Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review

Abstract

Introduction: Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Methods: Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Results: Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Conclusions: Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.Key words: chronic condition, Indigenous health, systematic review, telehealth. © S Fraser, T Mackean, J Grant, K Hunter, K Towers, R Ivers 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 IntroductionChronic diseases including such conditions as cardiovascular, respiratory and renal diseases, as well as disability caused by injury such as burns and to the spinal cord, affect many people around the world. These conditions are mostly characterised by complex causality, multiple risk factors, long latency periods, a prolonged course of illness and functional impairment or disability 1 . As a result of their often intense and prolonged requirement for health care, chronic conditions impose significant costs and challenges to health systems aiming to deliver cost effective, yet effective and appropriate, health care 2 . Compounding these challenges is the fact that chronic conditions disproportionally affect more Indigenous than non-Indigenous people, who have been shown to have significant challenges accessing health care 3,4 .Telehealth, a relatively new modality for healthcare delivery, aims to address some of the challenges facing health systems by increasing healthcare access and quality, enhancing health outcomes and reducing the high costs associated with speciality healthcare services 5,6 . Tele...

Barriers to Telemedicine Implementation in Southwest Tribal Communities During COVID‐19

“…Aside from barriers to access, the acceptability and effectiveness of telemedicine among tribal communities must be considered. 14 With this in mind, we agree with Kakol et al that telehealth expansion has the potential to improve access to care. However, substantial progress must be made toward increasing broadband Internet service on tribal lands before the potential of telemedicine to serve geographically dispersed but tightly woven communities, such as the Navajo Nation, can be realized.…”

“…Without access to technology needed for telemedicine, members of rural American Indian communities are distinctly disadvantaged. Aside from barriers to access, the acceptability and effectiveness of telemedicine among tribal communities must be considered 14 . With this in mind, we agree with Kakol et al that telehealth expansion has the potential to improve access to care.…”

Lockdown During COVID-19 and the Increase of Frailty in People With Neurological Conditions

“…Telehealth is becoming an important component of health care systems because it has the potential to address challenging issues such as access to health care and health inequalities (34). For example, telehealth has been used successfully with people living in remote areas, such as indigenous communities and rural populations (37,38).…”

Telemedicine: Healthcare’s Response to the COVID Crisis is Not without Disadvantages

“…The predominant advantageous feature is the increased accessibility of medical care, particularly, for patients in underserved or remote areas. Furthermore, patients who are homebound, have medical or psychiatric impediments that limit their access to care, or who have rare (or uncommon) medical disorders can also be cared for by physician specialists remotely [3,17,18]. Lastly, remote monitoring of chronic medical conditions, such as diabetes, via virtual peripheral medical devices (for example, a digital point-of-care device remotely linked to an endocrinology database) can further ensure high quality continuity of care [16][17][18].…”