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      Determining if Telehealth Can Reduce Health System Costs: Scoping Review

      review-article
      , PhD, MPH, BPharm 1 , 2 , , MPH, BSc (Hons) 1 , 2 , , PhD, BEcon, BPT 2 , , PhD, MEd, BNurs 1 , 2 , 3 , , PhD, MMed, MBBS 2 , , PhD, DipAppSci, BInfoTech 1 , 2 ,
      (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      JMIR Publications
      cost-benefit analysis, telemedicine, review

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          Abstract

          Background

          Telehealth represents an opportunity for Australia to harness the power of technology to redesign the way health care is delivered. The potential benefits of telehealth include increased accessibility to care, productivity gains for health providers and patients through reduced travel, potential for cost savings, and an opportunity to develop culturally appropriate services that are more sensitive to the needs of special populations. The uptake of telehealth has been hindered at times by clinician reluctance and policies that preclude metropolitan populations from accessing telehealth services.

          Objective

          This study aims to investigate if telehealth reduces health system costs compared with traditional service models and to identify the scenarios in which cost savings can be realized.

          Methods

          A scoping review was undertaken to meet the study aims. Initially, literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature in telehealth. The investigators then conducted an expert focus group to identify domains where telehealth could reduce health system costs, followed by targeted literature searches for corresponding evidence.

          Results

          The cost analyses reviewed provided evidence that telehealth reduced costs when health system–funded travel was prevented and when telehealth mitigated the need for expensive procedural or specialist follow-up by providing competent care in a more efficient way. The expert focus group identified 4 areas of potential savings from telehealth: productivity gains, reductions in secondary care, alternate funding models, and telementoring. Telehealth demonstrated great potential for productivity gains arising from health system redesign; however, under the Australian activity-based funding, it is unlikely that these gains will result in cost savings. Secondary care use mitigation is an area of promise for telehealth; however, many studies have not demonstrated overall cost savings due to the cost of administering and monitoring telehealth systems. Alternate funding models from telehealth systems have the potential to save the health system money in situations where the consumers pay out of pocket to receive services. Telementoring has had minimal economic evaluation; however, in the long term it is likely to result in inadvertent cost savings through the upskilling of generalist and allied health clinicians.

          Conclusions

          Health services considering implementing telehealth should be motivated by benefits other than cost reduction. The available evidence has indicated that although telehealth provides overwhelmingly positive patient benefits and increases productivity for many services, current evidence suggests that it does not routinely reduce the cost of care delivery for the health system.

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          Most cited references117

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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            Scoping studies: towards a methodological framework

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              Scoping studies: advancing the methodology

              Background Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. Discussion We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Summary Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                October 2020
                19 October 2020
                : 22
                : 10
                : e17298
                Affiliations
                [1 ] Centre for Online Health The University of Queensland Brisbane Australia
                [2 ] Centre for Health Services Research The University of Queensland Brisbane Australia
                [3 ] Centre for Innovative Medical Technology University of Southern Denmark Odense Denmark
                Author notes
                Corresponding Author: Liam J Caffery l.caffery@ 123456uq.edu.au
                Author information
                https://orcid.org/0000-0002-4298-9369
                https://orcid.org/0000-0001-5333-2955
                https://orcid.org/0000-0003-2840-3496
                https://orcid.org/0000-0002-7756-5136
                https://orcid.org/0000-0003-2141-0802
                https://orcid.org/0000-0003-1899-7534
                Article
                v22i10e17298
                10.2196/17298
                7605980
                33074157
                b3e3e01d-f850-4d7d-ad54-e99e407c39a4
                ©Centaine L Snoswell, Monica L Taylor, Tracy A Comans, Anthony C Smith, Leonard C Gray, Liam J Caffery. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.10.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 4 December 2019
                : 7 July 2020
                : 2 August 2020
                : 17 August 2020
                Categories
                Review
                Review

                Medicine
                cost-benefit analysis,telemedicine,review
                Medicine
                cost-benefit analysis, telemedicine, review

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