Telehealth: systematic review of analytic studies and environmental scan of relevant initiatives
Deshpande A, Khoja S, Lorca J, McKibbon A, Rizo C, Jadad AR
Record ID 32008000105
"Objective was to provide a critical evaluation of the available data on the use of clinical applications of asynchronous telehealth. This report describes two components: 1) a systematic review of the peer-reviewed literature on the impact of asynchronous telehealth on health outcomes, process of care, access to health services, and health resources 2) an environmental scan to help synthesize the available practices from existing organizations providing asynchronous telehealth services, so that the information is relevant to Canadian policy makers." (executive summary)
Authors' results and conclusions:
The systematic review included 52 original studies out of 238 citations identified. The included studies had diverse designs, interventions, and outcomes, precluding meta-analysis. Sixteen studies were judged to be of high quality based on the use of standardized quality assessment tools. Almost half of the studies focused on teledermatology. Most studies showed beneficial effects in terms of diagnostic accuracy, wait times, referral management, and satisfaction with services.
The overall quality of most of the original studies in asynchronous telehealth is poor. These studies, however, provide consistent evidence suggesting that this telehealth modality could lead to shorter wait times, fewer unnecessary referrals, high levels of patient and provider satisfaction, and equivalent (or better) diagnostic accuracy when compared with face-to-face consultations The number of organizations identified in the environmental scan highlights the potential of asynchronous telehealth and underscores the need for standardized ways to document their work so that institutions may be compared.
In Canada, where the reduction in wait times for health care has become a priority, asynchronous telehealth could be an option to choose for improving access to specialized services. It is unknown, however, whether the benefits that have been shown in small local studies could be realized after wide-scale implementation.
Policy makers could play a role in helping to shape the future of asynchronous telehealth in Canada. By formulating pragmatic objectives with consistent and reasonable outcomes, policy makers and researchers could promote projects, such as asynchronous telehealth triage services, that could increase the efficiency of the health care system and enrich the body of research.
Canadian policy makers have an opportunity to leverage the experience and resources of the five existing asynchronous telehealth services. Efforts are underway to promote standardization, particularly through the National Telehealth Outcomes Indicators Project (NTOIP), which could foster collaboration among institutions. These programs could act as living laboratories in which to gain a better understanding, under controlled conditions, of the depth and breadth of services, their associated risks and benefits, their resource implications, and the regulatory framework that would be needed to ensure that asynchronous telehealth contributes to the sustainability of the health care system in Canada.
English language abstract:
An English language summary is available
Canadian Agency for Drugs and Technologies in Health
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Canadian Agency for Drugs and Technologies in Health (CADTH)