Impact statement
Why does this paper matter?
Introduction
Methods
Data sources
Study selection
Data collection
Data synthesis
Quality assessment
Results
Characteristics of included studies
1st author (Year), Country | Population (Sample size, main eligibility criteria, age, sex) | Setting | Types of TM | Category of Reported Outcomes (Measuring tools) |
---|---|---|---|---|
Randomized Controlled Clinical Trials | ||||
50 older adults who received home care services, Mean age of 67.5 years old (44% Female) | Home health services (HHS) by the Kwachun Community Health Promotion Center (CHPC) | Videoconference consultation | General care experience (Non-validated questionnaire) | |
Service use and usability (Non-validated questionnaire) | ||||
512 older adults visiting their physician, Mean age of 68 years old (0% Female) | Two Veterans' Administration general medical clinics | Phone consultation | General care experience (Validated questionnaire: Patient Satisfaction questionnaire [39]) | |
Service use and usability (Administrative database—Veterans' Administration (VA) national database) | ||||
Health-related and behavioural outcomes (Validated questionnaire: Short Form-36 Health Survey [40]; Non-validated questionnaire from original telephone care study [41]) | ||||
Quantitative Non-Randomized Studies | ||||
7382 older adults with cognitive disorders, Mean age not reported, (Sex distribution not reported) | Fundacio ́ ACE non-profit organization "memory clinic" | Videoconference and phone consultation | General care experience (Validated questionnaire: Healthcare Professionals’ Perceptions [42]) | |
Service use and usability (Administrative data) | ||||
182 older adults who received a phone consultation with a physician or a nurse, Mean age of 78.5 years old (43% Female) | Five primary care practices | Phone consultation | General care experience (Non-validated Questionnaire) | |
Health-related and behavioural outcomes (Validated questionnaire: Patient Enablement Instrument [43]) | ||||
40 older adults who were scheduled to receive a phone consultation with a clinician, Mean age not reported (75.2% Female) | Women’s health or general medicine clinic in an urban safety-net system | Videoconference consultation | General care experience (Non-validated questionnaire) | |
4525 older adults from a nationally representative sample of Medicare beneficiaries, Mean age of 79.6 years old (57% Female) | National Health and Aging Trends Study database | Phone consultation | General care experience (Survey data from the National Health and Aging Trend Study [44]) | |
207 nurses providing care to older adults, Mean age not reported (94.5% Female) | Home care organizations located in the middle, western, and southern areas of the Netherlands | Videoconference consultation | General care experience (Non-validated Questionnaire; Validated questionnaire: Positive and Negative Affect Schedule (PANAS) scale [45]) | |
Quantitative Descriptive Studies | ||||
286 older patients visiting their physician, Mean age of 73.8 years old (64% Female) | 250 general practices in southwest Poland’s Lower Silesia Province | Videoconference and phone consultation | General care experience (Interviews) | |
120,269 older adults calling a nurse-led telephone line, Mean age of 77.3 years old (63% Female) | Nurse-led health triage, screening, counselling and referral telephone line | Phone consultation | Service use and usability (Administrative database—Linha Saúde 24 (S24) administration system—public–private partnership integrated into the National Health Service) | |
49 clinicians using telemedicine with older adults, Mean age not reported (Sex distribution not reported) | Seattle Veterans Affairs Primary Care Clinic | Videoconference consultation | General care experience (Non-validated questionnaire) | |
530 older adults who received a phone consultation with a nurse, Mean age not reported (Sex distribution not reported) | 3 Veterans' Administration system (electronic record) primary care geriatric Clinic | Phone consultation | Service use and usability (Administrative data, Veterans' Administration system (VA)) | |
Qualitative Studies | ||||
1 older adult who received a phone consultation with a physician, Age of 69 years old (Male) | Swiss Center for Telemedicine | Phone consultation | General care experience (Case report) | |
30 older adults who attended community or day centers, Mean age not reported (87% Female) | Out-of-hours primary care services from community groups based in southeast London | Phone consultation | General care experience (Focus groups) | |
13 healthcare providers providing care to older adults, Mean age not reported, (86% Female) | Six NYC-area practices in home-based primary care | Videoconference consultation | General care experience (Semi-structured interviews) | |
Service use and usability (Semi-structured interviews) | ||||
10 older adults who attended a local public primary care clinic, Mean age of 74 years old (60% Female) | Single General Outpatient Clinic (GOPC) in Hong Kong | Videoconference consultation | General care experience (Semi-structured interviews) | |
15 older adults who attended a primary heath care center (PHCC) and had at least one chronic disease (hypertension, diabetes, COPD), Mean age of 73.2 years old (53.3% Female) | Three primary health care centers (PHCCs) in Southern Sweden | Videoconference and phone consultation | General care experience (Focus groups) | |
21 older adults who attended a general practice and had two or more long-term conditions, Mean age of 77 years old, (52% Female) | Six general Practices involved previously in research in New Zealand | Phone consultation | General care experience (Semi-structured interviews) | |
Service use and usability (Semi-structured interviews) | ||||
Mixed Methods Studies | ||||
10,400 older adults who received a video consultation with a physician, (QUAN) & 26 interviews (QUAL), Mean age not reported, (QUAL: 62% Female) | National study sample registry in a Swedish region | Videoconference consultation | General care experience (Semi-structured interviews) | |
173 older adults who received a video consultation with a nurse (QUAN) & 7 interviews (QUAL), Mean age not reported, (Sex distribution not reported) | Town-based general practice | Videoconference consultation | General care experience (Non-validated questionnaire; interviews) | |
256 older adults from various clubs and organizations (QUAN) & 15 interviews (QUAL), Mean age 70 years old in phase 1 & 87 years old in phase 2, (50% Female in phase 1, 60% Female) | Community Care and general population (Patient advocacy organizations, Senior social clubs, Health care organizations, and a senior information day in Utrecht) | Videoconference consultation | General care experience (Observations; Validated questionnaires: - Technology experience [46] | |
Service use and usability (Validated questionnaire: Demographic and Health-related [49]) |
Barriers | Ambivalent | Facilitators | ||||
---|---|---|---|---|---|---|
Dimension | Determinants | Relevant quote from the articles related to the framework dimension | Articles reporting the determinant as a barrier | Articles reporting the determinant as both a facilitator and a barrier | Articles reporting the determinant as a facilitator | |
Human Dimension | Healthcare Providers | |||||
1.1 | Comfort with workflow | “Providers were concerned about negative impacts on their clinic flow” [22] | n = 1 [22] | n = 0 | n = 0 | |
1.2 | Comfort with patient communication | “Many expressed concerns about their needs being assessed over the telephone, including doubts about the ability of unknown doctors to make accurate diagnoses in these circumstances. […] ‘I don’t think it is advisable to talk to the doctor over the phone about what you are suffering with and what the symptoms are and so on. I think it is most important that a doctor sees you’. (Male, group 4.)” [34] | n = 5 | n = 1 [22] | n = 1 [27] | |
1.3 | Comfort with provider interaction | “There was also the mutually perceived incidental benefit of opportunity for doctor-nurse communication, often carrying over beyond individual cases” [37] | n = 0 | n = 1 [37] | n = 2 | |
1.4 | Expertise with technology | “Nurses with high technology experience (e.g., computers, microwaves, Skype, tablets) (n = 41) had a significantly lower negative affect score related to the use of home telehealth” [36] | n = 0 | n = 2 | n = 2 | |
1.5 | Education and training | “It was clear that this rather public learning process had been uncomfortable for some of the nurses involved” [37] | n = 1 [37] | n = 1 [30] | n = 0 | |
1.6 | Resistance to change | “Undoubtedly, this was related to the local team leader’s role in initiating the development, but it was clear that her colleagues also found the development interesting and worthwhile” [37] | n = 0 | n = 0 | n = 3 | |
Patients & Caregivers | ||||||
2.1 | Disease characteristics / sociodemographic characteristics | “Older adults 'described ‘The aging body as a barrier’ with impaired practical abilities such as trembling fingers or impaired vision or hearing” [31] | n = 1 [23] | n = 13 | n = 0 | |
2.2 | Technology skills and knowledge | “Older people believed that they were not able to accomplish certain technological tasks (low self-efficacy), but discovered that they actually were able to do so or could do so after a small suggestion on how to proceed” [36] | n = 7 | n = 1 [31] | n = 2 | |
2.3 | User habits/preferences | “’I don’t feel this can work and doesn’t feel real to me. I prefer going to a doctor in a clinic, let the doctor see myself through his own eyes’ “ [32] | n = 6 | n = 8 | n = 1 [27] | |
2.4 | Location/travel time | “One participant felt that e-consultation could break down geographical barriers that potentially reduce access to healthcare […] 'I don't have to waste my time coming in for check-ups'” [32] | n = 0 | n = 5 | n = 7 | |
2.5 | Patient awareness / support | “Although some participants were against e-consultation because of difficulty with internet access, they would consider using the service with the help from family members and friends, as this participant described: ‘It [e-consultation] is only feasible if I can receive help from the younger ones, helping me to use the internet…’ [Fishermen, retired, female, age above 65]” [32] | n = 1 [33] | n = 1 [32] | n = 1 [36] | |
2.6 | Technology equipment | “26 scheduled visits were cancelled due to lack of patients’ telecommunications devices” [29] | n = 6 | n = 0 | n = 0 | |
2.7 | Medical cost (out-of-pocket) | “Relying on paid caregivers often meant using the aides’ own phone and data plan. As one provider asked, ‘is someone reimbursing [the aide] for that [data]? Is there Wi-Fi in the home? Do they [the aide] even have a smartphone?’ (CD, Practice 6)” [33] | n = 2 | n = 3 | n = 0 | |
System Dimension | Organization | |||||
3.1 | Leadership | “Undoubtedly, this was related to the local team leader’s role in initiating the development” [37] | n = 0 | n = 0 | n = 1 [37] | |
3.2 | Change management | “While participants generally expressed pride in how quickly they and their patients adapted, they also described limitations […] including the need to rapidly consent patients, set up patient portal accounts, and learn a new system quickly” [33] | n = 0 | n = 1 [33] | n = 0 | |
3.3 | Budget | N/A | n = 0 | n = 0 | n = 0 | |
3.4 | Workflow reengineering | “Instead of providing a way to maintain contact with patients without requiring them to appear in clinic frequently, telephone appointments became simply an additional service” [19] | n = 3 | n = 1 [19] | n = 4 | |
3.5 | Organizational culture | “They also had thoughts about differences between the organizations. One of the participants wondered why short text message reminders are common in the dental care but not in primary care” [31] | n = 2 | n = 0 | n = 0 | |
3.6 | Hospital information systems | N/A | n = 0 | n = 0 | n = 0 | |
3.7 | Training and support | N/A | n = 0 | n = 0 | n = 0 | |
Technology | ||||||
4.1 | Reliability of technology | “Some participants demanded high internet stability for the service, as they felt it would be useless if the technology itself was unreliable: ‘If the computer system is slow then it [e-consultation] isn’t helpful. It will take longer if the computer system constantly breaks down and need to spend hours to recover.’” [32] | n = 5 | n = 2 | n = 0 | |
4.2 | Storage | N/A | n = 0 | n = 0 | n = 0 | |
4.3 | System speed | N/A | n = 0 | n = 0 | n = 0 | |
4.4 | User interface / intended use /usability | “Overall, providers noted the diversity of options (institutional platforms, other HIPAA-compliant commercial platforms, and consumer platforms) allowed greater access to patients than would otherwise have been possible. Providers appreciated the ease of texting images of a skin condition or meeting quickly by FaceTime and hoped this flexibility could continue as privacy rules were enforced again. ‘We just did whatever we really felt was needed for that patient, and it’s going to be spoiled going back to the regular [institutional platform] way’, noted one social worker” [33] | n = 1 [34] | n = 9 | n = 0 | |
4.5 | Data quality | “GPs [General Practitioners] reported some sound issues, difficulties seeing rashes and skin problems.” [37] | n = 1 [37] | n = 0 | n = 0 | |
4.6 | Transmission | “Having digital access to information about the medication was described as another potential advantage” [31] | n = 0 | n = 0 | n = 1 [31] | |
4.7 | Interoperability | “The main issue that the participants talked about was that there was ‘Poor communication between health care organizations’ IT systems’. As no organization was fully updated with all the information, the participants expressed ‘disappointment over poor IT systems’” [31] | n = 1 [31] | n = 0 | n = 1 [33] | |
4.8 | Information security | ““I think e-consultation opens up an opportunity for criminal activities if safety measures [online security] are not taken.’ [Police, retired, male, age above 65]” [32] | n = 0 | n = 2 | n = 0 | |
Environment Dimension | Society | |||||
5.1 | 3rd party payers | “The accelerated pace of change driven by the pandemic and resulting changes in regulation and reimbursement have also allowed for rapid HBPC practice innovations that would not otherwise have been possible.” [33] | n = 0 | n = 0 | n = 1 [33] | |
5.2 | Technology infrastructure | N/A | n = 0 | n = 0 | n = 0 | |
5.3 | Reimbursement | N/A | n = 0 | n = 0 | n = 0 | |
5.4 | Insurance fee schedule | N/A | n = 0 | n = 0 | n = 0 | |
5.5 | Social norms and values / temporal trends | N/A | n = 0 | n = 0 | n = 0 | |
Rules/Policy | ||||||
6.1 | Medical liability | N/A | n = 0 | n = 0 | n = 0 | |
6.2 | Practice certification and license | N/A | n = 0 | n = 0 | n = 0 | |
6.3 | Governmental authority | “Governmental regulations in the establishment and running of e-consultation services would enhance participants’ trust in the service.’As long as the government is at the back of the service [e-consultation], I would then have confidence in it.’ [Domestic helper, retired, female, age 40–65]” [32] | n = 0 | n = 0 | n = 1 [32] | |
6.4 | Privacy and security rules | “Providers appreciated the ease of texting images of a skin condition or meeting quickly by FaceTime and hoped this flexibility could continue as privacy rules were enforced again. ‘We just did whatever we really felt was needed for that patient, and it’s going to be spoiled going back to the regular [institutional platform] way’, noted one social worker” [33] | n = 0 | n = 1 [33] | n = 0 | |
6.5 | Interface standards | N/A | n = 0 | n = 0 | n = 0 |
TM effects on general care experience
TM effects on healthcare service use and usability
TM effects on health-related and behavioural outcomes
Quality assessment
1st author (Year), Country | Methodological Quality Criteria | ||||
---|---|---|---|---|---|
Randomized Controlled Clinical Trial | |||||
Is randomization appropriately performed? | Are the groups comparable at baseline? | Are there complete outcome data? | Are outcome assessors blinded to the intervention provided? | Did the participants adhere to the assigned intervention? | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | ✓ | Can’t tell | ✓ | |
Quantitative Non-Randomized Studies | |||||
Are the participants representative of the target population? | Are measurements appropriate regarding both the outcome and intervention (or exposure)? | Are there complete outcome data? | Are the confounders accounted for in the design and analysis? | During the study period, is the intervention administered (or exposure occurred) as intended? | |
✓ | ✓ | ✓ | X | ✓ | |
✓ | ✓ | ✓ | Can’t tell | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
Quantitative Descriptive Studies | |||||
Is the sampling strategy relevant to address the research question? | Is the sample representative of the target population? | Are the measurements appropriate? | Is the risk of nonresponse bias low? | Is the statistical analysis appropriate to answer the research question? | |
✓ | Can’t tell | Can’t tell | ✓ | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
Can’t tell | ✓ | ✓ | X | ✓ | |
✓ | ✓ | ✓ | Can’t tell | ✓ | |
Qualitative Studies | |||||
Is the qualitative approach appropriate to answer the research question? | Are the qualitative data collection methods adequate to address the research question? | Are the findings adequately derived from the data? | Is the interpretation of results sufficiently substantiated by data? | Is there coherence between qualitative data sources, collection, analysis and interpretation? | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | Can’t tell | ✓ | Can’t tell | |
✓ | ✓ | ✓ | ✓ | ✓ | |
✓ | ✓ | ✓ | ✓ | ✓ | |
Mixed Methods Studies | |||||
Is there an adequate rationale for using a mixed methods design to address the research question? | Are the different components of the study effectively integrated to answer the research question? | Are the outputs of the integration of qualitative and quantitative components adequately interpreted? | Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? | Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? | |
✓ | ✓ | ✓ | ✓ | ✓ | |
Can’t tell | Can’t tell | Can’t tell | Can’t tell | Can’t tell | |
✓ | ✓ | ✓ | ✓ | ✓ |
Discussion
Strengths and limitations
Impact on clinical practice
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Ensure that clinicians or clinical teams feel able to maintain a clear communication with patients,
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Support the familiarization of clinicians with available communication technologies, to enhance their confidence in collecting comprehensive patients' information through these tools and facilitate interdisciplinary collaboration inside and outside clinical teams,
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Encourage leadership-driven TM initiatives and acknowledge or reward the contributions of peers or other groups and organisations in supporting these initiatives.
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Introducing tools adapted to their technology skills, supporting patients in their TM platform navigation as needed and providing assistance to foster self-efficacy,
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Promoting the advantages and benefits of selected TM, notably on travel and travel time, to further encourage its acceptability,
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Advocating for a greater accessibility of technological tools that could improve patients' health, to ensure the access of their patients to appropriate equipment.