JMIR Publications

ABSTRACT

Background:

The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about impacts and sustainability of this intervention at global level.

Objective:

Identify immediate experiences and impacts on patients and clinicians across the globe of this transformation, focusing on: Patient Experience, Clinician-Patient relationship, and Health Inequalities. Verify whether initial drivers of implementation support sustainability.

Methods:

Followed a published protocol. Searches were undertaken in academic databases and the web to capture world-wide grey literature in its original language between March 2020 until March 2022. Texts (academic abstracts or grey literature text extracts) were screened by two researchers. Abstracts and extracts were mapped against a healthcare technology adoption framework. We undertook qualitative content analysis against sociotechnical grounded theory.

Results:

134 texts met our criteria, of which 27.6% were grey literature. The texts identified had a global scope. According to the protocol’s Population-Concept-Context criteria we found 49% reported no specific population group, with population groups split by age and sex in 29% and 14% of texts respectively. Concept-wise, 42% combined two of the concepts studied, while 21% touch upon Clinician-Patient relationship only, 19% on patient experience only, and 8% on health inequalities only, with the remainder combining all three. The context identified that 55% of texts referred to what in the UK would be an outpatient (ambulatory care) setting and 34% to Primary Care. Patient experience reflected positive patient satisfaction and sustained access at the time of lockdowns. Clinician-Patient Relationship was more nuanced and reflected impacts on the interaction and quality of the encounter. We found gaps in evidence which made it difficult to pinpoint impacts on health inequalities on specific groups, with some evidence on negative impacts on those at the fringe of social and health systems. Mapping to the NASSS framework identified 93% of texts had a reference to the sustainability of the innovation with moderately positive comments. Over half of texts (56%) identified challenges in terms of sustainability and/or made recommendations on how to address them. 28% had a generally positive outlook setting out plans for growth and further embedding, while the remaining texts either did not address sustainability (11%) or did not support it (4%). We found gaps in evidence on clinical conditions, outcomes and digital skills.

Conclusions:

The sustainability of telemedicine is less clear once restrictions ease. Overwhelmingly positive patient satisfaction (from those who completed a digital encounter) and cautious optimism from clinicians in terms of quality are markers of sustainability. Of concern is the limited evidence on the healthcare experience of those who were disenfranchised by the move to telemedicine. We recommend additional research focused on vulnerable migrants, those with highest degree of socioeconomic deprivation and/or with no healthcare insurance coverage.