Interpretation of the Position Paper on Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-related Cardiovascular Diseases by the Italian Society of Arterial Hypertension (SIIA) in 2023

doi:10.12114/j.issn.1007-9572.2024.0096

Chinese General Practice ›› 2024, Vol. 27 ›› Issue (26): 3197-3203.DOI: 10.12114/j.issn.1007-9572.2024.0096

• Guidelines Interpretation • Next Articles

Interpretation of the Position Paper on Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-related Cardiovascular Diseases by the Italian Society of Arterial Hypertension (SIIA) in 2023

1.General Practice Ward/International Medical Center Ward/Leaching & Research Section/General Practice Research Institute, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610000, China
2.Institute of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu 610000, China
3.NSFOCUS Technologies Group Co., Ltd. Chengdu, Chengdu 610000, China
4.Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610000, China

Received:2024-03-25 Revised:2024-05-15 Published:2024-09-15 Online:2024-06-14
Contact: JIANG Lihua, DAI Hua
About author:
YANG Rong and YANG Ziyu are co-first authors

2023年意大利高血压学会《远程医疗和数字医疗在高血压和高血压相关心血管疾病临床管理中的应用》立场声明文件解读

1.610000　四川省成都市，四川大学华西医院全科医学中心全科特需病房　全科医学教研室　全科医学研究室
2.610000　四川省成都市，四川大学华西医院生物医学大数据研究院
3.610000　四川省成都市，北京绿盟科技有限公司成都分公司
4.610000　四川省成都市，四川大学华西公共卫生学院　华西第四医院　卫生政策与管理学系

通讯作者: 蒋莉华, 代华
作者简介:
杨荣和杨梓钰为共同第一作者
作者贡献：
杨荣、杨梓钰负责构思与设计，论文起草；蒋莉华、代华负责质量控制与审校；廖晓阳、刘力滴、张鹏、田宸宇、杨寒飞、姚易、贾禹、程永浪、沈灿负责文献查阅、专业性审核以及论文修订；所有作者确认论文终稿。
基金资助:
四川省科技厅项目(2023YFS0027); 四川省卫生健康委科技项目(川干研2023-101)

Abstract

Abstract:

High prevalence and low control rate of hypertension have brought a significant disease burden globally. In order to improve the level of hypertension prevention and treatment, remote healthcare and digital medicine have been rapidly developed and widely used worldwide. Currently, there are no relevant regulations in China for these technologies. In 2023, the Italian Society of Arterial Hypertension issued a position statement to guide the development, validation, and clinical use of remote medicine and digital healthcare. This article will interpret this position paper, focusing on the forms of application of telemedicine and digital healthcare in managing hypertension and its related cardiovascular diseases, key research evidence, existing advantages, as well as current opportunities and challenges. The aim is to guide general practitioners in China on how to utilize these technologies in managing hypertension and related cardiovascular conditions.

Key words: Hypertension, Remote healthcare, Digital medicine, Italian Society of Arterial Hypertension, Interpretation

摘要：

高血压患病率高，控制率低，给全球带来了极大的疾病负担。为了提高高血压防治水平，远程医疗和数字医疗发展迅速，在全球范围内广泛运用。目前我国没有相关文件对这些技术进行规范。意大利高血压学会在2023年发布了《远程医疗和数字医疗在高血压和高血压相关心血管疾病临床管理中的应用》立场文件，以指导远程医学和数字医疗的开发、验证和临床使用。本文将对其进行解读，主要包含远程医疗和数字医疗在高血压及其相关心血管疾病管理中的应用形式、关键研究证据、存在的优势以及现存的机遇和挑战，以指导我国全科医生在高血压及高血压相关心血管疾病管理中对远程医疗和数字医疗的应用。

关键词: 高血压, 远程医疗, 数字医疗, 意大利高血压学会, 解读

YANG Rong,YANG Ziyu,LIAO Xiaoyang, et al. Interpretation of the Position Paper on Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-related Cardiovascular Diseases by the Italian Society of Arterial Hypertension (SIIA) in 2023[J]. Chinese General Practice, 2024, 27(26): 3197-3203. DOI: 10.12114/j.issn.1007-9572.2024.0096.
杨荣,杨梓钰,廖晓阳等. 2023年意大利高血压学会《远程医疗和数字医疗在高血压和高血压相关心血管疾病临床管理中的应用》立场声明文件解读[J]. 中国全科医学, 2024, 27(26): 3197-3203. DOI: 10.12114/j.issn.1007-9572.2024.0096.

Figures/Tables 3

References 48

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患者表型	潜在问题	潜在的解决方案
可疑新诊断的高血压患者^[19，23]	医护人员进行详细身体检查的机会有限、患者表达潜在担忧的机会有限、患者对医护人员的信心有限、医护人员使用RBPM的培训不足	患者不能在现场的情况下，医生、助理或护士通过录像对患者进行初步评估，并适当培训患者自我测量血压技术
因急性或慢性疾病导致活动受限患者^[24，25]	RBPM的准确性可能会受到并发症如术后心房颤动的影响	使用可对患者进行多参数评估的RBPM设备，减少潜在并发症的影响
老年和/或衰弱患者^[26，27]	可能因为认知障碍、使用电子设备技能不足、视力障碍限制和不准确使用RBPM	使用有以下功能的RBPM设备：能够将记录的血压直接传输给医务人员、使用配备语音或视频辅助的RBPM系统、指导患者正确使用设备
疑似白大衣高血压或假性高血压患者^[19，23]	由于以下原因从RBPM获得的血压值不准确：焦虑、情绪、心理压力、不正确的家庭血压记录	教育患者了解家庭血压监测的重要性。使用配有语音或视频的RBPM系统辅助设备，辅以提醒患者自我血压测量
在门诊就诊的3级高血压患者^[28]	RBPM的准确性可能会受到以下因素的影响：血压测量时患者焦虑和存在心理压力、远程血压采集次数不足患者担心血压升高、选择性低报血压读数	RBPM设备能够将记录的血压直接传输给医务人员医生、助理或护士应就血压自我测量的重要性和规范测量技术提供健康教育
需要彻底改变治疗方案的患者^[29，30]	血压测量次数不足，不能提供新治疗所达到的血压控制的准确信息；在开始新的治疗后，避免潜在副作用的机会有限	向患者提供目标血压、正常血压变异、血压过高或过低、或出现副作用时应采取的措施等方面的教育和反馈；RBPM设备能够与医务人员快速互动，以调整治疗剂量和时间表
可以从更多参与疾病管理中获益的患者^[28]	RBPM的准确性可能会受到以下因素的影响：血压测量次数不足、选择性低报血压读数、未能传输血压读数	使用远程监测系统将获取的血压值直接传送给医务人员

患者表型	潜在问题	潜在的解决方案
可疑新诊断的高血压患者^[19，23]	医护人员进行详细身体检查的机会有限、患者表达潜在担忧的机会有限、患者对医护人员的信心有限、医护人员使用RBPM的培训不足	患者不能在现场的情况下，医生、助理或护士通过录像对患者进行初步评估，并适当培训患者自我测量血压技术
因急性或慢性疾病导致活动受限患者^[24，25]	RBPM的准确性可能会受到并发症如术后心房颤动的影响	使用可对患者进行多参数评估的RBPM设备，减少潜在并发症的影响
老年和/或衰弱患者^[26，27]	可能因为认知障碍、使用电子设备技能不足、视力障碍限制和不准确使用RBPM	使用有以下功能的RBPM设备：能够将记录的血压直接传输给医务人员、使用配备语音或视频辅助的RBPM系统、指导患者正确使用设备
疑似白大衣高血压或假性高血压患者^[19，23]	由于以下原因从RBPM获得的血压值不准确：焦虑、情绪、心理压力、不正确的家庭血压记录	教育患者了解家庭血压监测的重要性。使用配有语音或视频的RBPM系统辅助设备，辅以提醒患者自我血压测量
在门诊就诊的3级高血压患者^[28]	RBPM的准确性可能会受到以下因素的影响：血压测量时患者焦虑和存在心理压力、远程血压采集次数不足患者担心血压升高、选择性低报血压读数	RBPM设备能够将记录的血压直接传输给医务人员医生、助理或护士应就血压自我测量的重要性和规范测量技术提供健康教育
需要彻底改变治疗方案的患者^[29，30]	血压测量次数不足，不能提供新治疗所达到的血压控制的准确信息；在开始新的治疗后，避免潜在副作用的机会有限	向患者提供目标血压、正常血压变异、血压过高或过低、或出现副作用时应采取的措施等方面的教育和反馈；RBPM设备能够与医务人员快速互动，以调整治疗剂量和时间表
可以从更多参与疾病管理中获益的患者^[28]	RBPM的准确性可能会受到以下因素的影响：血压测量次数不足、选择性低报血压读数、未能传输血压读数	使用远程监测系统将获取的血压值直接传送给医务人员

机遇	挑战	风险
通过通信技术向社会提供有效和持续的医疗支持	费用和报销；人群的数字鸿沟	卫生系统提供资金不足；由于人口内识字率低和数字鸿沟导致不公平
及时记录和评估临床数据	整个数字通信系统的数据保护	缺乏隐私、隐私泄露和数据保护失败
改善医患沟通	验证过的仪器。经科学验证的医疗建议和数据记录	不合格的医疗建议。未经科学证实的信息
整合医疗保健系统	医务人员的平台、管理和培训	对医务人员的技术支持和培训不足。医务人员缺乏对规划和决策的参与
提高医疗保健系统的公平性	患者的参与和信息。技术支持和用户培训	排斥社会贫困者和弱势群体

机遇	挑战	风险
通过通信技术向社会提供有效和持续的医疗支持	费用和报销；人群的数字鸿沟	卫生系统提供资金不足；由于人口内识字率低和数字鸿沟导致不公平
及时记录和评估临床数据	整个数字通信系统的数据保护	缺乏隐私、隐私泄露和数据保护失败
改善医患沟通	验证过的仪器。经科学验证的医疗建议和数据记录	不合格的医疗建议。未经科学证实的信息
整合医疗保健系统	医务人员的平台、管理和培训	对医务人员的技术支持和培训不足。医务人员缺乏对规划和决策的参与
提高医疗保健系统的公平性	患者的参与和信息。技术支持和用户培训	排斥社会贫困者和弱势群体

Interpretation of the Position Paper on Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-related Cardiovascular Diseases by the Italian Society of Arterial Hypertension (SIIA) in 2023

2023年意大利高血压学会《远程医疗和数字医疗在高血压和高血压相关心血管疾病临床管理中的应用》立场声明文件解读

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