Barriers to use of remote monitoring technologies (RMT) used to support COVID-19 patients: A rapid review.

BACKGROUND The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of Remote Monitoring Technologies (RMTs) in healthcare delivery. It is important to demonstrate how these technologies were implemented during early stages of this pandemic to identify the application and barriers to adoption, particularly among vulnerable populations. OBJECTIVE The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to COVID-19 patients and identify perceived benefits and barriers for their use. The review placed a special emphasis on health equity considerations. METHODS A rapid review of published research was conducted using Embase, Medline and QxMD for records published from inception of COVID-19 from December 2019 to July 6th, 2020. Synthesis involved content analysis of reported benefits and barriers to the use of RMTs when delivering healthcare to patients with COVID-19, in addition to health-equity considerations. RESULTS Of 491 records identified, 48 publications were included in this review that described 35 distinct RMTs. RMTs included use of existing technologies (e.g., video conferencing) and development of new ones that have COVID-specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, were mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (e.g. for hospitals, healthcare practitioners) (28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (e.g., affordability of technology for users, poor internet connectivity, poor health literacy) (n=16), the need for quality 'best practice' guidelines for use of RMTs in clinical care (n=12) and the need for additional resources to develop and support new technologies (n=11). Twenty-three of 48 records commented on equity characteristics that stratify health opportunities and outcomes including general characteristics that vary over time (e.g., age, comorbidities, etc.) (n=17), place of residence (n=11), and socioeconomic status (n=7). CONCLUSIONS Results of the present rapid review highlight the breadth of RMTs being utilised to monitor and inform treatment of COVID-19, the potential benefits of utilising these technologies and existing barriers to their use. Results can be used to prioritise further efforts in implementation of RMTs. For instance, developing 'best practice' guidelines for use of RMTs and generating strategies to improve equitable access for marginalised populations. CLINICALTRIAL