Evidence onEvidence on the sustainability of telemedicine in outpatient and primary care during the first two years of the COVID-19 pandemic: a global scoping review Evidence on the sustainability of telemedicine in outpatient and primary care during the first two years of the COVID-19 pandemic: a global scoping review the sustainability of telemedicine in outpatient and primary care during the first two years of the COVID-19 pandemic: a global scoping review (Preprint)

Abstract

The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about sustainability of this intervention at global level.

Verify whether initial drivers of implementation support sustainability of telemedicine as a consultation medium once lockdowns and social restrictions ease, mapping findings against an established sociotechnical framework of technological adoption in healthcare (NASSS).

Followed a peer-reviewed published protocol against established Population-Concept-Context methodology for Scoping reviews, as follows. Population (any group)-concept (Patient experience/Clinician-patient relationship/Health Inequalities), context (telemedicine in primary/outpatient care). Searches were undertaken in academic databases and the web to capture world-wide grey literature in its original language between March 2020 until March 2022. Texts (academic abstracts or other text extracts) were screened by two researchers, following the latest data extraction guidance by the Joanna Briggs Institute. Abstracts and extracts were mapped against a healthcare technology adoption framework. Results are discussed from the point of view of sociotechnical grounded theory.

134 texts met our criteria, of which 27.6% had no structured abstract. The texts identified had a global scope. According to the protocol’s Population-Concept-Context criteria we found 49% reported no specific population group, with population groups split by age and sex in 29% and 14% of texts respectively. Concept-wise, 42% combined two of the concepts studied, while 21% touch upon Clinician-Patient relationship only, 19% on patient experience only, and 8% on health inequalities only, with the remainder combining all three. The context identified that 55% of texts referred to what in the UK would be an outpatient (ambulatory care) setting and 34% to Primary Care. Patient experience reflected positive patient satisfaction and sustained access at the time of lockdowns. Clinician-Patient Relationship was more nuanced and reflected impacts on the interaction and quality of the encounter. We found gaps in evidence which made it difficult to pinpoint impacts on health inequalities on specific groups, with some evidence on negative impacts on those at the fringe of social and health systems. Mapping to the NASSS framework identified 93% of texts had a reference to the sustainability of the innovation with moderately positive comments. Over half of texts (56%) identified challenges in terms of sustainability or made recommendations on how to address them. 28% had a generally positive outlook setting out plans for growth and further embedding, while the remaining texts either did not address sustainability (11%) or did not support it (4%). We found gaps in evidence on clinical conditions, outcomes and digital skills.

The sustainability of telemedicine is less clear once lockdowns ease, despite patient satisfaction among those with completed consultations and cautious optimism from clinicians. Additional research needed on the healthcare experience of those disenfranchised telemedicine due to socioeconomic deprivation and limited healthcare insurance.

Study has been registered on Open Science Framework (4z5ut).