What do Cochrane systematic reviews say about telemedicine for healthcare?

Abstract

BACKGROUND: Telemedicine has emerged as a tool for overcoming the challenges of healthcare systems and is likely to become increasingly viable, since information and communication technologies have become more sophisticated and user-friendly. OBJECTIVE: We aimed to identify all Cochrane systematic reviews (CSRs) on telemedicine within healthcare and to summarize the current evidence regarding its use. DESIGN AND SETTING: Review of CSRs, developed at the Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS:We searched for studies that compared use of telemedicine with conventional treatment or management of diseases within healthcare. Diagnostic telemedicine studies or studies using automatic text, voice-text or even self-managed care were excluded. The main characteristics and the certainty of evidence were synthetized and critically discussed by all authors. RESULTS: We included 10 CSRs that investigated a broad range of diseases. There is still insufficient evidence to determine what types of telemedicine interventions are effective, for which patients and in which settings, and whether such interventions can be used as a replacement for the standard treatment. Harm relating to telemedicine technologies needs to be better investigated and addressed. CONCLUSION: Telemedicine might be an excellent way to facilitate access to treatment, monitoring and dissemination of important clinical knowledge. However, given the recognition of systematic reviews as the best evidence resource available for decision-making, further randomized controlled trials with stricter methods are necessary to reduce the uncertainties in evidence-based use of telemedicine.

Telemedicine, drug-resistant epilepsy, and ketogenic dietary therapies: A patient survey of a pediatric remote-care program during the COVID-19 pandemic

“…Telemedicine is the use of information and communication technology (ICT) applied to different healthcare fields, especially when geographical distance is a critical factor [ 2 , 3 ]. Since the first medical consultation by telephone was documented in 1879, there has been an enormous development in the use of telemedicine, also in the fields of child and adult neurology [ [4] , [5] , [6] , [7] ]. Although scientific evidence is still insufficient, telemedicine emerges as a valid alternative for conventional medicine or as a complement to reduce disparities and improve access to healthcare [ 5 ].…”

Hurdles to Developing and Scaling Remote Patients’ Health Management Tools & Systems: A Scoping Review

“…While a number of systematic reviews did not provide enough details to determine the extent to which, discussed interventions were accessible to the general patient or potential patient population, the majority [4], [9], [10], [11], [12], [14], [18], [23], [24], [29], [31], [32], [34], [48], [49], [50], [51], [63] and [64] provided information which indicated that accessibility was limited as depicted in Figure 8. Among the many mentioned factors which negatively affect accessibility were usability, integration between patients and electronic health records, and giving personalized feedback [4], [63], centralized and decentralized data problem, which is a source of confusion and poses security and privacy challenges [32], performance in clinical settings is still controversial [31] and insu cient healthcare infrastructure and funding [11], [29].…”

“…Other reviews, however highlighted more systemic and historical challenges including those related to inequalities and the needs of the target use group which ought to be taken into consideration early in the design and development of mhealth tools; vulnerable, hard-to-reach, or otherwise high-risk patient populations [10], [34], [48], [49] and [64]; varying degrees of literacy, connectivity and accessibility and some patients who were concerned that their care would become dependent on technology, resulting in depersonalised care, reductions in face-to-face interaction, and increased out of pocket costs [14], [18]; characteristics of the care setting and Studies of telehealth should consider combinations of apps of telehealth and outcomes that are important in these new models and that evaluate the speci c contribution telehealth can make in these contexts [24] and review [23] pointed out that prior to deploying a newly developed intervention into healthcare settings, its practicality, clinical effectiveness and potential commercial bene ts ought to be established and backed up by concrete evidence.…”

“…Nine reviews [5], [14], [24], [30], [31], [34], [48], [49] and [51] gave evidence of wishing to pursue a user-centred design but there was an indication that such design was either not achieved or was limited due to factors such as unavailability of mHealth apps on some operating systems [49], limited mobility and exibility, in addition to the trustworthiness and quality of the content, and personalization possibilities through customization and adaptability [5], usability drawbacks, as well as reports of the need for more comprehensive solutions, including the provision of real-time feedback and the integration of the EHRs systems being used by the care providers [51]. The layout of design approach for systematic reviews is depicted in Figure 11.…”

“…A signi cant number of systematic reviews (nine) did not contain information about the extent to which discussed interventions integrated or intended to integrate with /-into traditional healthcare systems. Of the 26 reviews, 9 [4], [9], [12], [24], [29], [47], [31], [48] and [49] provided information to suggest or demonstrate that above integration was either achieved or at least attempted.…”