Liberati, A.,Tetzlaff, J.,Altman, D. G.,the PRISMA Group(2009).Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.Annals of Internal Medicine,151(4),264-269.
20. Oremus, M.,Wolfson, C.,Perrault, A.,Demers, L.,Momoli, F.,Moride, Y.(2001).Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer's disease drug trials.Dementia and Geriatric Cognitive Disorders,12(3),232-236.
21. Pare, G.,Jaana, M.,Sicotte, C.(2007).Systematic review of home telemonitoring for chronic diseases: The evidence base.Journal of the American Medical Informatics Association,14(3),269-277.
22. Seto, E.(2008).Cost comparison between telemonitoring and usual care of heart failure: A systematic review.Telemedicine Journal and e-Health,14(7),679-686.
23. Svetkey, L. P.,Harsha, D. W.,Vollmer, W. M.,Stevens, V. J.,Obarzanek, E.,Elmer, P. J.,Appel, L. J.(2003).Premier: A clinical trial of comprehensive lifestyle modification for blood pressure control: Rational, design and baseline characteristics.Annals of Epidemiology,13(6),462-471.
24. Zullig, L. L.,Melnyk, S. D.,Goldstein, K.,Shaw, R. J.,Bosworth, H. B.(2013).The role of home blood pressure telemonitoring in managing hypertensive populations.Current Hypertension Reports,15(4),346-355.
25. 戴佛安(2016)。2015年台灣高血壓治療指引摘要。家庭醫學與基層醫療，31(3)，72-81。

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