JMIR Publications

ABSTRACT

Background:

Telemedicine has been widely used for the treatment and management of patients with chronic diseases. However, there is both favorable and controversial evidence on the application of telemedicine to this field. We conducted an overview of all the systematic reviews available to provide the benefits and challenges of applying telemedicine to patients with diabetes, lung diseases, cancer and cardiovascular diseases.

Objective:

Given that the concept of telemedicine is complicated, it is essential to clarify and evaluate the effective interventions of telemedicine on chronic disease patients. The study aims to evaluate telemedicine's impact on chronic disease patients from three dimensions (Improving the patient experience of care, improving populations' health, and reducing the per capita cost of health care). We focus on the four major chronic diseases that WHO has highlighted [16] , namely, cardiovascular diseases (e.g., heart attacks and stroke), cancers, chronic lung diseases (such as chronic obstructed pulmonary disease and asthma), and Diabetes. Our findings, with solid evidence and insights, will help policymakers harness the power of telemedicine to improve the care of those with chronic diseases.

Methods:

Medline, EMBASE and Web of Science databases were explored for systematic reviews of telemedicine applications for the chronic diseases from 1 January 2019 to 31 December 2022. Two patient engagement frameworks were synthesized to provide a three-level classification of interventions and solutions to patient care. GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was used to evaluate the quality of evidence. The IHI Triple Aim framework was adopted to evaluate the effectiveness of telemedicine on patients with diabetes, lung diseases, cancer and cardiovascular diseases.

Results:

Of the 90 included reviews, 30 focused on diabetes, 13 focused on lung diseases, 20 examined telemedicine in cancer and 27 in diabetes. Interventions at the consultation level were included in 23 reviews. 59 reviews examined interventions at the involvement level, eight at the level of partnership and shared leadership and 23 investigated various interventions across the three levels. With respect to the outcomes, 18 reviews reported the effects of telemedicine on patient experience of care, such as good receptiveness and empowerment. 26 reviews examined the effects of telemedicine on the improvement of population health, such as a significant reduction in HbA1c. Nine reviews focused on the use of telemedicine in reducing the per capita cost of healthcare.

Conclusions:

Telemedicine has the potential to improve patient experience of care and population health, and may reduce healthcare costs per capita. However, future research is needed to examine telemedicine interventions at different levels in order to confirm their feasibility in chronic diseases.