JMIR Publications

ABSTRACT

Background:

Covid-19 has thrust video consulting into the limelight, as health care practitioners around the world shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption with limited consideration of how video consulting can be mainstreamed and sustained.

Objective:

The study sought to (a) review and synthesize reported opportunities, challenges and lessons learnt in the scale-up, spread, and sustainability of video consultations, and (b) identify transferable insights that can inform policy and practice.

Methods:

We combined a broad search (using broad telehealth and telemedicine search terms) with a specific search (using video-consultation-specific terms) to identify papers published since 2010 (via PubMed, CINAHL, and Web of Science) that reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage. We used the Non-adoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework for health and care technologies to synthesise findings relating to 7 domains: an understanding of the health condition(s) for which video consultations are being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organisational factors, wider macro-level considerations, as well as emergence over time.

Results:

We identified 13 papers describing 10 different video consultation services in 6 regions, covering (i) video-to-home services, connecting providers directly to the patient; (ii) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural centre; and (iii) large-scale top-down evaluations scaled-up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, and general specialist care and primary care. Potential enablers to spread and scale up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to focus on service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues and technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorising the distinct processes required to achieve widespread adoption.

Conclusions:

There remains a significant lack of evidence that can support spread and scale-up of video consulting. Given the recent pace of change due to Covid-19, a more definitive evidence base is urgently needed that can support global efforts and match enthusiasm for extending use. Clinical Trial: N/A