Technical, economic, and political factors led to notable disparities between high-income and low-and middle-income countries, an international assessment shows.
Although the impact of COVID-19 accelerated a rapid adoption of telehealth services, large-scale implementation was hampered by a lack of uniform guidelines, access inequities, and infrastructure issues, particularly in low- and middle-income countries(LMICs), according to a recent study published in BMC Health Services Research.
Historically, underdeveloped countries have made slow progress in integrating telehealth, a result of limited resources, unreliable power supply, poor internet connectivity, and high cost for the poverty stricken, the authors wrote. Further, a lack of national policies and regulations, evidenced in both high and LMICs, have made for significant challenges.
“Addressing these challenges will help countries adopt telehealth at a national level,” the authors wrote.
They sought to understand progress and paucity in advancing telehealth systems by comparing available research from high-income and LMICs before and during the COVID-19 pandemic. World Bank classification was used to categorize high-income and LMICs.
The authors began their scoping review by downloading potentially qualifying studies from ProQuest, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE by applying Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. They specifically used the key search term telehealth.
Studies had to be published in English as full-text articles and peer reviewed. Forty-six studies from 19 countries met criteria for final inclusion in the review.
In general, adoption of telehealth before the pandemic was not common in high-income countries and LMICs. Even so, the authors’ literature review identified evidence of effective telehealth applications tailored to address special needs or circumstances:
In addition, the rapid expansion of telehealth during the pandemic era introduced challenges inherently unique to each country, the findings showed:
However, telehealth interventions also led to important health benefits, the authors noted:
Although this review advanced knowledge of telehealth, the researchers acknowledged limitations. There are limited studies on telehealth in LMICs, and inclusions in the review were limited to those written in the English language and peer reviewed. Moreover, by using telehealth as a key search term to increase specificity of the research, they may have limited their study’s scope.
“Primary quantitative and qualitative studies must be conducted to address challenges encountered during the pilot implementation of telehealth in both high-income countries and LMICs,” the authors concluded. “Telehealth has the capacity to improve health care access and outcomes for patients while reducing health care costs across a wide range of conditions and situations.”
Kissi J, Annobil C, Mensah NK, Owusu-Marfo J, Osei E, Asmah ZW. Telehealth services for global emergencies: implications for COVID-19: a scoping review based on current evidence. BMC Health Services Research. Published online June 1, 2023. doi:10.1186/s12913-023-09584-4