Trade-offs Between Accessibility and Practicality in Global Telemedicine: A Systematic Review
-
Muhammad Thoriq
,
Wilda Fitria Rachmadina
,
Julian Benedict Swannjo
,
Fajrul Falah Farhany
,
Adrian Kus
,
Agus Rachmanto
,
. Sulistiawati
Abstract
Background: Telemedicine is increasingly vital in healthcare, offering remote consultations via message-based and video call-based platforms. These methods improve healthcare accessibility, particularly when in-person visits are limited. Telemedicine is increasingly vital in healthcare, offering remote consultations via message-based and video call-based platforms. These methods improve healthcare accessibility, particularly when in-person visits are limited.Methods: A systematic search was conducted in ScienceDirect, PubMed, and up to August 2024. Studies evaluating the accessibility and practicality of global telemedicine were evaluated. From initial 439 records, 19 studies were finally in this systematic review. Studies were reviewed thoroughly with quality appraisal using the Newcastle Ottawa Scale, in which those rated for high quality studies were included.
Results: Most studies (74%) were from high-income countries, notably the United States (26%) and Denmark (11%). Observational studies dominated (95%), focusing on follow-up consultations (47%) and diagnostic services (32%), particularly in general care (32%), neurology (11%), and surgery (5%). Research peaked in 2022 (32%) during the COVID-19 pandemic. Common platforms included WhatsApp, AnyDesk, and QliqSOFT. Accessibility was the primary focus in 53% of studies, while 47% addressed feasibility. Challenges like technological barriers and privacy concerns were particularly noted in lower-income regions.
Conclusion: Telemedicine has enhanced healthcare accessibility and demonstrated feasibility. However, technological limitations and remote consultation challenges persist, particularly in lower-income regions. Continued research is needed to optimize telemedicine and equitable access.
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2. Stoltzfus M, Kaur A, Chawla A, et al (2023). The role of telemedicine in healthcare: an overview and update. Egypt J Intern Med, 35:49.
3. Krupinski EA, Weinstein RS (2013). Tele-medicine in an Academic Center—The Arizona Telemedicine Program. Telemed J E Health, 19:349–356.
4. Gajarawala SN, Pelkowski JN (2021). Tele-health Benefits and Barriers. J Nurse Pract, 17:218–221.
5. Alviani R, Purwandari B, Eitiveni I, et al(2023). Factors Affecting Adoption of Telemedicine for Virtual Healthcare Services in Indonesia. Journal of Infor-mation Systems Engineering and Business Intel-ligence, 9:47–69.
6. Eze ND, Mateus C, Cravo Oliveira Hashiguchi T (2020). Telemedicine in the OECD: An umbrella review of clini-cal and cost-effectiveness, patient expe-rience and implementation. PLoS One, 15:e0237585.
7. Hubley S, Lynch SB, Schneck C, et al (2016). Review of key telepsychiatry outcomes. World J Psychiatry, 6:269-82.
8. Torous J, Roberts LW (2023). The Impact of Remote Monitoring on Hospitaliza-tions for Chronic Diseases: A Review. Journal of Chronic Disease Management, 31:451–460.
9. Houser SH, Flite CA, Foster SL (2023). Pri-vacy and Security Risk Factors Related to Telehealth Services-A Systematic Re-view. Perspect Health Inf Manag, 20(1):1f.
10. Perl J, Brown EA, Chan CT, et al (2023). Home dialysis: conclusions from a Kid-ney Disease: Improving Global Out-comes (KDIGO) Controversies Confer-ence. Kidney Int, 103:842–858.
11. Darbyshire JL, Greig PR, Hinton L, et al (2021). Monitoring sound levels in the intensive care unit: A mixed-methods system development project to optimize design features for a new electronic in-terface in the healthcare environment. Int J Med Inform, 153:104538.
12. Halcomb EJ, Ashley C, Dennis S, et al (2023) Telehealth use in Australian pri-mary healthcare during COVID-19: a cross-sectional descriptive survey. BMJ Open, 13:e065478.
13. Chechter M, Dutra da Silva GM, E Costa RAP, et al (2023). Evaluation of patients treated by telemedicine in the beginning of the COVID-19 pandemic in Sao Pau-lo, Brazil: A non-randomized clinical trial preliminary study. Heliyon, 9 (4): e15337.
14. Yang J, Yang X-S, Fan S-W, et al (2021). Prognostic value of microRNAs in heart failure. Medicine (Baltimore), 100:e27744.
15. Koonin LM, Hoots B, Tsang CA, et al (2020). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep, 69:1595–1599.
16. Ding H, Chen SH, Edwards I, et al (2020). Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis. J Med Internet Res, 22:e20032.
17. Anawade PA, Sharma D, Gahane S (2024). A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus, 16(3): e55996.
18. Dziedzic TA, Bala A, Marchel A (2022). Anatomical aspects of the insula, oper-cula and peri-insular white matter for a transcortical approach to insular glioma resection. Neurosurg Rev, 45:793–806.
19. Bell S, Karamchandani U, Malcolmson K, Moosajee M (2021). Acceptability of Telegenetics for Families with Genetic Eye Diseases. Genes (Basel), 12:276.
20. Molina F, Soulos PR, Brockman A, Old-field BJ (2023). Clinical and Sociodemo-graphic Factors Associated with Tele-medicine Engagement in an Urban Community Health Center Cohort Dur-ing the COVID-19 Pandemic. Telemed J E Health, 29:875–885.
21. Scholarworks S, Dissertations W, Studies D, Moore JS (2024). Strategies to Implement Telemedicine Systems in Health Care Strategies to Implement Telemedicine Systems in Health Care Organizations. In: https://scholarworks.waldenu.edu/dissertations
22. Dorsey ER, Topol EJ (2020). Telemedicine 2020 and the next decade. Lancet, 395:859.
23. Nina L, Yuzkiv H, Yanchytska K, et al (2022). Modern learning models through teacher and student dynamic interaction in HEI towards COVID-19 pandemic condition. Int J Health Sci (Qassim), 6:234–243.
24. Singh V, Sarbadhikari SN, Jacob AG, et al (2022). Challenges in delivering primary care via telemedicine during COVID-19 pandemic in India: A review synthesis using systems approach. J Family Med Prim Care, 11:2581–2588.
25. Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM (2016). The Empirical Evidence for Telemedicine Interven-tions in Mental Disorders. Telemed J E Health, 22:87–113.
26. James SL, Abate D, Abate KH, et al (2018). Global, regional, and national inci-dence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Glob-al Burden of Disease Study 2017. Lancet, 392:1789–1858.
27. Smith AC, Thomas E, Snoswell CL, et al (2020). Telehealth for global emergen-cies: Implications for coronavirus dis-ease 2019 (COVID-19). J Telemed Telecare, 26:309–313.
28. Harindhanavudhi T, Areevut C, Sa-hakitrungruang T, et al (2022). Imple-mentation of diabetes care and educa-tional program via telemedicine in pa-tients withCOVID ‐19 in home isolation in Thailand: A real‐world experience. J Diabetes Investig, 13:1448–1457.
29. O’Neill L, Brennan L, Sheill G, et al (2023). Moving Forward with Telehealth in Cancer Rehabilitation: Patient Perspec-tives From a Mixed Methods Study. JMIR Cancer, 9:e46077.
30. Fonner VA, Kennedy S, Desai R, et al (2021). Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study. JMIR Form Res, 5:e22513.
31. Chechter M, Dutra da Silva GM, e Costa RAP, et al (2023). Evaluation of Patients Treated by Telemedicine in the Beginning of the COVID-19 Pandemic in São Paulo, Brazil: a non-randomized Clinical Trial Preliminary Study. Heliyon, 9(4):e15337.
32. Kim E, Sung HC, Kaplow K, et al (2024). Donor Perceptions and Preferences of Telemedicine and In-Person Visits for Living Kidney Donor Evaluation. Kidney Int Rep, 9(8):2453–61.
33. Asukile M, Chishimba L, Chomba M, et al (2022). Implementation of a Teleneurology Clinic in Zambia during the COVID ‐19 Pandemic. Ann Neurol, 91(4):445–54.
34. Lawford BJ, Hinman RS, Morello R, et al (2022). Perceptions about the Efficacy and Acceptability of Telephone and video-delivered Allied Healthcare for Adults with Disabilities during the COVID-19 pandemic: a cross-sectional National Survey. Arch Phys Med Rehabil, 103(7):1368-1378.
35. Gren C, Egerod I, Linderoth G, et al (2022). “We Can’t Do without it”: Parent and call-handler Experiences of Video Triage of Children at a Medical Helpline. Mordaunt DA, editor. PLoS One, 17(4):e0266007.
36. Fonner VA, Kennedy S, Desai R, et al (2021). Patient-Provider Text Messaging and Video Calling among Case-Managed Patients Living with HIV: Formative Acceptability and Feasibility Study. JMIR Form Res, 5(5):e22513.
37. Gren C, Asbjoern Boerch Hasselager, Linderoth G, et al (2023). Video Triage of Children with Respiratory Symptoms at a Medical Helpline Is Safe and Feasible–a Prospective Quality Improvement Study. PLoS One, 18(4):e0284557–7.
38. Barca I, Novembre D, Giofrè E, et al (2020). Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic. Int J Environ Res Public Health, 17(20):7365.
39. Bell S, Karamchandani U, Malcolmson K, et al (2021). Acceptability of Telegenetics for Families with Genetic Eye Diseases. Genes (Basel), 12(2):276.
40. O’Neill L, Brennan L, Sheill G, et al (2023). Moving Forward with Telehealth in Cancer Rehabilitation: Patient Perspectives from a Mixed Methods Study. JMIR Cancer, 9:e46077.
41. Lucas CW, Kochs S, Jost J, et al (2024). Digital Participation of Brain Tumour Patients in the Assessment and Treatment of Communication Disorders. Front Psychol, 14:1287747.
42. Peralta E, Taveras M (2020). Effectiveness of Teleconsultation Use in Access to Mental Health Services during the Coronavirus Disease 2019 Pandemic in the Dominican Republic. Indian J Psychiatry, 62(Suppl 3):S492–4.
43. Tuot DS, Mukherjee A, Churape A, et al (2024). Lessons from the Field from a Volunteer Telehealth Ambassador Program to Enhance Video Visits among Low-Income Patients: Qualitative Improvement Study. JMIR Form Res, 8:e49993.
44. Pinyopornpanish K, Nantsupawat N, Buawangpong N, et al (2022). Concerns of Home Isolating COVID-19 Patients While Receiving Care via Telemedicine during the Pandemic in the Northern Thailand: a Qualitative Study on Text Messaging. Int J Environ Res Public Health, 19(11):6591.
45. John O, Gummidi B, Jha V (2020). Continuum of Care for non-communicable Diseases during COVID-19 Pandemic in Rural India: a Mixed Methods Study. J Family Med Prim Care, 9(12):6012–7.
46. Saywell NL, Mudge S, Kayes NM, et al (2023). A six-month Telerehabilitation Programme Delivered via Readily Accessible Technology Is Acceptable to People following stroke: a Qualitative Study. Physiotherapy, 120:1–9.
47. Chu JN, Kaplan C, Lee JS, et al(2022). Increasing Telehealth Access to Care for Older Adults during the COVID-19 Pandemic at an Academic Medical Center: Video Visits for Elders Project (VVEP). Jt Comm J Qual Patient Saf, 48(3):173–9.
48. Bhadola S, Tang C, Marks A, et al (2022). Disparate Healthcare Access and telehealth-based Hybrid Consultations during the COVID-19 Pandemic. Work, 73(2):377–82.
49. Solans O, Vidal-Alaball J, Cabo PR, et al (2021). Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res, 23(5):e28629.
2. Stoltzfus M, Kaur A, Chawla A, et al (2023). The role of telemedicine in healthcare: an overview and update. Egypt J Intern Med, 35:49.
3. Krupinski EA, Weinstein RS (2013). Tele-medicine in an Academic Center—The Arizona Telemedicine Program. Telemed J E Health, 19:349–356.
4. Gajarawala SN, Pelkowski JN (2021). Tele-health Benefits and Barriers. J Nurse Pract, 17:218–221.
5. Alviani R, Purwandari B, Eitiveni I, et al(2023). Factors Affecting Adoption of Telemedicine for Virtual Healthcare Services in Indonesia. Journal of Infor-mation Systems Engineering and Business Intel-ligence, 9:47–69.
6. Eze ND, Mateus C, Cravo Oliveira Hashiguchi T (2020). Telemedicine in the OECD: An umbrella review of clini-cal and cost-effectiveness, patient expe-rience and implementation. PLoS One, 15:e0237585.
7. Hubley S, Lynch SB, Schneck C, et al (2016). Review of key telepsychiatry outcomes. World J Psychiatry, 6:269-82.
8. Torous J, Roberts LW (2023). The Impact of Remote Monitoring on Hospitaliza-tions for Chronic Diseases: A Review. Journal of Chronic Disease Management, 31:451–460.
9. Houser SH, Flite CA, Foster SL (2023). Pri-vacy and Security Risk Factors Related to Telehealth Services-A Systematic Re-view. Perspect Health Inf Manag, 20(1):1f.
10. Perl J, Brown EA, Chan CT, et al (2023). Home dialysis: conclusions from a Kid-ney Disease: Improving Global Out-comes (KDIGO) Controversies Confer-ence. Kidney Int, 103:842–858.
11. Darbyshire JL, Greig PR, Hinton L, et al (2021). Monitoring sound levels in the intensive care unit: A mixed-methods system development project to optimize design features for a new electronic in-terface in the healthcare environment. Int J Med Inform, 153:104538.
12. Halcomb EJ, Ashley C, Dennis S, et al (2023) Telehealth use in Australian pri-mary healthcare during COVID-19: a cross-sectional descriptive survey. BMJ Open, 13:e065478.
13. Chechter M, Dutra da Silva GM, E Costa RAP, et al (2023). Evaluation of patients treated by telemedicine in the beginning of the COVID-19 pandemic in Sao Pau-lo, Brazil: A non-randomized clinical trial preliminary study. Heliyon, 9 (4): e15337.
14. Yang J, Yang X-S, Fan S-W, et al (2021). Prognostic value of microRNAs in heart failure. Medicine (Baltimore), 100:e27744.
15. Koonin LM, Hoots B, Tsang CA, et al (2020). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep, 69:1595–1599.
16. Ding H, Chen SH, Edwards I, et al (2020). Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis. J Med Internet Res, 22:e20032.
17. Anawade PA, Sharma D, Gahane S (2024). A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus, 16(3): e55996.
18. Dziedzic TA, Bala A, Marchel A (2022). Anatomical aspects of the insula, oper-cula and peri-insular white matter for a transcortical approach to insular glioma resection. Neurosurg Rev, 45:793–806.
19. Bell S, Karamchandani U, Malcolmson K, Moosajee M (2021). Acceptability of Telegenetics for Families with Genetic Eye Diseases. Genes (Basel), 12:276.
20. Molina F, Soulos PR, Brockman A, Old-field BJ (2023). Clinical and Sociodemo-graphic Factors Associated with Tele-medicine Engagement in an Urban Community Health Center Cohort Dur-ing the COVID-19 Pandemic. Telemed J E Health, 29:875–885.
21. Scholarworks S, Dissertations W, Studies D, Moore JS (2024). Strategies to Implement Telemedicine Systems in Health Care Strategies to Implement Telemedicine Systems in Health Care Organizations. In: https://scholarworks.waldenu.edu/dissertations
22. Dorsey ER, Topol EJ (2020). Telemedicine 2020 and the next decade. Lancet, 395:859.
23. Nina L, Yuzkiv H, Yanchytska K, et al (2022). Modern learning models through teacher and student dynamic interaction in HEI towards COVID-19 pandemic condition. Int J Health Sci (Qassim), 6:234–243.
24. Singh V, Sarbadhikari SN, Jacob AG, et al (2022). Challenges in delivering primary care via telemedicine during COVID-19 pandemic in India: A review synthesis using systems approach. J Family Med Prim Care, 11:2581–2588.
25. Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM (2016). The Empirical Evidence for Telemedicine Interven-tions in Mental Disorders. Telemed J E Health, 22:87–113.
26. James SL, Abate D, Abate KH, et al (2018). Global, regional, and national inci-dence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Glob-al Burden of Disease Study 2017. Lancet, 392:1789–1858.
27. Smith AC, Thomas E, Snoswell CL, et al (2020). Telehealth for global emergen-cies: Implications for coronavirus dis-ease 2019 (COVID-19). J Telemed Telecare, 26:309–313.
28. Harindhanavudhi T, Areevut C, Sa-hakitrungruang T, et al (2022). Imple-mentation of diabetes care and educa-tional program via telemedicine in pa-tients with
29. O’Neill L, Brennan L, Sheill G, et al (2023). Moving Forward with Telehealth in Cancer Rehabilitation: Patient Perspec-tives From a Mixed Methods Study. JMIR Cancer, 9:e46077.
30. Fonner VA, Kennedy S, Desai R, et al (2021). Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study. JMIR Form Res, 5:e22513.
31. Chechter M, Dutra da Silva GM, e Costa RAP, et al (2023). Evaluation of Patients Treated by Telemedicine in the Beginning of the COVID-19 Pandemic in São Paulo, Brazil: a non-randomized Clinical Trial Preliminary Study. Heliyon, 9(4):e15337.
32. Kim E, Sung HC, Kaplow K, et al (2024). Donor Perceptions and Preferences of Telemedicine and In-Person Visits for Living Kidney Donor Evaluation. Kidney Int Rep, 9(8):2453–61.
33. Asukile M, Chishimba L, Chomba M, et al (2022). Implementation of a Teleneurology Clinic in Zambia during the COVID ‐19 Pandemic. Ann Neurol, 91(4):445–54.
34. Lawford BJ, Hinman RS, Morello R, et al (2022). Perceptions about the Efficacy and Acceptability of Telephone and video-delivered Allied Healthcare for Adults with Disabilities during the COVID-19 pandemic: a cross-sectional National Survey. Arch Phys Med Rehabil, 103(7):1368-1378.
35. Gren C, Egerod I, Linderoth G, et al (2022). “We Can’t Do without it”: Parent and call-handler Experiences of Video Triage of Children at a Medical Helpline. Mordaunt DA, editor. PLoS One, 17(4):e0266007.
36. Fonner VA, Kennedy S, Desai R, et al (2021). Patient-Provider Text Messaging and Video Calling among Case-Managed Patients Living with HIV: Formative Acceptability and Feasibility Study. JMIR Form Res, 5(5):e22513.
37. Gren C, Asbjoern Boerch Hasselager, Linderoth G, et al (2023). Video Triage of Children with Respiratory Symptoms at a Medical Helpline Is Safe and Feasible–a Prospective Quality Improvement Study. PLoS One, 18(4):e0284557–7.
38. Barca I, Novembre D, Giofrè E, et al (2020). Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic. Int J Environ Res Public Health, 17(20):7365.
39. Bell S, Karamchandani U, Malcolmson K, et al (2021). Acceptability of Telegenetics for Families with Genetic Eye Diseases. Genes (Basel), 12(2):276.
40. O’Neill L, Brennan L, Sheill G, et al (2023). Moving Forward with Telehealth in Cancer Rehabilitation: Patient Perspectives from a Mixed Methods Study. JMIR Cancer, 9:e46077.
41. Lucas CW, Kochs S, Jost J, et al (2024). Digital Participation of Brain Tumour Patients in the Assessment and Treatment of Communication Disorders. Front Psychol, 14:1287747.
42. Peralta E, Taveras M (2020). Effectiveness of Teleconsultation Use in Access to Mental Health Services during the Coronavirus Disease 2019 Pandemic in the Dominican Republic. Indian J Psychiatry, 62(Suppl 3):S492–4.
43. Tuot DS, Mukherjee A, Churape A, et al (2024). Lessons from the Field from a Volunteer Telehealth Ambassador Program to Enhance Video Visits among Low-Income Patients: Qualitative Improvement Study. JMIR Form Res, 8:e49993.
44. Pinyopornpanish K, Nantsupawat N, Buawangpong N, et al (2022). Concerns of Home Isolating COVID-19 Patients While Receiving Care via Telemedicine during the Pandemic in the Northern Thailand: a Qualitative Study on Text Messaging. Int J Environ Res Public Health, 19(11):6591.
45. John O, Gummidi B, Jha V (2020). Continuum of Care for non-communicable Diseases during COVID-19 Pandemic in Rural India: a Mixed Methods Study. J Family Med Prim Care, 9(12):6012–7.
46. Saywell NL, Mudge S, Kayes NM, et al (2023). A six-month Telerehabilitation Programme Delivered via Readily Accessible Technology Is Acceptable to People following stroke: a Qualitative Study. Physiotherapy, 120:1–9.
47. Chu JN, Kaplan C, Lee JS, et al(2022). Increasing Telehealth Access to Care for Older Adults during the COVID-19 Pandemic at an Academic Medical Center: Video Visits for Elders Project (VVEP). Jt Comm J Qual Patient Saf, 48(3):173–9.
48. Bhadola S, Tang C, Marks A, et al (2022). Disparate Healthcare Access and telehealth-based Hybrid Consultations during the COVID-19 Pandemic. Work, 73(2):377–82.
49. Solans O, Vidal-Alaball J, Cabo PR, et al (2021). Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res, 23(5):e28629.
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| Issue | Vol 54 No 10 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20136 | |
| Keywords | ||
| Telemedicine Accessibility Message Video call | ||
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How to Cite
1.
Thoriq M, Rachmadina W, Swannjo J, Farhany F, Kus A, Rachmanto A, Sulistiawati . Trade-offs Between Accessibility and Practicality in Global Telemedicine: A Systematic Review. Iran J Public Health. 2025;54(10):2173-2189.
