Healthcare Remote Monitoring Systems in patients with Chronic Diseases in Primary Health Care: A Systematic Review (Preprint)

BACKGROUND The digital age, with ICT, IoT, and big data, has opened new opportunities for improving the delivery of healthcare services, with remote monitor systems playing a crucial role, reaching out to patients. The versatility and necessity of these systems has been demonstrated during the current COVID-19 pandemic. Health Remote Monitoring Systems (HRMS) have various advantages such as the reduction of patient load at hospitals and health centers, which is accomplished through the remote monitorization of patients. Patients that would benefit from remote monitoring are those with chronic diseases, the elderly and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. OBJECTIVE This paper aims to perform a systematic review of the literature regarding HRMS in primary health care (PHC) settings, to identify the current status of the digitalization of the health process, the remote data acquisition and the remote interaction process between medical personnel and patients. METHODS A systematic literature review was conducted, using the PRISMA guidelines, to identify articles that explore interventions with HRMS in patients with chronic diseases in the PHC setting. The search was conducted in Scopus and Web of Science Core Collection. The studies considered to this study included (1) continuous electronic recording of patient indicators (sensors or wearables) linked to a computer system integrated into PHC centers, (2) patient input devices linked to a computer system allowing real-time data visualization for analysis by PHC professionals or (3) collection of electronic personal health/clinical data transmitted for analysis by a remote PHC professional. RESULTS The literature review yielded 123 publications, 18 of those met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (34.6%) and cardiovascular diseases (26.9%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integrating of the information in the already existing systems into the PHC infrastructures and in changing working processes of the PHC’s Professionals (83.4%). CONCLUSIONS The PHC context is specific and can integrate multidisciplinary teams and patients with often complex chronic pathologies. Despite all the theoretical framework, objective identification of problems and the involvement of stakeholders in the design and implementation processes, these interventions mostly fail to be extrapolated into a large scale. This study aimed at demonstrating the importance of matching technological development to the working methods of human resources in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management in PHC, so that information with clinical value is not lost or even gained along the way.