Facilitators of and Barriers to Accessing Hospital Medical Specialty Telemedicine Consultations During the COVID-19 Pandemic: Systematic Review

Abstract

Background The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. 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 disparities in health care access, especially for the most susceptible populations. Objective We aimed to characterize the determinant factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic and to identify the main opportunities and challenges (technological, ethical, legal, and social) generated by the use of telemedicine in the context of the COVID-19 pandemic. Methods We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases (Scopus, Web of Science, PubMed, and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3, 2020, and December 31, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and the results were integrated into a thematic synthesis. The identification of the 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. The following facilitating factors of telemedicine use were identified: 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. We identified the following barriers to telemedicine use: 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 the need for complementary diagnostic tests or the delivery of test results. Conclusions The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of a technological nature (access to technological devices and internet services and level of digital literacy), a sociocultural and demographic nature (ethnic and racial disparities, geographic disparities, language barriers, and age), a socioeconomic nature (income level and health insurance coverage), and an ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most susceptible communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses.

Alcances y limitaciones de la teleconsulta en pandemia de covid-19: relatos de profesionales de la salud del primer nivel de atención de la Ciudad Autónoma de Buenos Aires

“…Se detectaron factores relacionados con aspectos tecnológicos (conectividad, dispositivos o analfabetismo digital), aspectos estructurales (lugar, energía eléctrica, convivientes o interrupciones), institucionales (protocolos, recomendaciones, normativas o convenios con prestadores), clínicos (motivos de consulta inapropiados a la modalidad o restricciones en el examen físico) y vinculares (contacto más distante con pacientes conocidos solo por teleconsulta, trabajo solitario con menor intercambio con colegas, etc.). En forma consistente, Habib et al (45) reportaron que la mayor barrera percibida (68,7%) fueron las dificultades técnicas; mientras que Cunha et al (46) identificaron las siguientes: falta de acceso a servicios de Internet; falta de acceso a dispositivos tecnológicos; disparidades raciales, étnicas y etarias; baja alfabetización digital; falta de recursos económicos; barreras del idioma; falta de cobertura por parte del seguro médico; preocupaciones sobre la privacidad y confidencialidad de los datos; disparidades geográficas; y la necesidad de pruebas diagnósticas complementarias o la entrega de resultados de las pruebas. En nuestro estudio, la edad y la cobertura de seguro médico también fueron variables que estuvieron presentes de manera reiterada en los relatos.…”

Analyzing the Effectiveness of Non-remote Monitoring Telemedicine Within the United States After 2019, Including Future Implications as a Healthcare Medium, Regarding Its Statistical and Analytical Disciplines: A Systematic Review

“…The personal limitations at hand can limit telemedicine's effectiveness, as the disabled will have a decreased ease of use for this technology (Yi et al, 2021). The utilization of telemedicine has seen increased use in our research period, especially following the COVID-19 pandemic, which can be attributed to global lockdown events and preventative procedures (Cunha et al, 2023), (Feldman & Baum, 2021. Promising results in the field of chronic disease management, as well as optimistic conclusions for alleviating worker shortages, demonstrate further positive outcomes of utilizing telemedicine (Nguyen et al, 2023), (Parish & Chan, 2021).…”

“…Across the 14 included studies that were identified to contain trends from the Ethical research perspective, many trends exhibited results contrary to the previous research perspectives, in that there continue to be existing concerns regarding telemedicine, its barriers to implementation, and additional training for medical professionals. An abundance of concerns regarding telemedicine remain within the various fields of applications alongside healthcare professionals (Cunha et al, 2023). Access to technology and the internet have remained the most prominent barriers to telemedicine use (Cunha et al, 2023).…”

“…An abundance of concerns regarding telemedicine remain within the various fields of applications alongside healthcare professionals (Cunha et al, 2023). Access to technology and the internet have remained the most prominent barriers to telemedicine use (Cunha et al, 2023). Underserved communities, who may not have proper or adequate access to traditional in-person healthcare, can benefit greatly from telemedicine's effectiveness in these communities (Virani et al, 2022).…”

Application of telemedicine system for older adults postoperative patients in community: a feasibility study

“…This indicates that the remote medical care model is more effective in addressing the medical requirements of older adults postoperative patients. Based on a systematic review, an individual's social, cultural, and digital technological competence is a crucial factor in determining the benefits derived from telemedical care (14). Consequently, this study diligently endeavored to impart suitable training to patients and their families enrolled in the telemedicine system.…”