Introduction
Methodology
Literature search
Inclusion and exclusion criteria
Results
Before COVID-19 | ||
---|---|---|
High-Income Countries | LMICs | |
1. Telehealth adoption | 4 | 2 |
2. Application in Specialised Services & Advantages | 6 | 5 |
3. Challenges | 2 | 2 |
During COVID-19 | ||
1. Telehealth adoption | 6 | 3 |
2. Application in Specialised Services & Advantages | 5 | 3 |
3. Challenges | 4 | 4 |
High-Income Countries (HICs) | ||
Year | Authour(s) | Key Findings |
2017 | Kayyali et al., [14] | Although the Whole System Demonstrator (WSD) project, which is considered the world’s largest randomised controlled trial (RCT) on telehealth showed that telehealth can significantly reduce hospital admission rates (P=0.0017), the length of stay (P=0.023), and mortality rates (P<0.001), telehealth adoption is still poor in the UK. |
2012 | Zanaboni & Wootton, [1] | Almost no telehealth application had reached large-scale and enterprise-wide adoption as of 2012. The widespread use of telehealth was underdeveloped and needed strengthened new research directions. |
2015 | Bradford et al., [10] | A study conducted in the Queensland community in Australia makes it known that out of the 60% of participants who were aware of telehealth, only 13% had used telehealth services. This shows that although people know about telehealth, only a few people use it. |
2019 | Maia et al., [7] | A study conducted in Portugal shows that telehealth is a complementary healthcare service and only compensates for existing asymmetries and inadequate resources. |
Low-and-Middle-Income Countries (LMICs) | ||
2013 | Wamala & Augustine, [12] | Observations from Wamala & Augustine (2013) postulate dearth commitment and efforts to the optimise use of telehealth in Africa. Before the COVID-19 pandemic, countries like Ethiopia and South Africa recorded some progress in the adoption of telehealth, while others like Nigeria and Burkina Faso recorded slow progress as a result of lack of political will. |
2014 | Van Dyk L. [11] | Although telehealth has the potential to increase accessibility and quality of healthcare, there was slow or no widespread adoption of telehealth in most LMICs. In South Africa, telehealth services that were successful in the pilot phase could not be sustained. |
High-Income Countries (HICs) | ||
Year | Author(s) | Key Findings |
2014 | Bradford et al., [15] | In Australia, telehealth is equally an effective way of treating paediatric palliative care. Virtual spaces provide an opportunity for clinicians to observe the living surroundings of patients and include these observations in diagnosing conditions. |
2018 | Jong et al., [8] | A study in Nunavut, Canada postulates that the implementation of telehealth reduced travel costs by 50% for patients, health professionals, or both who would have traveled to seek or render specialized healthcare services. |
2014 | Durland et al., [9] | Some health facilities in the United States (U.S.) are using telehealth through telephone-mediated psychosocial interventions to manage depressed medical populations confronting significant barriers to face-to-face treatment. |
2018 | Selzler et al., [16] | In the context of Canada, features of telehealth such as telemonitoring, teleconsultation, tele-education, and telehealth-pulmonary rehabilitation are used in the management of chronic respiratory diseases. |
2013 | Turner & McGee-Lenon, [2] | A study that assessed the advances of telehealth over the past 10 years in the UK showed that pre-COVID-19, telecare systems provided social connectedness to the aged. Reminders were integrated into telehealth systems to alert forgetful adults to watch their favourite television programmes. |
2015 | Garcia et al., [4] | A study by Gracia et al. stipulates that in 2015, telehealth reduced costs associated with health conditions for patients in U.S. and Brazil while eliminating the distance between patients and doctors. Telehealth efficiently ensured clinical data sharing, patient’s visualisation and inspection through high-definition cameras, and real-time collection of vital signs. |
Low-and-Middle-Income Countries (LMICs) | ||
2019 | Siddiquee et al., [17] | The implementation of telehealth in Nepal is addressing issues such as geographical remoteness (21%), shortage of healthcare service providers (11%), extreme conditions (10%), cost (9%), service quality (9%), and real-time services (8%). |
2014 | Bagayoko et al., [18] | The implementation of telehealth in Mali increased patient visits from 8% to 35%. Patients who utilised telehealth saved an average cost of $25 and maximum of $75 compared to those who traveled to cities for face-to-face specialised services. |
2016 | Chakrabarti & Shah, [19] | As cited in Chakrabarti & Shah, clinical outcomes of telepsychiatric interventions are comparable to face-to-face treatment among patients of all ages, ethnicities, cultures and diagnostic groups across diverse clinical settings. |
2015 | Ganapathy K. [20] | In India, although there are only 2.67% of the total neurologists and neurosurgeons living in rural communities covering a population of 84.59 million, the implementation of telemedicine has partially resolved the acute manpower shortage. Video Conferencing (VC) systems are commercially applied to conduct teleconsultation sessions for neurological patients. |
2019 | Sayani et al., [21] | Telehealth is improving chronic disease outcomes in LMICs while reducing cost for patients living in LMICs. |
High-Income Countries (HICs) | ||
Year | Author(s) | Key Findings |
2019 | Alghamdi et al., [22] | A study that assessed the adherence and dropout rates of individuals with chronic obstructive pulmonary disease (COPD) in telehealth interventions showed that there is a lack of knowledge on the effectiveness of telehealth for COPD care post-implementation. This makes it difficult to assess the impact of telehealth on COPD management. |
2012 | Sanders et al., [23] | A qualitative study conducted in the UK shows that patients are reluctant to risk potential disruptive changes to existing face-to-face services that are highly valued. There are difficulties in recruiting health professionals for telehealth services, where recruitment difficulties are reported at 80% refusal rate. |
Low-and-Middle-Income Countries (LMICs) | ||
2015 | Scott et al., [24] | In LMICs, telehealth has still not been integrated into existing healthcare systems. Some of the reasons are: limited resources, unreliable power supply, poor internet connectivity, and high cost for the poverty stricken. |
2013 | Cilliers & Flowerday, [25] | A barrier to the effective implementation of a telehealth system in LMICs is the lack of awareness regarding the telehealth system. The study further elaborates that health professionals are apprehensive when using telehealth, and this contributes to less frequent usage. |
High-Income Countries (HICs) | ||
Year | Author(s) | Key Findings |
2021 | James et al., [26] | The disruptive impact of COVID-19 has rapidly progressed the implementation and use of telehealth in Australian PHC as has occurred in other developed countries. |
2022 | Tang & Reddy, [27] | As cited in Tang & Reddy (2022), the U.S. saw an increase of 154% in telehealth visits at the end of March 2022 compared to the same period in 2019. |
2021 | Heneghan et al., [13] | A mixed-method study conducted in the UK and Canada postulates that although patient’s satisfaction with telehealth in musculoskeletal physical therapy is widely reported as high as face-to-face care, widespread adoption of telehealth within physical therapy has been slow. |
2021 | Reisinger-Kindle et al., [28] | There were 698 (39%) telehealth visits out of a total of 1788 prenatal visits by 558 patients. This shows that there was high adoption of telehealth during COVID-19 in Springfield, Massachusetts. |
2022 | Alpert et al., [29] | Telemedicine was not utilized in cancer care before COVID-19. The COVID-19 pandemic forced health systems to quickly adapt to telehealth use for cancer treatment. |
2021 | Rangachari et al., [3] | While specialties like psychiatry, cardiology, and radiology are recording higher telehealth use, others like allergy-immunology, family medicine, and gastroenterology are recording lower telehealth use. |
Low-and-Middle-Income Countries (LMICs) | ||
2021 | Cruz et al., [30] | Based on responses from a study conducted in Mozambique, 69% of respondents were willing to use teleconsultation public health services for mild illness and review consultations. It was realised that respondents were willing to adopt to telehealth use due to its relatively cheaper price of services. |
2021 | Ranjbar et al., [31] | Out of a total of 523 nurses and midwives who participated in the study, 73.0% had positive attitude towards telenursing and telehealth. Higher education was positively associated with the understanding of telehealth. |
2020 | Kazi et al., [32] | Telehealth was initially in its infancy in LMICs, however, the COVID-19 pandemic accelerated the demand for telehealth following social distancing protocols globally. |
Discussion
A Comparison Between High-Income Countries (HICs) and LMICs on Telehealth Before COVID-19 Pandemic
A Comparison Between HICs and LMICs on Telehealth During COVID-19 Pandemic
High-Income Countries (HICs) | ||
Year | Author(s) | Key Findings |
2021 | Tsou et al., [34] | Telehealth is used in rural and remote emergency departments to effectively improve clinical care processes, and speed of care. Telestroke has been proven during the COVID-19 pandemic to be effective in the timely management of stroke conditions. |
2022 | Peixoto et al., [35] | In resource-challenged areas in Brazil, teleconsultation is a strategic technological tool for patients to access quality healthcare in a COVID-19 pandemic era where social distancing is a new normal. |
2021 | Freske & Malczyk, [36] | Implementation of telehealth in Nebraska has increased access to health services among rural residents and deeply impacted clinical practice. Clinicians in Nebraska plan to continue providing services via telehealth if policies and regulations are well-enacted post-COVID-19. |
2021 | Smith et al., [38] | Australia has implemented the Breastscreen Australia Remote Radiology Assessment Model (RRAM) to address the hurdle of inadequate access to a local radiological workforce in regional Australia. Majority of participants saw no difference between telehealth services and the onsite model. |
2020 | Evenski et al., [37] | The COVID-19 pandemic brought about the novel adoption of telehealth in the field of Orthopaedic Oncology, which is expected to positively impact healthcare access and compliance. 42% of participants in the Evenski et al., (2020) study rated tele-orthopedic services at 9.7 out of 10. This result is consistent with previous findings with telehealth in other specialties. |
Low-and-Middle-Income Countries (LMICs) | ||
2020 | Indria et al., [33] | During the COVID-19 pandemic era, 78% of clinicians who took part in a study organised in the city of Makassar in Indonesia indicated their satisfaction with telehealth systems. 69% of participants indicated that telehealth allowed for quicker diagnosis and treatment. |
2022 | Tahir et al., [5] | In South Africa, telehealth is perceived as a mitigator of healthcare provider shortages, and poor rural and remote access to healthcare services. |
2021 | Hoffer-Hawlik et al., [6] | The application of telehealth in the area of hypertension management in LMICs saw a significant reduction in blood pressure among hypertensive patients. |
High-Income Countries (HICs) | ||
Year | Author(s) | Key Findings |
2022 | Zaman et al., [39] | Although telehealth interventions that were designed to help people self-manage chronic diseases demonstrated positive effects, barriers to using telehealth interventions in older adults were identified and some were: knowledge gaps, lack of willingness to adopt new skills, and reluctance to technology use. |
2021 | Leone et al., [40] | A scoping review conducted in the UK showed that there were no established uniform guidelines for telehealth implementation. |
2021 | Naito et al., [41] | Although findings support the rapid adoption of telehealth in clinical care delivery in North America, the implementation of telehealth has faced critical challenges such as variations in state licensure requirements for telehealth, disparities in access to telehealth among disadvantaged populations, lack of consistency among individual investigational review boards (IRBs) on telehealth studies. |
2020 | Kho et al., [42] | The implementation of telehealth services often result in challenges stemming from the lack of attention to change management. |
Low-and-Middle-Income Countries (LMICs) | ||
2020 | Zobair et al., [43] | In a study conducted in rural Bangladesh, exemplary barriers to telehealth adoption that were identified and confirmed (p<0.01) were; lack of organizational effectiveness, health staff motivation, patient satisfaction, and trustworthiness. Lack of Information Communication and Technology (ICT) infrastructures and allocation of resources were identified as indirect barriers. |
2022 | Haroon et al., [44] | Telehealth system vulnerabilities may result in inappropriate access to patient information, medical device malfunction, or breakdown of health services that are provided, which may result in ethical and legal issues. |
2022 | Poonsuph, [45] | Existing telehealth services in Thailand is limited to only fundamental medical consultation services. |
2021 | Mahdi et al., [46] | Lack of governance and stakeholder support, lack of effective logistical and clinical procedures, and patients’ ability to adapt to telehealth care are the barriers to the mass adoption of telehealth services in Pakistan. |