|Year : 2022 | Volume
| Issue : 1 | Page : 4-8
Effectiveness and barriers of telehealth services during COVID-19 pandemic: A narrative review
Nipin Kalal, N Sabari Vel, Sarita Mundel, Seema Daiyya, Seema Dhayal, Sharmila Bishnoi, Simran Asiwal, Sonika Jhajhariya
College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Submission||17-May-2021|
|Date of Decision||23-Sep-2021|
|Date of Acceptance||23-Sep-2021|
|Date of Web Publication||19-Jan-2022|
Mr. Nipin Kalal
All India Institute of Medical Sciences, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
The coronavirus outbreak has introduced many challenges for the health-care delivery system, its workers, and health-care recipients. To overcome the challenges coming up during the coronavirus disease-2019 (COVID-19) pandemic, health-care sector was majorly helped by telehealth, e-health, and technologies involved in consultation, diagnosis, and treatment of patients from a distance. However, it has own benefits and barriers, which are discussed in this review. This review has been conducted through searching five databases including PubMed, ResearchGate, Google Scholar, Cochrane, and ScienceDirect. Inclusion criteria included studies clearly defining any use of telehealth services during COVID-19 pandemic and its effects and barriers, written in English language, published from 2019 to till date, and including studies from different countries. Narrative synthesis was undertaken to summarize and report the findings. Ten studies met the inclusion criteria out of the 97 search results. The articles included in our studies showed a significant increase in the uptake of telehealth services during this COVID-19 pandemic. Countries like the U.S.A showed an 80% decline in-person visits among the Canadian population 41% of them wanted virtual visits compared to in-person visits. The patients have reported high satisfaction with telehealth services according to the related studies although have reported hindrances and potential barriers to it like limited access to Internet availability, devices, lack of awareness about technology, high cost for implementation, and legal framework related to policies that includes privacy and confidentiality. Based on the findings of this review study, telehealth has been found as an effective way of health delivery system in these difficult times, but there are certain factors and issues related to its use which need to be looked upon. This narrative review indicates that the use of telemedicine and telehealth services during this COVID-19 pandemic has a plan of much help, as when compared to the barriers, it may produce to reach a large population at their home without putting the lives of health-care workers and the patients themselves at risk.
Keywords: Coronavirus disease-2019 pandemic, e-health services, telehealth services, telemedicine, virtual care
|How to cite this article:|
Kalal N, Vel N S, Mundel S, Daiyya S, Dhayal S, Bishnoi S, Asiwal S, Jhajhariya S. Effectiveness and barriers of telehealth services during COVID-19 pandemic: A narrative review. Indian J Med Spec 2022;13:4-8
|How to cite this URL:|
Kalal N, Vel N S, Mundel S, Daiyya S, Dhayal S, Bishnoi S, Asiwal S, Jhajhariya S. Effectiveness and barriers of telehealth services during COVID-19 pandemic: A narrative review. Indian J Med Spec [serial online] 2022 [cited 2023 Jan 30];13:4-8. Available from: http://www.ijms.in/text.asp?2022/13/1/4/335971
| Introduction|| |
Coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome (SARS) coronavirus 2 that can affect both humans and animals. In humans, few of them are known to cause respiratory infections ranging from common cold to more severe infections. The primary symptoms of COVID-19 comprise fever, dry cough, breathing difficulty, and loss of smell. First case of COVID-19 was reported officially on December 31, 2019, from Wuhan province of China, and the COVID was declared as a global pandemic on March 11, 2020, by WHO. Till date, human lives have suffered a lot due to coronavirus, as of now, we have lost 2,85,4276 people to COVID-19.
In these modern times of digitalization where technology has entered in every possible field to make work more easily and for the better advancement of the human race, it has begun to mark its existence in the area of medical sciences. Simply, telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health-care services remotely and manage your health.
According to the World Health Organization, telehealth is the delivery of health services, where distance is an important factor, by all health-care professionals using information and communication technologies for the exchange of information for diagnosis, treatment, and prevention of disease and injuries, research hand evaluation, and for the continuing education of health-care providers, all in the interests of promoting the health of individuals and their communities.
The first step toward telehealth was taken in 1940s Pennsylvania when the first electronic medical record transfer occurred, afterward, telemedicine appeared in urban communities in the early 1960s. On March 24, 2000, President Bill Clinton formally commissioned the world's first very small aperture terminal enabled village hospital at Aragonda in the state of Andhra Pradesh in India, which is considered as an important establishment for the future of telehealth in India. Telemedicine was started as a pilot project of the Indian Space Research Organization. Earlier, when the SARS outbreak in 2005 occurred, China began to explore more into telehealth and integrate electronic technologies into the health-care system.
When the COVID-19 pandemic halted the world with lockdown and quarantine to prevent its further transmission, people suffered from getting medical assistance, especially people with the symptoms of coronavirus infection and people with chronic diseases who require timely medical supervision. To overcome these issues and provide a safer platform for both the patients and physicians, telehealth approach was adopted around the world increasingly. Globally, there has been an upsurge in the adoption and need for telehealth after the occurrence of COVID-19 which increased from single digit to 77% in all over the world. According to a CDC report, the willingness to book telehealth visits during COVID-19 has increased 54% during the last week of March 2020 compared with the same period in 2019. Using telehealth as a health-care delivery platform has provided several advantages during these tough times by decreasing face-to-face contact with infected patients, decreasing overall consumption of PPE and other medical resources, and providing a platform where sick or quarantined physicians could continue to work. Although telehealth is well-accepted by patients as well as clinicians, it is not without limitations and challenges.
This study is the review of articles related to telehealth services use during the COVID-19 pandemic identifying the effectiveness and barriers raised while doing so.
| Methods|| |
The aim of this narrative review is to explore the effectiveness and barriers of telehealth-care services during the COVID-19 pandemic. This review is focused to address the effectiveness and barriers of telemedicine; we followed the PRISMA guidelines to conduct this narrative review.
Search strategy and data sources
Six online databases, included PubMed, ResearchGate, Google Scholar, ScienceDirect, Cochrane, and manual search, were searched to identify relevant and published studies. The search was conducted on titles and abstracts. The combination of keywords and medical subject headings was used: telehealth, telemedicine, e-health, virtual health, effectiveness, barriers, advantages, limitations, challenges, COVID-19 pandemic or COVID-19 outbreak, and global reports. The search in each database was adapted accordingly.
The selection criteria are summarized in [Table 1].
Study selection and data extraction
We performed the literature search following the inclusion and exclusion criteria and did the screening of the studies based on the titles and abstracts. Details of literature search and process of screening are shown in [Figure 1]. After screening, full text of studies was obtained. Data were extracted from all articles which met the eligibility criteria for the review and which were related to telehealth services, effectiveness, and barriers with its use during the COVID-19 pandemic.
| Results|| |
The characteristics of the included studies are demonstrated in [Table 2].
| Discussion|| |
Use of telehealth has significantly increased around the globe during this COVID-19 pandemic. The study conducted by CDC during the period of January–March 2020 showed a sharp rise in telehealth use, and with the availability of telehealth services the infection rate has reduced and it benefited the general public. Telehealth has been seen specifically beneficial for the people who are reluctant to take in-person consultation and had difficulty in accessing in-person care or population with chronic conditions.
According to a research conducted in Malta by a team of local experts called the “Community COVID-19 Initial Assessment Team,” majority (91%) of infected patients were managed safely in the community itself without admitting them in hospital and there was no significant mortality or morbidity with the medical consultations provided with the use of their telemedicine tool. In the USA, telemedicine visits increased by 68.3% in urgent care, out of all 56.2% and 17.6% urgent and nonurgent visits, respectively, were COVID-19 related showing a huge shift to telemedicine taking place during March and April 2020 with a decline of 80% in in-person visits.
In the Indian scenario, a considerable part of population shows a positive attitude toward telehealth. Among the practitioners who have used telehealth during this pandemic, the psychiatrist found this way of consultation easy to work with and without any major issue. Furthermore, for its better adaptation, the Indian government has revised its guidelines in 2020 on the practice of telemedicine which was published in 2005 and adopted the same during the period of pandemic, even the CDC has updated their guidelines on infection prevention and emphasized the use of telemedicine facilities for reducing the chances of transmission. The Canadian population in a health survey showed that 41% of them preferred to have virtual visits with their provider rather than in-person visits. World Health Organization itself has mentioned telemedicine among their recommendation for essential services in building a stronger health system response to COVID-19 policy. In Shandong province, China, the adoption and implementation of telemedicine services has been shown to lower the death rate incidences during the COVID-19 pandemic.
To encourage the physicians to use the telehealth services, government of countries like Australia has even started to provide funding for Medicare telemedicine services against COVID-19. Video visit utilization during the COVID-19 pandemic were significantly higher than in-person visits. Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. In all these studies, patients have reported being highly satisfied with the telehealth services used in general practice during this lockdown.
Although the use of telehealth services has been quite helpful during this pandemic, some studies have also reported the barriers they faced during its use such as it could be a hindrance to direct clinical decision-making and treatment. Furthermore, it could affect the patient–doctor relationship and trust. Digitally recorded information about the patient can be a vulnerable factor, as also limited access to Internet availability or devices such as smartphones, tablets, or computers. There may be a lack of awareness about the technology, computer illiteracy, and linguistic barriers between the provider and patient. For some patients with certain conditions, virtual visits might not be appropriate. Issues such as high cost of implementation and poor policies of reimbursements for care delivery, licensing issue, absence of legal framework related to policies that include patient privacy and confidentiality, and health professional authentication have also been observed as major obstacles for telemedicine uptake and application.
Our narrative review has three limitations, first, we have not been able to include studies which were published in languages other than English (e.g. Mandarin and French). Second, we were not able to access some other databases such as CINAHL and PsycINFO. Third, there is a possibility that some relevant studies might have skipped our attention or we could not reach them, though we have applied our best knowledge to adopt an extensive search strategy and cover a wide range of facts and evidences globally.
| Conclusion|| |
This study provides a comprehensive narrative review which explores the effectiveness and barriers of telehealth services during the COVID-19 pandemic. The COVID outbreak significantly affected the health-care delivery system and the restrictions opposed by the major health organization for preventing its spread among the population. To overcome this, telehealth and telemedicine have come up as a widely applied technology around the globe. After reviewing the selected articles, it was noticed that majority of studies favored the use of telehealth services and had a good experience with its application, especially during the COVID situation, It will help and protect from unnecessary exposure to the corona virus. It has seen that telehealth has reduced indirect cost of patients such as time and money lost in traveling, missed work meetings, and waiting rooms. Not only different countries but international bodies such as WHO have also supported the implementation of telehealth services during the COVID-19 pandemic. Countries such as the USA, Australia, Canada, China, Saudi Arabia, New Zealand, India, and others too have willingly adopted telehealth services to provide care to their population. Based on the findings of this review study, telehealth has been found as an effective way of health delivery system in these difficult times, but there are certain factors and issues related to its use that need to be looked upon.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]