Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Jun 22, 2022
Date Accepted: Oct 2, 2022
Date Submitted to PubMed: Oct 20, 2022
Visit Types in Primary Care with Telehealth Use during COVID-19: Systematic Review
ABSTRACT
Background:
Telehealth was rapidly incorporated into primary care during COVID-19. However, there is limited evidence on which primary care visits are suitable for Telehealth.
Objective:
To review evidence on 1/ which visit types in primary care are reported with Telehealth support during COVID-19; 2/ suitability of Telehealth for each visit type; and 3/ benefits and drawbacks of Telehealth in primary care during COVID-19.
Methods:
A systematic review using narrative synthesis. Studies were obtained from four databases (OVID (MEDLINE), CINAHL Complete, PDQ-Evidence, and ProQuest) and grey literature (NSW Health, RACGP, and WHO guidelines). Three independent reviewers screened studies featuring Telehealth use during COVID-19 in primary care. Levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). Critical appraisal was conducted using the Mixed Methods Appraisal Tool or the Joanna Briggs Institute (JBI) checklist of systematic reviews. The benefits and drawbacks of Telehealth were assessed according to the National Quality Forum Telehealth Framework. PROSPERO registration: CRD42022312202. PRISMA-compliant: See Appendix A for the completed checklist of preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines.
Results:
Twenty-eight studies, predominately cross-sectional surveys/interviews (61%, 17/28), were included. Seven visit types in primary care were reported with Telehealth support during COVID-19: chronic condition management, mental health/behavioural management, medication management, existing patients, new patients, post-discharge follow-up, and post-test results follow-up. Benefits and drawbacks of Telehealth were reported across all visit types, with chronic condition management reporting the greatest support (68%, 19/28) due to a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of Telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models.
Conclusions:
Evidence from this review suggests Telehealth is suitable for specific primary care encounters (e.g., chronic condition management). Further research is required to validate our findings and explore the long-term use of Telehealth for different visits in primary care.
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