JMIR Publications

ABSTRACT

Background:

Telemedicine is becoming routine in healthcare. Post-pandemic, a universal return to face-to-face consultations may risk losing some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy and effectiveness could potentially lead to suboptimal health outcomes, and downstream challenges to providers.

Objective:

This review assesses telemedicine interventions against international guidance, and sufficiency of evidence to support post-pandemic utilisation in paediatric settings.

Methods:

This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on 15/04/2021, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy and/or renal disease. Exclusion criteria included: studies published before 2011 as the technologies used have likely been improved or replaced; studies in adult populations or where it was not possible to disaggregate data for under-18 year olds as the focus of the review was on paediatric care; and studies not published in English. Four authors extracted data and corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness.

Results:

Of the 3004 studies identified, 48 were suitable for final inclusion and analysis. Data on feasibility and/or usability of interventions (41 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (27 studies) was mostly positive. Across all studies there was limited measurement of standardised clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (HbA1c). Financial cost effectiveness data (three studies) all supported cost effectiveness of telemedicine with a reduction of healthcare costs.

Conclusions:

There is promising evidence supporting telemedicine in paediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for non-inferiority of clinical outcomes, and this review highlights the need for a more standardised approach to evaluation of digital interventions.