Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: A Systematic Review (Preprint)

BACKGROUND Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled rapid adoption of telemedicine around the world. What were the effects of this rapid adoption? Are barriers the same today after the rapid adoption compared to pre-pandemic conditions? OBJECTIVE Objective: The objective of this systematic literature review was to examine research literature published during the pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine to determine if changes have occurred in the industry. METHODS Methods: Conducting the review in accordance with the Kruse Protocol and reporting the results in accordance with PRISMA, we analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. RESULTS Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, 14 results (compared to a control group) themes and observations. Twenty-two percent of the articles analyzed reported strongly satisfied or satisfied (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant results from the control group, and 40% and 10% reported an improvement in, or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. CONCLUSIONS Conclusion: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges previous research have identified. Several barriers still exist for health policy makers to address, but healthcare administrators can feel confident in the modality as the evidence shows it is safe, effective, and widely accepted. CLINICALTRIAL This systematic review was registered in PROSPERO on 2/8/2021: ID CRD42021235933.