Impoverished Countries Had Less Capacity to Implement Telehealth During COVID-19

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 India, where only 2.67% of neurologists and neurosurgeons live in rural communities covering a population of 84.59 million, telemedicine partially resolved the acute manpower shortage
• In the Canadian Arctic Archipelago (Nunavut Territory), telehealth is estimated to have reduced travel costs by 50% for patients and health care providers
• In Nepal, telehealth services addressed such issues as remoteness and extreme conditions

In addition, the rapid expansion of telehealth during the pandemic era introduced challenges inherently unique to each country, the findings showed:  

• In rural Bangladesh, barriers to telehealth adoption included lack of organizational effectiveness, health staff motivation, patient satisfaction, and trustworthiness
• In the United Kingdom, there were no uniform guidelines for telehealth implementation
• In Singapore, system vulnerabilities could lead to inappropriate access to patient information, medical device dysfunction, or breakdown of provided health services
• In Thailand, telehealth services were limited to fundamental medical consultation services
• In North America, implementation challenges included variations in state licensing requirements for telehealth, disparities in access to telehealth among disadvantaged populations, and lack of consistency among investigational review boards on telehealth studies
• In Pakistan, the lack of government and stakeholder support and of logistical and clinical procedures impeded mass adoption of telehealth services

However, telehealth interventions also led to important health benefits, the authors noted:  

• In Mozambique, 69% of respondents were willing to use teleconsultation public health services for mild illness and review consultations
• In LMICs, the use of telehealth to manage hypertension saw a significant reduction in blood pressure in patients who were hypertensive
• Australia implemented a remote radiology assessment model to address inadequate access to a local radiological workforce in regional Australia
• In one study in Indonesia, 69% of patients indicated that telehealth allowed for quicker diagnosis and treatment.

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.”

Reference

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