Review of effectiveness criteria in the application of Telemedicine

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Abstract

SUMMARY Telemedicine is a very useful tool and resource for medical diagnosis and treatment. Since its inception in the 70s it has developed progressively, demonstrating the clinical benefit it brings to patients and being increasingly present in the daily activities of clinicians. Different studies have tried to define and limit its effectiveness at the time of application versus face-to-face assistance, this being an important variable to clarify. This article reviews the different variables that have been coined to define the effectiveness when trying to demonstrate the cost-effectiveness of including telemedicine in daily healthcare activity.

Translated abstract

RESUMEN La telemedicina es una herramienta y recurso de gran utilidad para el diagnóstico y tratamiento médico. Desde su inicio en la década de los 70 se ha desarrollado de forma progresiva, demostrando el beneficio clínico que aporta a los pacientes y estando cada vez más presente en la actividad diaria de los clínicos. Diferentes estudios han tratado de definir y acotar su efectividad a la hora de aplicarse versus la asistencia presencial, siendo esta una variable importante a despejar. Este artículo realiza una revisión de las diferentes variables que se han acuñado para definir efectividad a la hora de tratar de demostrar la rentabilidad de incluir la telemedicina en la actividad asistencial diaria.

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Evaluating barriers to adopting telemedicine worldwide: A systematic review

Clemens Scott Kruse, Priyanka Karem, Kelli Shifflett … (2016)

Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.

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Telehealth and patient satisfaction: a systematic review and narrative analysis

Clemens Scott Kruse, Nicole Krowski, Blanca Rodriguez … (2017)

Background The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations. Objective The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency. Methods Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE. Results 2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences. Conclusion This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.

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What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions

Sarah J Iribarren, Kenrick Cato, Louise Falzon … (2017)

Background Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Methods Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Results Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62–100, STD 14.18) and the top quartile reported 91.3–100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Conclusions Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of intervention effectiveness of a health-related outcome and reported economic data, many did not report all recommended economic outcome items and were lacking in comprehensive analysis. The identified economic evaluations varied by disease or condition focus, economic outcome measurements, perspectives, and were distributed unevenly geographically, limiting formal meta-analysis. Further research is needed in low and low-middle income countries and to understand the impact of different mHealth types. Following established economic reporting guidelines will improve this body of research.

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Journal

Journal ID (publisher-id): sm

Title: Sanidad Militar

Abbreviated Title: Sanid. Mil.

Publisher: Ministerio de Defensa (Madrid, Madrid, Spain )

ISSN (Print): 1887-8571

Publication date (Print and electronic): September 2020

Volume: 76

Issue: 3

Pages: 161-169

Affiliations

[1] Cercedilla Madrid orgnameSERMAS orgdiv1Hospital La Fuenfría orgdiv2FEA Medicina Interna

[5] Madrid orgnameHospital Central de la Defensa «Gómez Ulla»

[3] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1UAAN. Sección de Infecciosas orgdiv2FEA Medicina Interna

[4] Madrid Madrid orgnameUniversidad de San Pablo orgdiv1Facultad de Medicina Spain

[6] Cercedilla Madrid orgnameSERMAS orgdiv1Hospital La Fuenfría orgdiv2FEA Medicina Interna

[2] Madrid orgnameHospital Central de la Defensa «Gómez Ulla»

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Publisher ID: S1887-85712020000300161 Publisher ID: S1887-8571(20)07600300161

DOI: 10.4321/s1887-85712020000300004

SO-VID: ae67e7ed-59a6-44ae-bb3d-dab607dd1d03

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http://creativecommons.org/licenses/by/4.0/

History

Date received : 16 February 2020

Date accepted : 21 September 2020

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Figures: 0, Tables: 0, Equations: 0, References: 49, Pages: 9

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Review of effectiveness criteria in the application of Telemedicine

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Most cited references 48

Evaluating barriers to adopting telemedicine worldwide: A systematic review

Telehealth and patient satisfaction: a systematic review and narrative analysis

What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions

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