Effectiveness of telemedicine: A systematic review of reviews

Abstract

To conduct a review of reviews on the impacts and costs of telemedicine services. Methods: A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet-based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review. Results: In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes. Conclusions: The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest.2 Introduction Previous reviews of telemedicine have concluded that irrefutable evidence regarding the positive impact of telemedicine on clinical outcomes still eludes us. One review [1] of more than 150 articles concluded that potential effectiveness could only be attributed to teleradiology, telepsychiatry, transmission of echocardiographic images and consultations between primary and secondary health providers. Another systematic review [2] that assessed more than 1300 papers making claims about telemedicine outcomes found only 46 publications that actually studied at least some clinical outcomes. A review that analyzed the suitability of telemedicine as an alternative to face-to-face care [3] concluded that establishing systems for patient care using telecommunications technologies is feasible; however, the studies provided inconclusive results regarding clinical benefits and outcomes. A report on peer-reviewed literature for telemedicine services that substituted face-to-face services with ICT based services at home and in offices or hospitals [4] identified 97 articles that met the inclusion criteria for analysis. The authors concluded that telemedicine is being used even if the use ...

Highly flexible, wearable, and disposable cardiac biosensors for remote and ambulatory monitoring

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Involving Citizen-Patients in the Development of Telehealth Services: Qualitative Study of Experts’ and Citizen-Patients’ Perspectives (Preprint)

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Designing and Undertaking a Health Economics Study of Digital Health Interventions

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