Original Title: État des connaissances - Soins virtuels en pneumologie

Authors' objectives: The aging of the population and the increasing prevalence of chronic diseases will undoubtedly lead to a significant increase in the demand for continuous home and institutional care, in the current context of limited professional resources in Québec. Furthermore, the COVID-19 pandemic has led to a major advance in the use of virtual care tools to ensure access to care and services and to promote continuity of care. In addition to information technologies, that are now frequently used, the integration of virtual care modalities into care pathways is of growing interest for the evaluation, treatment and follow-up of patients in specialty medicine. These modalities have the potential to improve access to health care for most patients, but also to foster their engagement in the management of their illness. In the context of a national project on virtual care, the Ministère de la Santé et des Services sociaux (MSSS) has mandated the Institut national d'excellence en santé et en services sociaux (INESSS) to provide a state-of-knowledge report to guide the use of virtual care in specialty medicine. This work will help maintain or optimize care pathways and support clinical practices and the provision of care and services to patients. The objective of this work is to inform public decision-makers, medical associations, and health and social services professionals about virtual care practices in specialty medicine. The project involves the following seven reports: 1) Pediatrics, 2) Psychiatry, 3) Neurology, 4) Hematology/Oncology, 5) Respirology (this report), 6) General Surgery and 7) Internal Medicine.

Authors' results and conclusions: RESULTS (#1 FINDINGS CONCERNING VIRTUAL CARE IN RESPIROLOGY): Telemonitoring is the most studied intervention in all the care pathways examined. • The results concerning virtual care interventions mentioned in care pathways often involve several modalities, e.g., telemonitoring, teleconsultation, teleeducation, rehabilitation teleconsultation and teleassistance. • Many authors of the selected studies conclude that further studies of good quality will be necessary. (#2 VIRTUAL CARE PATHWAYS REPORTED AS BEING CLINICALLY EFFECTIVE): Pulmonary rehabilitation, education, therapeutic support and follow-up via rehabilitation teleconsultation and telemonitoring for patients with COPD. • Assessment, education, therapeutic support and follow-up via telemonitoring and teleconsultation for patients with asthma or sleep apnea. (#3.1 VIRTUAL CARE MODALITIES FOR WHICH A POSITIVE IMPACT HAS BEEN REPORTED): Tele-education, teleassistance, telemonitoring or teleconsultation used alone or in combination with other virtual care modalities for patients with asthma to improve the management of their disease and their quality of life. • Teleconsultation between specialists and non-specialists to support primary care physicians in the diagnosis of COPD and asthma (#3.2 ASPECTS THAT NEED TO BE CLARIFIED BY FURTHER STUDIES:): • For rehabilitation teleconsultation: – Efficacy according to the sociodemographic characteristics, cognitive abilities and experience with the technology in patients with COPD. – Efficacy in patients with a chronic respiratory disease other than COPD. • The long-term efficacy of virtual care in terms of medication adherence in patients with asthma. • The long-term efficacy of telemonitoring on treatment adherence in patients with sleep apnea. (#3.3 VIRTUAL CARE MODALITIES REPORTED AS HAVING A POSITIVE IMPACT ON ORGANIZATIONAL EFFICIENCY): Telemonitoring, rehabilitation teleconsultation or telemonitoring for patients with COPD to reduce the need for services. • Teleconsultation for people with respiratory diseases to save time by avoiding unnecessary face-to-face consults. (#3.4 FEW RESULTS CONCERNING PATIENT SAFETY): An improved sense of safety about their physical health was reported by patients with COPD who used rehabilitation teleconsultation and telemonitoring. • No adverse effects were reported regarding the use of virtual care for the assessment, follow-up, therapeutic support, or education for patients with asthma. • Teleconsultation between specialists and non-specialists could help prevent the misdiagnosis of respiratory diseases. (#3.5 VIRTUAL CARE MODALITIES REPORTED AS HAVING A POSITIVE IMPACT ON EQUITY OF ACCESS TO CARE): Rehabilitation teleconsultation and telemonitoring to improve access to care for patients with COPD. Teleconsultation for respiratory diseases to enable the patients to receive specialized care closer to home. (#3.6 A PROMISING LEVEL OF SATISFACTION, ALBEIT WITH CERTAIN CONCERNS): Patients and care providers generally express satisfaction with virtual care, particularly because of the flexibility, accessibility or easier care management. • Some patients express concerns about using virtual care, e.g., concerns about the ability to use a new technology, problems associated with the technology, and a lack of in-person contact with health professionals. LIMITATIONS: This report is limited by the following methodological constraints: the type of documents selected, the literature review period of 5 years, the independent study selection for only 10% of the studies, the absence of a formal evidence assessment, and the descriptive data synthesis with no meta-analysis. Most of the selected systematic reviews aggregate or select, without distinction, data from primary studies conducted in various care settings with a variety of comparators, clinical situations, and technologies. For meta-analyses, the heterogeneity of the studies and interventions, the small number of studies compared and/or the small number of participants, and the poor quality of the studies are often listed in the limitations. In addition, cultural sensitivity and collaborative care, which are topics that should not be overlooked for equity in virtual care, were very rarely discussed. Lastly, selection, confounding and measurement biases observed in the studies also need to be taken into consideration. CONCLUSION: For the use of virtual care in respirology, the most studied care pathway is for COPD. Telemonitoring is the most frequently used virtual care modality in the care pathways studied. Overall, the modalities are used alone or in combination with other modalities, and virtual care can be used in place of or in addition to standard care.

Authors' methods: A scoping review was conducted to portray the care pathways that might be supported or optimized with the use of virtual care. A review of the scientific and grey literature was carried out for the past 5 years. The existing national and international guidelines, guidance documents and discussion papers, and health technology assessment (HTA) reports published on the topic were also consulted to identify additional pathways or to confirm those identified by the systematic reviews. Documents were selected according to predefined inclusion and exclusion criteria. These steps were carried out by one reviewer, and 10% of the titles and abstracts evaluated were independently re-evaluated by a second reviewer. The data extraction from the selected documents was carried out by a reviewer. The extracted data were analyzed and presented in the form of a narrative synthesis and tables for each care pathway identified. Due to the rapid nature of the work and the type of review conducted, the methodological quality of the selected documents was not assessed. In addition, the consistency of the study results, the number of studies and their perceived quality, the biases noted, and the statistical analyses of the metaanalyses were taken into account when drawing up the findings concerning care pathways and virtual care modalities that support or optimize clinical practices in specialty medicine.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/OrganisationsSoins/INESSS_Soins_virtuels_Pneumologie_EC.pdf

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/OrganisationsSoins/INESSS_Soins_virtuels_Pneumologie_EC.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)