Telemedicine in rural care. Part 2: Assessing the wider issues

Telemedicine in the primary care of older adults: a systematic mixed studies review

BACKGROUND

Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults.

METHODS

In this systematic mixed studies review, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, and clinical trials research registers were searched for articles in English, French or Russian. Two reviewers performed study selection, data extraction and assessment of study quality. TM's effects were reported through the tabulation of key variables. TM use determinants were interpreted using thematic analysis based on Chang's framework. All data were integrated using a joint display matrix.

RESULTS

From 3,328 references identified, 20 studies were included. They used either phone (n = 8), videoconference (n = 9) or both (n = 3). Among studies reporting positive outcomes in TM experience, 'user habit or preferences' was the most cited barrier and 'location and travel time' was the most cited facilitator. Only one study reported negative outcomes in TM experience and reported 'comfort with patient communication' and 'user interface, intended use or usability' as barriers, and 'technology skills and knowledge' and 'location and travel time' as facilitators. Among studies reporting positive outcomes in service use and usability, no barrier or facilitator was cited more than once. Only one study reported a positive outcome in health-related and behavioural outcomes.

CONCLUSIONS

TM in older adults' primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.

Stakeholders’ experience of teledermatology in a nurse-led community clinic: a case study

Dermatology is regarded as especially suitable for the application of telemedicine because it relies to a large extent on visual information for diagnosis and holds promise as an alternative means of delivering healthcare. Interest in teledermatology has come at a time when there is an increased demand for dermatological services and has been advocated as a mode of delivery that may diminish inequalities in the provision of an overstretched service and improve access to dermatological care. A qualitative case study based on interviews and observations was undertaken to explore the perceptions of stakeholders (nurses, patients, GPs, consultants) when interacting with a nurse-led teledermatology service in primary care. The study found that the delineation of roles and changing professional boundaries were important issues for stakeholders. It has provided further evidence that teledermatology is more than images and diagnostics.

Health information technologies in geriatrics and gerontology: a mixed systematic review

OBJECTIVE

To review, categorize, and synthesize findings from the literature about the application of health information technologies in geriatrics and gerontology (GGHIT).

MATERIALS AND METHODS

This mixed-method systematic review is based on a comprehensive search of Medline, Embase, PsychInfo and ABI/Inform Global. Study selection and coding were performed independently by two researchers and were followed by a narrative synthesis. To move beyond a simple description of the technologies, we employed and adapted the diffusion of innovation theory (DOI).

RESULTS

112 papers were included. Analysis revealed five main types of GGHIT: (1) telecare technologies (representing half of the studies); (2) electronic health records; (3) decision support systems; (4) web-based packages for patients and/or family caregivers; and (5) assistive information technologies. On aggregate, the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical processes. Although less frequently studied, positive impacts were found on patients' health, productivity, efficiency and costs, clinicians' satisfaction, patients' satisfaction and patients' empowerment.

DISCUSSION

Further efforts should focus on improving the characteristics of such technologies in terms of compatibility and simplicity. Implementation strategies also should be improved as trialability and observability are insufficient.

CONCLUSIONS

Our results will help organizations in making decisions regarding the choice, planning and diffusion of GGHIT implemented for the care of older adults.

Expanding nurses' roles in telemedicine & genetics services

This article presents nursing roles in telemedicine and genetics services. Telemedicine offers a promising solution to delivering comprehensive genetics services to children and families when travel, distance, and shortage of genetics professionals interfere with access. Nurses are already using telemedicine to provide nursing and healthcare services but have become involved in the delivery of genetics services via telemedicine only recently. Involving nurses in the development of telemedicine systems for genetics services is essential as they serve as a vital link between the patient, the healthcare system, and the community. Some of the emerging nursing roles in telemedicine include genetic family-health risk assessment, evaluation and counseling at the advanced practice level and at the primary care level, referral, participation in genetic evaluation and counseling, and family- and community-based care coordination and management. The Genomics Nurse Case Coordinator role as described by is presented as a means of further expanding the maternal-child health nursing role in supporting women and families to manage their own genomic health. Telemedicine offers nurses an opportunity to assure and provide quality genetic healthcare tailored to the individual and family's specific needs within their own community.