JMIR Publications

ABSTRACT

Background:

The pandemic of COVID-19 has transformed healthcare delivery, requiring rapid adaptation of all stakeholders to this new reality. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated inequalities in access to healthcare, particularly for the most vulnerable populations.

Objective:

To characterize the determinants factors (facilitators and barriers) of telemedicine use, regarding the access to medical specialty consultations, and identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of this technology, in the context of the COVID-19 pandemic.

Methods:

A systematic review was conducted according to PRISMA guidelines. Four databases were used to identify empirical studies concerning the pandemic period, published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis to identify facilitating factors and barriers of telemedicine use on access to medical specialty consultations. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results.

Results:

Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America. The facilitating factors to telemedicine use identified were health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. The barriers to telemedicine use identified were lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and performing complementary diagnostic tests or delivering results.

Conclusions:

Telemedicine has been used to facilitate and enable access to specialized health care, especially since the onset of the COVID-19 pandemic. However, its use of is not yet accessible to everyone. In order to expand access to healthcare and provide high-quality care for all through the use of this digital solution, including the most vulnerable communities, the determinants of technological, sociocultural, demographic, socioeconomic, ethical, and legal challenges identified in this systematic review must be researched and addressed with informed and dedicated responses. Future research should examine whether the identified opportunities and challenges in accessing telemedicine services during the pandemic period are applicable in other international contexts and whether and how they apply to non-pandemic settings.