Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

Abstract

Background The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted.

Assessing Telemedicine Efficiency in Follow-up Care With Video Consultations for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial

“…Thus, there was an initial interest in telemedicine among participants. This might have led to a self-selection bias in favor of higher satisfaction with telemedicine from the start because patients who were more comfortable with digitalization were more likely to participate in the study [ 22 ]. Although all patients consented to undergo a video consultation, it was found that patients in the intervention group were more likely to choose a video consultation for their next follow-up appointment than those in the control group, further supporting the effect of comfortability.…”

“…Although all patients consented to undergo a video consultation, it was found that patients in the intervention group were more likely to choose a video consultation for their next follow-up appointment than those in the control group, further supporting the effect of comfortability. Although this self-selection bias is evident for all telemedicine evaluations with a similar study design, it leads to the limitation that the data do not show results for the general population but only show results for patients with a baseline interest in telemedicine [ 22 ]. Short of forcing patients to participate in telemedicine, a procedure that appears both unethical in principle and unfeasible in clinical practice, there is no acceptable way of addressing this limitation.…”

“…In addition, regardless of medical specialty, there were barriers that still negatively impacted readiness for adoption despite the benefits of telemedicine. These barriers included, for example, resistance to change, lack of technical literacy, or uncertainties about costs and reimbursement [ 21 , 22 ]. However, since the outbreak of the COVID-19 pandemic, the need for telemedicine has increased considerably in the field of orthopedic and trauma surgery, among other medical areas [ 7 , 16 , 18 ].…”

The financial implications of telemedicine practice patterns across pediatric surgical specialties

“…Current literature focuses on how wide-scale telehealth adoption increases healthcare accessibility and may mitigate the looming physician shortage [26] , [27] , [28] , [29] . It also focuses on the disadvantages, like exacerbation of disparities in resources and quality of patient care [ 26 , 27 , 30 ].…”

Citizens’ Use of eHealth Services During COVID-19 in Relation to National Policy Goals

“…Countries around the world have developed strategies with the aim to increase citizens' use of eHealth services, and thereby facilitate access to health and social care. Implementation and use of eHealth services has varied greatly in different parts of the world until the COVID-19 pandemic accelerated their adoption globally [1]. Several publications highlight, however, that inequalities in the access to connectivity or the lack of digital literacy may prevent certain social groups from taking advantage of eHealth services, thus risking increasing stigma or isolation for certain social groups [2][3][4].…”