Visit Types in Primary Care with Telehealth Use during COVID-19: Systematic Review (Preprint)

Abstract

Telehealth was rapidly incorporated into primary care during COVID-19. However, there is limited evidence on which primary care visits had utilised Telehealth.

The objective of the study was to conduct a systematic review to assess 1/ what visit types in primary care have been reported with use of Telehealth during COVID-19, 2/ for each visit type identified in primary care, under what circumstances Telehealth is suitable, and 3/ benefits and drawbacks reported using Telehealth in primary care during COVID-19.

Systematic review using narrative synthesis. Studies were obtained from four databases (OVID (MEDLINE), CINAHL Complete, PDQ-Evidence, and ProQuest) and grey literature (NSW Health, RACGP, and WHO guidelines). Three independent reviewers screened studies featuring Telehealth use during COVID-19 in primary care. Levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). Critical appraisal was conducted using Mixed Methods Appraisal Tool. Benefits and drawbacks of Telehealth were assessed according to the National Quality Forum Telehealth Framework. PROSPERO registration: CRD42022312202. PRISMA-compliant: See Appendix 1 for the completed checklist of preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines.

Nineteen studies, predominately cross-sectional surveys/interviews (68%, 13/19), were included. Seven primary care visit types were identified: chronic condition management (89%, 17/19), existing patients (89%, 17/19), medication management (89%, 17/19), new patients (84%, 16/19), mental health/behavioural management (79%, 15/19), post-test results follow-up (74%, 14/19), and post-discharge follow-up (37%, 7/19). Benefits and drawbacks of Telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use due to a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of Telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks include technical barriers, impersonal interactions, and semi-established reimbursement models.

Telehealth was used for different visit types during COVID-19 in primary care, with a majority for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visits in primary care.