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Telemedicine has a long history; however, its efficacy has been reported with mixed reviews. Studies have reported a wide range of quality implications when using the telemedicine modality of care.
This study aimed to analyze the effectiveness of telemedicine through 6 domains of quality through an analysis of randomized controlled trials (RCTs) published in the literature published, to date, in 2022.
A total of 4 databases were searched using a standard Boolean string. The 882,420 results were reduced to 33 for analysis through filtering and randomization. The systematic literature review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; 2020).
The Cohen κ statistic was calculated to show agreement between the reviewers (Cohen κ=0.90, strong). Medical outcomes associated with the telemedicine modality were 100% effective with a weighted average effect size of 0.21 (small effect). Many medical outcomes were positive but not statistically better than treatment as usual. RCTs have reported positive outcomes for physical and mental health, medical engagement, behavior change, increased quality of life, increased self-efficacy, increased social support, and reduced costs. All 6 domains of quality were identified in the RCTs and 4 were identified in 100% of the studies. Telemedicine is highly patient-centered because it meets digital preferences, is convenient, avoids stigma, and enables education at one’s own pace. A few barriers exist to its wide adoption, such as staff training and cost, and it may not be the preferred modality for all.
The effectiveness of telemedicine is equal to or greater than that of traditional care across a wide spectrum of services studied in this systematic literature review. Providers should feel comfortable offering this modality of care as a standard option to patients where it makes sense to do so. Although barriers exist for wide adoption, the facilitators are all patient facing.
PROSPERO CRD42022343478; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343478
The World Health Organization defines telemedicine and telehealth as healing at a distance through the use of information communication technologies to improve health outcomes [
There is no exaggeration to correlate advances in technology with advances in telemedicine. Over the last century, technological advances have connected the world in ways never before thought possible. Once technology enabled communication at a distance, it enabled healing at a distance. The telegraph has even been named the “Victorian Internet” by scholars and was used during the American Civil War to send reports about wounded soldiers to medical teams [
The COVID-19 pandemic continues to teach the medical community many lessons, but one important lesson is that the modality of telemedicine is possible across a spectrum of services [
Health care quality is a broad but measurable concept. In 1999, the Institute of Medicine defined 6 domains of quality: safe, effective, patient-centered, timely, efficient, and equitable [
Telemedicine and its quality have been examined from a specialty point of view, but there has not been a comprehensive look across specialties. Telemedicine has been studied for its quality implications in diabetes [
A systematic review was published in 2020 that examined telemedicine use across multiple service lines in the United States [
A systematic review published in 2022 examined the effect of telemedicine on the quality of care in patients with hypertension and diabetes [
The purpose of this review was to analyze the effectiveness of telemedicine on quality of care across a spectrum of specialties around the world in studies published over the last year, to date, in academic, peer-reviewed journals, using a randomized controlled trial (RCT) or true experiment as the methodology.
The eligibility criteria for this review were as follows: human participants, published in 2022, published in a peer-reviewed journal, and RCTs, but not reviews. Other systematic reviews were excluded because they had already analyzed studies that could also be included in our review. Their exclusion helped to avoid confounding the results. All reports were in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 [
The information sources were PubMed (MEDLINE), CINAHL, Web of Science, and ScienceDirect. The databases were searched on September 19, 2022. These databases were chosen because they were readily available to health care researchers and enabled other researchers to duplicate this study. To eliminate duplicates, MEDLINE was excluded from all databases except PubMed.
A Boolean search string was assembled from the keywords provided by the Medical Subject Headings of the United States. Library of Medicine: (tele* OR mhealth) AND (quality OR safe* OR effective* OR timeliness OR “patient centered” OR equitable). The same search string was used for all databases that allowed wildcards. Where wildcards were not allowed, the following search string was used: (telemedicine OR mhealth) AND (quality OR safe OR effective OR timeliness OR “patient centered” OR equitable). Similar filter strategies were used in all databases, because not all databases offered the same filtering tools.
Following the Kruse protocol, we searched for key terms in all databases, filtered the results, and screened abstracts for applicability [
A standardized Excel spreadsheet from the Kruse protocol was used as a data extraction tool to collect additional data at each step of the process [
We collected the following fields of data for each step: Google Scholar search (date of publication, authors, study title, journal, impact factor from Journal Citations Reports, study design, key terms, experimental intervention, results, and comments from each reviewer); filter articles step (the number of results before and after each filter was applied in all 4 databases); abstract screening step (database source, date of publication, authors, study title, journal, screening decision for each reviewer, notes about rejections, consensus meeting one, determination of screening decision, and a set of rejection criteria); analysis step (database source, date of publication, authors, study title, participants, experimental intervention, results compared with a control group, medical outcomes, study design, sample size, bias effect size, country of origin, statistics used, the strength and quality of evidence patient satisfaction, facilitators to adoption, barriers to adoption, and domains of quality). All but the last 4 data items were standard fields on the standardized Microsoft Excel spreadsheet, whereas the last 4 items were specific to the research objective [
During the data extraction process, reviewers noted individual cases of bias such as sample bias. We combined individual cases of bias with the quality assessment of each study using the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) tool [
Our preferred measure of effect was the Cohen
Reviewers performed a thematic analysis to help make sense of the extracted data [
We tabulated the effect sizes during data extraction. Certainty assessments were performed by considering both the narrative analysis and effect size. We calculated the frequency of occurrence of each theme and reported these frequencies in affinity matrices. Frequency reporting provided confidence in the analyzed data.
Identification of studies via databases and registries. WoS: Web of Science.
Following the PRISMA checklist and the Kruse protocol for each study, we extracted the data fields for a Participants, Intervention, Comparison (with the control), Outcome (medical), Study Design table: participants, intervention, comparison (with control or other group), observation, and study design (
PICOSa.
Authors | Participants | Experimental intervention (as opposed to traditional care) | Results (compared with control group) | Medical outcomes reported (plainly stated) | Study design |
Bao et al [ |
Adults aged 18-60 years treated for TBb in clinic; 57.1% male; 100% Chinese | mHealthc (WeChat) for pulmonary TB self-management | Increase in self-care management behaviors (self-efficacy; |
Increase in self-efficacy, TB knowledge, social support, and degree of satisfaction with health knowledge | RCTd |
Bendtsen et al [ |
Adults; average age, 45 years; 58% female | mHealth app for self-reporting of alcohol consumption | Decreased drinking ( |
Decreased drinking and changed behavior | RCT |
Bhandari et al [ |
Adults with hypertension; average age 50.5 (SD 9.21) years; 44.5% female | mHealth SMS (TEXT4BP) to improve blood pressure | Decreased diastolic BPe ( |
Decreased BP, increased therapy compliance, increased medication adherence, increase in hypertension knowledge | RCT |
Catuara-Solarz et al [ |
Adults with high levels of perceived stress; average age 39.9 (SD 6.11) years; 54% male | mHealth app for mental health | Decrease in anxiety ( |
Decreased anxiety, increased resilience, increased sleep, increased mental well-being, and decreased stress | RCT |
Choi et al [ |
Young adult males; average age 21.67 (SD 1.81) years; 74.2% White | Digital HIV intervention (myDex) | Increase in education ( |
Increase in education, decrease in loneliness, decrease in web-based discrimination, decreased dangerous sexual behavior but not significantly | RCT |
Dalli et al [ |
Adults with acute coronary syndrome; average age 56, (SD 9.4) years; 91.5% male | Cardiac telerehabilitation | Increased mean VO2maxf ( |
Increased VO2max, decrease in apoB/apoA-I, and increase in physical activity | RCT |
do Amaral et al [ |
Adults going through smoking cessation; average age 45.7 (SD 12.8) years; 65% female | mHealth SMS for smoking cessation | Costs were lower ( |
Decreased smoking (continuous abstinence) | RCT |
Fernandez et al [ |
Adults calling the 2-1-1 call center for cancer-control and other needs; average age 45.5 (SD 12.4) years; 93.5% female; 43.8% Black | Telephone navigation service | Intervention resulted in greater completion of needed service ( |
Greater completion rates, more Papanicolaou tests, greater smoking cessation, completed mammograms, colorectal cancer screening and HPVh vaccinations | RCT |
Guillaumier et al [ |
Adult person who has had a stroke; average age 67.5 (SD 12) years; 65% male | eHealth app (Prevent 2nd Stroke, P2S) | QoLi significantly higher for intervention ( |
Increased QoL, increased self-efficacy, and increased usual activities | RCT |
Gustafson et al [ |
Adults aged >65 years; average age 76.5 (SD 7.4) years; 74% female; 89% White | eHealth app (ElderTree) | Improved depression (ORj –0.20; |
Decreased depression, increased mental health, and increased QoL | RCT |
Huggins et al [ |
Older adults recovering from cancer; average age 63.2 (SD 9.9) years; 62% male | Telephone or electronic nutrition counseling | No statistical difference in QALYsk than treatment as usual | Increased QALYs | RCT |
Itoh et al [ |
Adults; average age 47.4 (SD 11.3) years; 56.3% male | mHealth app for patient education and strengthening exercise therapy | Intervention group reported less back pain ( |
Less back pain, improved QoL, and less fear of movement | RCT |
Jamali et al [ |
Children with autism spectrum disorder aged 4-12 years; average age 8.28 (SD 2.57) years; and their parents aged >18 years; average age 37.48 (SD 5.36) years; mostly male | WhatsApp coaching intervention | Intervention group shows greater improvement in occupational performance, specified goals, and behavioral problems | Improved occupational performance, improved specified goals, and improved behavioral problems | RCT |
Leong et al [ |
Older adults; average age 58.6 (SD 44.6) years; 68.5% male | Social media–delivered patient education | Change in HbA1cl not significant, intervention group showed positive improvements in attitudes ( |
Improve HbA1c, increase in self-efficacy, and increase in attitude | RCT |
María Gómez et al [ |
Adults with type 2 diabetes; average age 59.6 (SD 11.7) years; 54.6% male | mHealth app (DM2) | Lower HbA1c levels in intervention group, decreased incidence of hypoglycemia 3.00 mmol/L and severe hypoglycemia | Decreased HbA1c, decreased incidence of hypoglycemia and severe hypoglycemia | RCT |
Mathiasen et al [ |
Adults; average age 35 (SD 14.1) years; aged 18-71 years; 74% female | Internet-based CBTm | Therapy compliance not as statistically high as TAUn, decreases in depression not as statistically much as TAU | Maintained therapy compliance and decreased symptoms of depression comparable with treatment as usual | RCT |
Molavynejad et al [ |
Adults with type 2 diabetes; average age 47.37 (SD 7.07) years; 50.4% male | Video telecare education | Mean changes of patients’ weight, glycemic parameters, and lipid profiles decreased more in the 2 educational groups than the control group | Lost weight, lower glycemic parameters, and lower lipid profiles | RCT |
Morcillo-Muñoz et al [ |
Adults with chronic pain; average age 54.8 (SD 10.7) years; 80% female | Web-based psychosocial chronic pain therapy | Intervention group showed lower catastrophizing ( |
Improved catastrophizing, helplessness, rumination, acceptance, and QoL; improvements were also noted in magnification and satisfaction, but these were not statistically significant | RCT |
Muschol et al [ |
Adults undergoing follow-up for orthopedic and trauma surgery | Telephone video consultations | The participants from the intervention group reported higher satisfaction, but it was not statistically significant ( |
Improved satisfaction | RCT |
Nagamitsu et al [ |
Adolescents aged 13-18 years | iCBTo | Intervention group reported reduced scores for depressive symptoms and suicide ideation, increase in health promotion, and improved self-monitoring skills to reduce depressive symptoms | Improved depression, less suicide ideation, and more self-efficacy and health promotion | RCT |
Ni et al [ |
Adults with coronary heart disease; average age 61 (SD 11) years; 80.1% male | mHealth (WeChat and Message Express) to improve medication adherence | Intervention group showed increase in medication adherence and decrease in systolic BP | Increased medication adherence and decrease in BP | RCT |
Pires et al [ |
Adults with type 2 diabetes; average age 43 (SD 8.3) years; 55% female | mHealth app for diabetes management | Intervention group decreased the prevalence of T2DMp and intermediate hyperglycemia | Improved symptoms of T2DM | RCT |
Pischke et al [ |
Older adults aged ≥60 and 65-75 years; average age 68.7 years; majority female | eHealth physical activity intervention | Intervention showed increased MVPAq | Increased activity | RCT |
Roddy et al [ |
Adults with type 2 diabetes; average age 56 (SD 9.5) years; 54% female | mHealth (FAMSr) for glycemic control | Family involvement helped decrease HbA1c | Decreased HbA1c | RCT |
Sahin et al [ |
Adults aged ≥60 years who recently underwent knee replacement; average age 66.8 years; | Telerehabilitation for patient with knee replacements | Intervention group demonstrated improvements in movement on the BIs ( |
Improved physical function of knee | RCT |
Sarker et al [ |
Adults aged >18 years with CKDt |
mHealth disease education | Intervention group demonstrated lower diastolic BP, lower BMI, and lower salt intake | Improved diet, decreased BMI, reduced BP | RCT |
Seib et al [ |
Adults with breast, blood, and gynecologic cancer; average age 52.6 (SD 9.4) years; 100% female; 95% breast cancer | eHealth cancer intervention | Intervention group demonstrated improved general health, bodily pain, vitality, and global physical and mental health scores | Improved physical and mental health, decreased pain, increased vitality | RCT |
Skvortsova et al [ |
Adults aged≥18 years; average age 24 (SD 6.79) years | mHealth physical activity intervention | Intervention participants increased daily step count ( |
Increased activity | RCT |
Stephenson et al [ |
Adult males with HIV; average age 30.4 years; 75% White; 100% male (as assigned at birth) | Telehealth couples counseling and testing | Couples in the intervention group reported safer sexual agreements ( |
Decreased interpersonal problems | RCT |
Thesen et al [ |
Adults with noncardiac chest pain; average age 52 years; 54% female | iCBT | Intervention group demonstrated improvements in cardiac anxiety ( |
Improvement in cardiac anxiety, increased health-related QoL, increased physical activity, improved depression | RCT |
Xia et al [ |
Adults with type 2 diabetes; 63.5% male | WeChat+T2DM (TangPlan) to support patients with type 2 diabetes | The intervention group demonstrated improved fasting blood glucose, FBGu ( |
Improved FBG, HbA1c, weight, systolic and diastolic BP, serum low-density lipoprotein cholesterol, and cholesterol mean | RCT |
Zeng et al [ |
Adults with HIV; 92.3% male (as assigned at birth); 100% Chinese; average age 27.5 years | mHealth WeChat app (Run4Love) | Increased QoL through positive coping ( |
Increased QoL | RCT |
Zhang et al [ |
Adults recovering from cancer; average age 57.6 (SD 12.6) years; 75% male | mHealth questionnaires with follow-up | Intervention group showed fewer irAEsv ( |
Fewer irAEs, fewer ED visits, better treatment engagement, higher QoL, better follow-up | RCT |
aPICOS: Participants, Intervention, Comparison (to control), Outcome (medical), Study Design.
bTB: tuberculosis.
cmHealth: mobile health.
dRCT: randomized controlled trial.
eBP: blood pressure.
fVO2max: maximum oxygen consumption.
gapoB/apoA-I: comparison of bad cholesterol with good cholesterol.
hHPV: human papillomavirus.
iQoL: quality of life.
jOR: odds ratio.
kQALY: quality-adjusted life year.
lHbA1c: average blood sugar over last 3 months.
mCBT: cognitive behavioral therapy.
nTAU: treatment as usual.
oiCBT: internet-based, cognitive behavioral therapy.
pT2DM: type 2 diabetes mellitus.
qMVPA: moderate to vigorous physical activity.
rFAMS: family-focused add-on to motivate self-care.
sBI: Barthal index.
tCKD: chronic kidney disease.
uFBG: fasting blood glucose.
virAE: immune-related adverse event.
wED: emergency department.
The JHNEBP quality assessment tool identified 100% (33/33) of the studies as level I and level A because all but RCTs were screened out. The JHNEBP tool assessed the strength of evidence as levels I to V: I is an RCT or experiment; II is quasi-experimental; III is qualitative or observational; and IV and V are opinion articles. The JHNEBP tool assessed the quality of evidence as A-C: A was defined by consistent results with adequate sample and control sizes (based on a power analysis), definitive conclusions, and consistent recommendations based on extensive literature reviews. Level B was defined by reasonably consistent results, adequate sample and control sizes, definitive conclusions, and recommendations. Level C was defined by little evidence with inconsistent results, insufficient sample sizes, and nondefinitive conclusions.
Reviewers also noted instances of bias, such as sample and selection bias, because these affect external and internal validity, respectively. There were 33 instances of selection bias and 32 of sample bias. Selection bias was identified when samples were taken from one locality, city, or country. Selection bias was identified when the sample comprised a majority of one sex or race.
Summary of analysis, sorted chronologically.
Authors | Intervention themes | Result theme | Outcome theme | Satisfaction theme | Facilitator theme | Barrier theme | Domain of quality theme |
Bao et al [ |
mHealtha |
Increase in self-efficacy Improved medical engagement Increase in social support |
Increase in self-efficacy Improved medical engagement Increase in social support |
Satisfied |
Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace Effective |
Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Patient-centered—Respect autonomy |
Bendtsen et al [ |
mHealth |
Changed behavior |
Changed behavior |
Satisfied |
Patients value technology Convenience Savings in time and mileage Meets a digital preference Meets a digital preference Avoids stigma Effective |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Bhandari et al [ |
mHealth |
Increase in physical health Increase in physical health Improved medical engagement Improved medical engagement Improved medical engagement Improved medical engagement |
Increase in physical health Improved medical engagement Improved medical engagement Improved medical engagement |
Satisfied |
Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace Effective |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Catuara-Solarz et al [ |
mHealth |
Increase in mental health Increase in mental health Increased QoLb Increase in mental health Increase in mental health |
Increase in mental health Increase in mental health Increased QoL Increase in mental health Increase in mental health |
Satisfied |
Effective Patients value technology Savings in time and mileage Meets a digital preference |
Cost Staff training |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Choi et al [ |
eHealth |
Improved medical engagement Increase in mental health Increase in social support Changed behavior |
Improved medical engagement Increase in mental health Increase in social support Changed behavior |
Satisfied |
Effective Convenience Meets a digital preference Avoids stigma |
Staff training Low reimbursement Cost May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Efficient—lean Effective—Evidence-based Patient-centered—Respect autonomy Equitable—No variance based on personal characteristics |
Dalli et al [ |
Telehealth |
Increase in physical health Increase in physical health Changed behavior |
Increase in physical health Increase in physical health Changed behavior |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
do Amaral et al [ |
mHealth |
Reduced costs Changed behavior |
Changed behavior |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Fernandez et al [ |
Telephone |
Improved medical engagement Increase in self-efficacy Increase in self-efficacy |
Improved medical engagement Increase in self-efficacy Increase in self-efficacy |
Satisfied |
Effective Patients value personal guidance Convenience |
Cost Low reimbursement |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Guillaumier et al [ |
eHealth |
Increased QoL Increase in self-efficacy Improved medical engagement |
Increased QoL Increase in self-efficacy Improved medical engagement |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Gustafson et al [ |
eHealth |
Increase in mental health Increased QoL |
Increase in mental health Increased QoL |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
May not be preferred modality Staff training Low reimbursement Cost |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Huggins et al [ |
Telephone | Increased QALYsc | Increased QALYs | Not satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace |
May not be preferred modality Staff training |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Equitable—No variance based on personal characteristics Patient-centered—Respect autonomy |
Itoh et al [ |
mHealth |
Increase in physical health Increased QoL Increase in mental health |
Increase in physical health Increased QoL Increase in mental health |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace |
May not be preferred modality Staff training Cost |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Jamali et al [ |
mHealth |
Increase in physical health Improved medical engagement Increased QoL |
Increase in physical health Improved medical engagement Increased QoL |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
May not be preferred modality Staff training Cost |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Leong et al [ |
mHealth |
Increase in physical health Increase in self-efficacy Increased QoL |
Increase in physical health Increase in self-efficacy Increased QoL |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
May not be preferred modality Staff training Cost |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
María Gómez et al [ |
mHealth |
Increase in physical health Increase in physical health Increase in physical health |
Increase in physical health Increase in physical health Increase in physical health |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
May not be preferred modality Staff training Cost |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Mathiasen et al [ |
eHealth |
Improved medical engagement Increase in mental health |
Improved medical engagement Increase in mental health |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
May not be preferred modality Staff training |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Molavynejad et al [ |
eHealth |
Increase in physical health |
Increase in physical health |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace |
May not be preferred modality Staff training |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Morcillo-Muñoz et al [ |
eHealth |
Increase in mental health Increased QoL |
Increase in mental health Increased QoL |
Not satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Muschol et al [ |
Telephone |
Improved medical engagement |
Improved medical engagement |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Nagamitsu et al [ |
eHealth |
Increase in mental health Increase in physical health Increase in self-efficacy |
Increase in mental health Increase in physical health Increase in self-efficacy |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Ni et al [ |
mHealth |
Improved medical engagement Increase in physical health |
Improved medical engagement Increase in physical health |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Pires et al [ |
mHealth |
Increase in physical health |
Increase in physical health |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Pischke et al [ |
eHealth |
Changed behavior |
Changed behavior |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Roddy et al [ |
mHealth |
Increase in physical health |
Increase in physical health |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Sahin et al [ |
Telehealth |
Increase in physical health |
Increase in physical health |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Sarker et al [ |
mHealth |
Increase in physical health Changed behavior |
Changed behavior Increase in physical health |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference Education at own pace |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Seib et al [ |
eHealth |
Increase in physical health Increase in physical health Increased QoL Increase in mental health |
Increase in physical health Increase in physical health Increased QoL Increase in mental health |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Skvortsova et al [ |
mHealth |
Increase in physical health Changed behavior |
Increase in physical health Changed behavior |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Stephenson et al [ |
Telehealth |
Changed behavior Increased QoL |
Increased QoL Changed behavior |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Thesen et al [ |
eHealth |
Increase in physical health Increase in mental health Increased QoL |
Increase in physical health Increase in mental health Increased QoL |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Xia et al [ |
mHealth |
Increase in physical health Changed behavior |
Increase in physical health Changed behavior |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Zeng et al [ |
mHealth |
Increased QoL Changed behavior |
Increased QoL Changed behavior |
Satisfied |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
Zhang et al [ |
mHealth |
Fewer irAEsd Changed behavior Improved medical engagement Increased QoL Improved medical engagement |
Fewer irAEs Changed behavior Improved medical engagement Increased QoL Improved medical engagement |
Not reported |
Effective Patients value technology Convenience Savings in time and mileage Meets a digital preference |
Cost Staff training May not be preferred modality |
Safe—Avoiding harm Timely—Reduce wait times Effective—Evidence-based Efficient—lean Patient-centered—Respect autonomy |
amHealth: mobile health.
bQoL: quality of health.
cQALY: quality-adjusted life year.
dirAE: immune-related adverse event.
Thematic analysis was performed to help make sense of the data collected. Themes and individual observations that did not fit the themes were tabulated. The mean sample size was 351.7 (SD 501.1). A total of 11 studies reported the effect sizes [
Results of telemedicine and quality.
Results themes | Frequency (n=92) |
Increase in physical healtha [ |
31 |
Increase in mental healtha [ |
16 |
Improved medical engagementa [ |
12 |
Changed behaviora [ |
11 |
Increased QoLb [ |
11 |
Increase in self-efficacy [ |
6 |
Increase in social support [ |
2 |
Fewer irAEsc [ |
1 |
Increased QALYsd [ |
1 |
Reduced costs [ |
1 |
aMultiple occurrences were observed in one study.
bQoL: quality of life.
cirAE: immune-related adverse event.
dQALY: quality-adjusted life year.
Medical outcomes of telemedicine and quality.
Outcome themes | Frequency (n=86) |
Increase in physical healtha [ |
29 |
Increase in mental healtha [ |
16 |
Improved medical engagementa [ |
11 |
Increased QoLa,b [ |
11 |
Changed behavior [ |
10 |
Increase in self-efficacy [ |
6 |
Increase in social support [ |
2 |
Fewer irAEsc [ |
1 |
Increased QALYsd [ |
1 |
aMultiple occurrences were observed in one study.
bQoL: quality of life.
cirAE: immune-related adverse event.
dQALY: quality-adjusted life year.
A total of 24 studies reported on satisfaction. Of the 33 studies, 22 (67%) reported satisfaction or high satisfaction [
Facilitators to the adoption of telemedicine and quality implications.
Facilitator themes | Frequency (n=166) |
Effective [ |
33 |
Meets a digital preference [ |
32 |
Convenience [ |
31 |
Patients value technology [ |
30 |
Savings in time and mileage [ |
30 |
Education at own pace [ |
7 |
Avoids stigma [ |
2 |
Patients value personal guidance [ |
1 |
Facilitators to the adoption of telemedicine and quality implications.
Barrier themes | Frequency (n=93) |
Staff training [ |
31 |
May not be preferred modality [ |
30 |
Cost [ |
29 |
Low reimbursement [ |
3 |
Domains of quality incident to the adoption of telemedicine.
Quality themes | Frequency (n=166) |
Safe—Avoiding harm [ |
33 |
Effective—Evidence-based [ |
33 |
Patient-centered—Respect autonomy [ |
33 |
Timely—Reduced wait times [ |
33 |
Efficient—lean [ |
32 |
Equitable—No variance based on personal characteristics [ |
2 |
Commensurate with the objective statement, this systematic literature review analyzed 33 RCT studies from 16 countries published in 2022, to date, to analyze the effectiveness (weighted average effect size 0.21, small) of telemedicine through the lens of 6 domains of quality. All these 33 studies reported the positive effectiveness of telemedicine as a modality across all 6 domains of quality. These studies showed positive outcomes in physical [
Patient engagement is important because it plays a central role in patient safety, chronic disease self-management, adverse event reporting, and medical record accuracy [
Telemedicine was effective for patients. Studies reviewed in this study mentioned that it is effective [
There are several barriers to telemedicine adoption. Staff must be trained in delivering care through telemedicine to ensure that quality does not decline [
Of the 6 domains of quality, 4 (67%) were identified in all of the analyzed studies: safe, effective, patient-centered, and timely. Efficiency was only mentioned in 97% (32/33) of studies and equitable in only 6% (2/33) of studies. This is largely owing to the technology gap that occurs along socioeconomic lines. This disparity has been identified in other literature [
Future research should expand some of these RCTs to help firmly establish telemedicine as an acceptable modality of care. This systematic literature review analyzed only 33 studies, but these studies focused on a wide range of specialties: tuberculosis, hypertension, alcohol consumption, mental health, HIV management, heart disease, smoking cessation, preventive medicine, stroke rehabilitation, nutrition, pain management, autism behavior management, diabetes management, Alzheimer disease, activity management, telerehabilitation for physical activity, and cancer recovery. Further research could expand on these specialties to identify where telemedicine is not an acceptable modality of care. After a family of systematic reviews was published, a review of these reviews summarized the effectiveness of telemedicine across all aspects of care.
This study has both practical and policy implications. Health care administrators should be confident in the investment of technology infrastructure to support the modality of telemedicine. The pandemic introduced transformational telehealth adoption, and restrictive regulations on modality were lifted [
This systematic literature review queried 4 research databases to control for sample bias. Additional research databases can also be queried. We only accepted published peer-reviewed literature to control for validity. Accepting gray literature could have better controlled for publication bias, but it may have introduced questionable internal and external validity. Our team has identified several instances of selection and sample bias. Our assessment was that their effect was small. However, it is possible that these instances could have presented significant challenges to both internal and external validity. To control for design bias, this systematic literature review used a previously published protocol. Other protocols could have been used. This review queried only 10 months of 2022 and only 33 articles were analyzed. Additional years and articles could have yielded more robust results.
Telemedicine serves as an effective modality of care for a wide range of medical services, and its effectiveness has been demonstrated across all 6 domains of quality. These interventions have a positive effect on physical and mental health, engagement with the medical community, changed behavior, increased QoL, self-efficacy, and social support. This modality is patient-centered because it puts the patient’s schedule before the providers, saves time and mileage, avoids the stigma of care associated with some clinics, and patients often prefer it. The results of this systematic review should enable providers to adopt telemedicine as a standard option of care for patients. Studies with robust designs have shown telemedicine to be an effective modality of care, and it falls within the preference of many patients. Administrators should be confident in investing in technology to enable this modality of care. Policy makers should focus on removing the barriers to adoption.
Observation-to-theme conversion: intervention, results, medical outcomes.
Observation-to-theme conversion: patient satisfaction, facilitators, barriers, domains of quality.
Other observations incident to review.
Johns Hopkins Nursing Evidence-Based Practice
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
quality of life
randomized controlled trial
Data from this study can be obtained by asking the lead author.
All authors contributed equally to this study. CSK was the lead author and editor. His protocol guided the design, structure, and conduct of this review. All authors participated in the abstract screening and data extraction. All authors reviewed and approved the final version of the manuscript for publication.
None declared.