JMIR Publications

ABSTRACT

Background:

Several systematic reviews evaluating the use of telemedicine by clinicians, patients and health authorities to improve the delivery of care in the 53 countries that are part of the European Region of the World Health Organization (53-WHORC) have been conducted in recent years. However, no study summarising the findings of these reviews has been carried out.

Objective:

This overview of systematic reviews aims to summarise findings regarding the use of telemedicine across the 53-WHORC and to identify the medical fields and levels of care in and at which the effectiveness, feasibility and applicability of telemedicine has been demonstrated. The barriers to and facilitators of telemedicine use are also evaluated and collated in order to help with the design and implementation of telemedicine interventions.

Methods:

Through a comprehensive systematic evaluation of published and unpublished literature, we extracted clinical, epidemiological and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 countries considered. We rated the methodological quality of each of the included reviews based on the AMSTAR 2 approach. The entire process was performed by two independent authors.

Results:

This overview drew on data from more than 2,239 primary studies, with more than 20,000 enrolled patients in total, within the European Region. Based on data from randomised trials, observational studies and economic evaluations from several WHORC, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter due to the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings and geographical locations. In addition to clinical outcomes of the interventions, social and economic ones are highlighted.

Conclusions:

The application of telemedicine is well-established across countries in the European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers relating to users, technology and infrastructure were found to be the biggest. Conversely, the provision of health services using technological devices was found to significantly enhance patients’ clinical outcomes, to improve long-term follow-up of patients by medical professionals and to offer logistical benefits for both patients and health workers.