The COVID-19 Pandemic and the Future of Telemedicine

Annex D. Overview tables of the literature review

Table D.1. Overview of included papers with results on user satisfaction with telemedicine

Author	Design	OECD Country(s)	Primary studies (if applicable)	Setting	Patients/Clinicians	Description of study	Intervention	Comparator	Relevant findings and conclusions
Aiken et al. 2021	Cohort study	United Kingdom		3 largest abortion providers in England	54 142 patients who accessed an early medical abortion	Comparison of outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine	Additional dose of misoprostol provided via telemedicine	Additional dose of misoprostol provided via in-person clinic visit	Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine See Table D.2 for patient safety results
Al-Arkee et al. 2021	Systematic review and meta‑analysis	Austria, Sweden, United States	16	Multiple	Patients with cardiovascular disease (CVD)	A systematic review and meta‑analysis of RCTs on mobile apps to improve medication adherence	App in conjunction with a package of participant support	App alone	One study used a validated System Usability Scale to demonstrate greater usability in the app intervention arm than in the control arm (intervention: mean 87.3, SD 13.9 vs control: mean 78.1, SD 18.9; P =.001) Three trials evaluated app usability with non-validated questionnaires and obtained positive feedback from 80% or more of the participants Patients with stroke rated the app extremely good as a medication management tool and as means to improve physician-patient rapport Patients with atrial fibrillation felt that the study app was user-friendly and helpful with additional positive feedback from physicians
Appleton et al. 2021	Systematic review	Multiple	77	Multiple	Staff working within the field of mental health, people receiving organised mental health care for any condition, family members or carers of people receiving mental health care	Investigation of the adoption and impacts of tele‑mental health approaches during the COVID‑19 pandemic, and facilitators and barriers to optimal implementation	Any form of spoken or written communication carried out between mental health professionals and service users/family members/unpaid carers	Any mental health communication delivered face‑to-face, digitally or remotely, waitlist control, or placebo	Remote care was seen as satisfactory by the majority of clinicians and service users in most studies A number of studies also reported that tele‑mental health enabled some groups to access care who found it difficult to engage with face‑to-face support While acceptability was high overall, this was not the case for all groups See Table D.2 for patient safety results
Aquilanti et al. 2020	Systematic review	Australia, France, Germany	13	Multiple	Patients and health practitioners	Assessment of the feasibility of teledentistry in communities or in a domiciliary setting where elderly people live	Teledentistry	None	A high level of acceptability of teledentistry was reported in the majority of the articles included in this review among patients, patients’ families, and caregivers Survey-based studies showed satisfaction among the users because of the increased confidence in residential aged care facilities
Augestad et al. 2020	RCT	Norway		University hospital and 5 medical centres	110 patients with a stoma	Investigation of the QoL of patients with a stoma, followed up in a hospital outpatient setting (controls) or by teleconsultation (intervention)	Teleconsultation (TC)	Hospital outpatient setting	Overall, there were no significant differences in the experience of hospital versus TC consultation (P = 1·000), and most patients in the TC group chose TC over hospital follow-up as their next consultation option (P < 0·001)
Baltaxe et al. 2020	RCT	Spain		1 hospital clinic	67 adult patients with chronic respiratory failure	RCT of a home‑based non-invasive ventilation intervention supported by a mobile health app	Face to face psychologist motivational intervention, followed up by a mobile app that allowed patients to report the number of hours of daily non-invasive ventilation use and problems with the therapy; advice was automatically delivered by the mobile app in case of a reported problem	App use	The patient satisfaction score was –3 (10/33, 31% promoters; 11/33, 34% passives; 11/33, 34% detractors) The 3 Likert-scale questions about the general satisfaction with the app that were rated from 1 (very bad) to 10 (very good) resulted in a mean score of 7.5/10 for the general impression of the app, mean score of 8.2/10 for the user friendliness, and mean score of 8.5/10 for usability of the app without assistance
Banks et al. 2021	Series of cross-sectional surveys	Ireland		2 epilepsy centres	1 180 patients receiving epilepsy care through telemedicine from 23rd Dec 2019 to 23rd Mar 2020 and 21 clinicians providing the care	Exploration of the perceptions of chronic epilepsy management via telephone consultations from a clinician and patient perspective	Telephone consultations	None	Clinicians expressed strong levels of satisfaction, but some doubted the suitability of new patients to the service or candidates for surgery receiving care via telemedicine Patients reported positive experiences surrounding telephone appointments comparing them favourably to face‑to-face encounters The survey showed that telemedicine is seen as an effective and satisfactory method of delivering chronic outpatient care
Barnett et al. 2021	Systematic review	Australia, Canada, Colombia, Denmark, France, Germany, Israel, Japan, Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland the United Kingdom, United States	19	Multiple – Umbrella review	Staff working within the field of mental health, people receiving mental health care or with mental health diagnoses, family members, or carers of people receiving mental health care	Umbrella review of systematic reviews available on the literature and evidence‑based guidance on telemental health, including both qualitative and quantitative literature	Any form of spoken or written communication conducted between mental health professionals and patients, service users, family members, carers, or other mental health professionals using either the internet or the telephone	None	Clinician satisfaction was reported in 5 reviews and patient satisfaction was reported in 7 reviews Overall, clinicians tend to report a preference for face‑to-face interventions for both assessment and treatment. However, some reviews have reported that clinicians find video-based therapies to be acceptable. High patient satisfaction was generally reported and patients tended to find remote interventions as satisfactory as face‑to-face alternatives One review reported a few studies indicating preference for face‑to-face interventions and a review of older people noted that initial scepticism between both service users and providers tended to dissipate following positive experiences of videoconferencing See Table D.2 for patient safety results
Bekkelund et al. 2021	RCT	Norway		1 neurological hospital department	402 headache patients	Examination to determine whether video consultations are noninferior to face‑to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway	Video consultations	Face‑to-face consultations	Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face‑to-face; P =.25)
Berlin et al. 2021	Cohort study	Canada		1 hospital cancer centre	3 507 cancer patients and 284 practitioners	Examination of the outcomes of a cancer centre – wide virtual care programme in response to the COVID‑19 pandemic	Cancer centre – wide virtual care programme (VC)	None	Overall, patients were highly satisfied with VC (1 808 [68%] recommended this care model), independent of VC modality Those undergoing video calls were more likely to consider them better than in-person visits (105 [24%] vs 385 [17%] [telephone]; P = .006) and to request VC for their future appointments (330 [77%] vs 1 478 [66%] [telephone]; P < .001) Overall practitioner satisfaction was comparable to that of patients. However, a higher proportion of physicians thought that VC led to compromises in patient care compared with in-person visits (46 [36%] in quality and 38 [31%] in safety of care vs 401 [15%] of patients for overall comparison); these perceptions improved over time See Table D.4 for use by technology results
Bertini et al. 2022	Systematic review	Australia, Canada, Israel, Italy, Korea, Norway, Spain, Switzerland, United Kingdom, United States	28	Multiple	Patients with gestational diabetes mellitus	Evaluation of the impact of remote monitoring technologies in assisting patients with gestational diabetes mellitus to achieve glycaemic goals	Remote monitoring technologies for patients with gestational diabetes mellitus	None	Multi-platform system with Bluetooth glucometer monitoring improved user satisfaction Many participants appreciated the ease of access (not having to keep a paper diary), ease of use, and convenience of the mobile application In another study, remote glycemia monitoring, although glycaemic control and maternal and neonatal outcomes were similar, women preferred this model of care Patients who used the system based on a mobile app and Bluetooth glucometer monitoring, according to a survey at the end of the study, reflect a high degree of satisfaction See Table D.4 for use by technology results
Bisson et al. 2021	Cross-sectional study	United States		1 university-affiliated orthopaedic practice	2 049 patients of all ages (children and adults) who were seen through in-person or telemedicine	Examination of the association between patient satisfaction and mode of visit (telemedicine versus in-person) and (2) predictors of patient satisfaction in a large orthopaedic practice during the onset of the pandemic	Telemedicine in a large orthopaedic practice	In-person care	No association was found between satisfaction score and mode of visit with and without adjustment for duration of patient-physician relationship, appointment type (new versus follow-up), provider type (physician versus nonphysician), and provider subspecialty (βunadjusted = 0.004 [SE = 0.01], P = 0.44; βadjusted = 0.001 [SE = 0.01], P = 0.92) Predictors of increased satisfaction score were White race (P = 0.001), >1 year relationship with provider (P1‑3 years = 0.01, P3‑5 years = 0.04, and P5+ years = 0.002), physician provider (P = 0.004), and foot/ankle provider (P = 0.04), whereas predictors of decreased PSA score were oncology provider (P = 0.02) and spine provider (P = 0.001)
Bizot et al. 2021	Cross-sectional study	France, Italy		18 hospitals and cancer centres	1 299 breast cancer patients who had at least one teleconsultation during the first wave of the COVID‑19 pandemic	Examination of the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period	Teleconsultation	None	The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 survey and Telemedicine Satisfaction Questionnaire scores, respectively Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score
Blanco Teres et al. 2022	Cross-sectional study	Spain		1 hospital coloproctology unit	115 patients assisted consecutively in the coloproctology unit	Analysis of patient satisfaction with the tele‑assistance given in a Colorectal Surgery Unit	Phone‑tele assistance	None	The average score in each of the survey items was higher than 6 in all the questions but 1. The factors related to greater willingness to tele‑assistance were male gender (37% vs 18.8%; P =.03) and a higher academic preparation level in favour of higher technical studies (35.9%) and university studies (32.4%) opposite to the rest (P =.043) The rest of variables studied, job status, labour regimen, diagnostic group and consultation type did not show any relationship
Bodle et al. 2021	Systematic review	Austria, Australia, Türkiye, United States	13	Multiple	Patients under treatment for acne vulgaris	Evaluation of acne vulgaris in teledermatology and identification of the differences between teledermatological examinations and face‑to-face consultations	Teledermatological examinations	Face‑to-face examinations	In general, patients are mostly positive about online visits The doctors’ satisfaction with the treatment did not vary significantly, regardless of whether teledermatological or conventional treatment was used In contrast to the patients, who can save a lot of time through teledermatological diagnoses and check-ups,13 this aspect hardly plays a role for doctors
Bonnaud et al. 2021	RCT	France		3 public hospitals and 3 private hospitals	54 patients with Crohn’s disease or ulcerative colitis	Comparison of quality of life and disease activity in patients with inflammatory bowel disease monitored using a telemedicine platform versus standard care	Telemedicine platform (MaMICI)	Standard care	Overall satisfaction with the MaMICI platform was high (mean score 7/10), and 46.2% of remaining patients in the MaMICI group continued to use the platform until 12 months
Brown et al. 2021	Systematic review	Australia, Netherlands, United Kingdom, United States	13	Multiple	Not specified	Evaluation of the evidence for telegenetics and its applicability to future service development	Videoconferencing to deliver consultations in any area of clinical genetics	None	Studies evaluating patient satisfaction with genetic counselling via telegenetics (n = 10) reported a high level of satisfaction with all types of counselling Four studies controlled for participant characteristics to examine whether specific factors were associated with satisfaction. One of these found no significant difference in satisfaction between the telegenetics and the in-person groups when controlling for age, marital status, computer anxiety, Internet use, education status, and genetic testing uptake. Conversely, another found that higher education status was associated with a lower satisfaction with the telemedicine service (p = 0.02)
Brown et al. 2022	Cross-sectional study	Australia		1 tertiary-level persistent pain centre	65 patients aged 18 to 85 years with persistent pain lasting more than 12 months	Exploration of patients’ thoughts and satisfaction with using videoconferencing during the COVID‑19 pandemic	Videoconference pain clinic appointment	None	Patient responses indicated that, overall, they were satisfied with the use of videoconferencing for their persistent pain consultations, particularly during the COVID‑19 pandemic with lockdown Convenience of the videoconference service was identified as a subcategory within patient satisfaction Two patients described how they entered a consultation with another patient within the videoconferencing platform, rather than the intended therapist, contradicting the quantitative outcomes of the patient satisfaction survey, where all patients agreed that their privacy was maintained in the videoconferencing appointment
Butler et al. 2022	Systematic review and meta‑analysis	Canada, Netherlands, United States	15	Multiple	1438 children and young people	Identification of the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1‑18 years) living with Juvenile idiopathic arthritis	eHealth and mHealth interventions	None	In one study two paediatric rheumatologists were satisfied with the care they provided for the intervention group (IG) compared with the care they provided for the control group (CG) Parent satisfaction did not differ between the IG and CG
Carrillo de Albornoz et al. 2022	Systematic review	Australia, Canada, Denmark, Japan, Spain, United Kingdom, United States,	11	Multiple	Not specified	Evaluation of the impact of telephone or video consultations compared to those conducted face‑to-face on key patient-relevant outcomes and health care utilisation in primary care, mental health, and allied health services	Telemedicine treatment delivered via telephone or videoconference	The same therapy (as in intervention) delivered face‑to-face	Patient satisfaction with telephone and video consultations and the therapeutic alliance was high across the studies High discontinuation rates in patients receiving teleconsultations indicated this may not be a suitable modality of health care delivery for all patients
Cartwright et al. 2021	Systematic review	Canada, Italy, Mexico, Spain, United Kingdom, United States	15	Multiple	1 334 patients on peritoneal dialysis (PD)	Identification and assessment of ‘active’ eHealth-based interventions to support patients and their caregivers in delivering and managing – PD	eHealth interventions	None	Within all nine studies that reported on patient satisfaction, patients reported they were either satisfied or very satisfied with the eHealth intervention overall Although five of the studies did not report comparison measures of satisfaction, three reported higher satisfaction than a control group and one noted no significant difference compared with pre‑intervention scores
Catalan-Matamoros et al. 2020	RCT	Norway		1 hospital	49 chronic heart patients with a pacemaker	Exploration of the communication experiences in the remote monitoring of older adults with a pacemaker	Remote monitoring (RM)	None	In general, participants reported positive experiences about the RM option Participants also indicated positive experiences about talking to the clinicians from home. No participant showed any dislike of these remote conversations with clinicians The majority of the participants (n = 9.75%) did not prefer to meet the clinicians in person. Two patients (16%) mentioned that they would have preferred to meet the clinicians in person only if their health status decreased or some problems occurred. One participant (8%) mentioned his preference to meet the clinicians sometimes in the hospital for specific questions
Champion et al. 2021	RCT	United States		1 institution	47 patients who underwent in-person and telemedicine postoperative appointments following third molar surgery	Comparison of key aspects of patient satisfaction in patients who underwent in-person and telemedicine postoperative appointments following third molar surgery	telemedicine postoperative appointments	In-person postoperative appointments	The mean total patient satisfaction score (maximum 50) was 46.46 for the in-person group and 48.78 for the telemedicine group; the difference was not statistically significant (P = 0.11) There were no statistically significant differences in patient satisfaction scores between the two groups with regards to the ease of scheduling the appointment, ease of attending the appointment, perceived usefulness of the appointment, or the quality of patient education received at the appointment. Perceived cost-effectiveness was higher for patients in the telemedicine group (P = 0.01)
Chaudhry et al. 2021	Systematic review and meta‑analysis	Canada, Finland Germany, Norway, United States	12	Multiple	Surgeons and 1 008 surgery patients	Investigation of patient and surgeon satisfaction with the use of telemedicine as a tool for orthopaedic care delivery, differences in patient-reported outcomes between telemedicine visits and in-person visits, differences in time commitment between telemedicine and in-person visits?	Telemedicine (any form of remote or virtual care including, but not limited to, video, telephone, or internet-based care)	In-person assessments performed by orthopaedic surgeons	There was no difference in the odds of patient satisfaction between patients receiving telemedicine care and those receiving in-person care (pooled odds ratio 0.89 [95% CI 0.40 to 1.99]; p = 0.79) 92% (537 of 581) of patients were satisfied or more than satisfied after telemedicine visits and 93% (489 of 528) were satisfied after in-person visits There was no difference in the pooled odds of surgeon satisfaction between telemedicine and in-person visits (OR 0.38 [95% CI 0.07 to 2.19]; p = 0.28). 91% (417 of 457) of surgeon responses were rated as good or very good with the use of telemedicine compared with 94% (384 of 408) of responses with the control visits
Cho et al. 2021	Systematic review	Multiple	33	Multiple	7 382 patients with cancer using electronic symptom self-reporting systems (e‑SRS)	Exploration of the acceptance and use of home‑based electronic symptom self-reporting systems (e‑SRS) by patients with cancer and identification of associated facilitators and barriers	Electronic symptom self-reporting systems (e‑SRS) for patients with cancer	None	High e‑SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system See Table D.3 for use by demographic results
Christensen et al. 2020	Systematic review	Australia, Canada, Spain, United States	21	Multiple	Patients’ and providers’ who used video consultations for depression treatment	A systematic review of the existing research literature, focusing on patients’ and providers’ experiences of virtual consultations (VCs) used in the treatment of patients 60+ years with unipolar depression	Videoconferencing by an outpatient tele‑mental health service (VC)	Face‑to-face treatment (FTFT)	High levels of patient and provider satisfaction and acceptability are frequently reported, and there were no significant differences between face‑to-face treatment (FTFT) and the use of video consultations (VCs) in the RCT studies Only two studies found that results favoured FTFT but they were not significant Two intervention studies found that VC groups rated the treatment higher than in-person therapy
Cole et al. 2020	Cross-sectional study	United States		3 wellness centre locations	65 new adult patients enrolling into intensive outpatient programs	Presentation of a novel survey based on an existing framework designed to assess telemedicine‑delivered medications for opioid use disorder (tMOUD) satisfaction, and present pilot data (N = 14) acquired from patients engaged in rural tMOUD care	Telemedicine delivered medications for opioid use disorder (tMOUD)	None	The preliminary findings showed an overall positive experience with tMOUD
Convery et al. 2020	RCT	Australia		Not specified	30 adults ≤85 years of age with a four‑frequency average hearing loss between 25 and 75 dB HL and (4) ≥1 year of bilateral hearing aid experience who owned a smartphone	Assessment of the usability of the remote communication feature of the app; and determination of whether hearing aid fitting outcomes are influenced by the mode of patient-provider communication	ReSound Assist™ app	None	The 11 participants who accessed ReSound Assist rated the feature as highly usable, were satisfied with its question and answer options and the new settings they received from their provider Participants reported a preference for app-based versus face‑to-face post-fitting patient-provider communication In responses to the open-ended questions about participants’ experiences using ReSound Assist there were 6 about satisfaction (4 positive, 2 negative)
Conway et al. 2021	Cross-sectional study	United States		3 health institutions	159 neuro‑ophthalmology patients, 157 neuro‑ophthalmologists	Analysis of both neuro‑ophthalmology physician and patient satisfaction with virtual health visits during the time of the COVID‑19 pandemic	Video clinical visits	None	Among 159 patients, 104 (65.4%) reported that they were satisfied with the visit, and 149 (93.7%) indicated that they were comfortable asking questions. Potential areas for improvement noted by patients included more detailed preparation instructions and better technology (phone positioning, Internet connection, and software)
Cottrell et al. 2021a	Non-randomised clinical trial	Australia		1 hospital physiotherapy department	71 patients 18 years of age or greater, resided outside of the local health service district, and presented with a non-urgent musculoskeletal spinal condition that was deemed appropriate for a pragmatic course of non-surgical management	Investigation to determine whether clinical outcomes achieved via telerehabilitation are as good as those achieved via in-person care	Telerehabilitation	In-person treatment	The telerehabilitation group reported significantly higher levels of treatment satisfaction (median: 97 vs. 76.5; p = 0.021)
Cremades et al. 2020	RCT	Spain		1 tertiary care hospital	200 adults aged between 18 and 75 years being treated in the General Surgery department, basic computer knowledge (ability to use e‑mail or a social network) and having the necessary equipment (computer with webcam) or having a partner who met these criteria	Evaluation the feasibility of introducing telemedicine in General Surgery	Telemedicine use in outpatient clinics	Conventional outpatient care	The median global satisfaction score was 5 (range 2‑5) in the conventional group and was also 5 (range 1‑5) in the telemedicine group, with no statistically significant differences (P = 0.099)  When patients in the telemedicine group were asked if they would accept the use of telemedicine as part of their medical treatment on an ongoing basis, they rated the proposition with a median score of 5 (range 1‑5)
Criner et al. 2021	RCT	United States		8 research sites	138 patients aged ≥40 years with moderate to very severe COPD and ≥10 pack-year smoking history	Evaluation of the effects of medication reminders via the BreatheMate device on adherence in patients with chronic obstructive pulmonary disease (COPD)	BreatheMate device, smartphone application, and vouchers to redeem pressurised metered-dose inhalers (pMDIs) for the prescribed 2 puffs of budesonide/formoterol 160/4.5 μg twice daily, as well as twice‑daily electronic reminders to take budesonide/formoterol	BreatheMate device, smartphone application, and vouchers to redeem pressurised metered-dose inhalers (pMDIs) for the prescribed 2 puffs of budesonide/formoterol 160/4.5 μg twice daily	Most patients reported the BreatheMate device and application were easy to use and that they had a clean look and feel, with suitable options and features In the intervention group, patient satisfaction was similar across all device and application survey questions for patients aged <65 and patients aged ≥65 years See Table D.2 for patient safety results
Cuadrado et al. 2021	Retrospective cohort study	Spain		1 tertiary hospital 43km from 1 prison	75 prison inmate patients who received anti-HCV treatment (May 2016–November 2017)	A cost-minimisation analysis comparing two strategies of HCV treatment in a prison: telemedicine clinical practice (TCP) and the usual clinical practice (UCP)	Telemedicine clinical practice (TCP)	Usual clinical practice (UCP)	The questionnaire revealed high levels of satisfaction with TCP, with a median score of 5 in each question
Damery et al. 2021	RCT	United Kingdom		4 outpatient liver clinics	54 clinically stable liver transplant patients	Evaluation of the feasibility of using real-time remote consultations for liver transplant patient between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and assessment of whether patient satisfaction differs between intervention and usual care patients	Real-time remote consultations	Usual care	Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups Sub-group analysis showed that the increases were significant for both intervention (P <. 001) and usual care (P =.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P =.10)
Danylchuk et al. 2021	Systematic review	Multiple	42	Multiple	Patients and providers of telehealth genetic counselling (THGC)	A systematic evidence review to compare telehealth genetic counselling (THGC), including videoconferencing and telephone counselling, across specialties to in-person genetic counselling (IPGC) for a range of outcomes specific to patient and provider experiences and access to care	Telehealth genetic counselling (THGC), including videoconferencing (VGC) and telephone counselling (TGC)	In-person genetic counselling (IPGC)	One study of a cancer population showed that, while overall satisfaction was high in both IPGC and TGC arms, the improvement in satisfaction scores was lower in African American participants compared with white participants Two studies reported comparisons between TGC and VGC. In a study of men with cancer receiving genetic counselling, patients who received VGC had higher mean satisfaction scores and knowledge scores VGC was also preferred over TGC in Italy by both patients seen for either prenatal or paediatric indications and their providers
Davis et al. 2021	Systematic review	Australia, Denmark, United Kingdom	18	Multiple	3 323 adults (≥18 years) with inflammatory bowel disease (IBD) in general or any form of IBD (ulcerative colitis or Chron’s disease or both)	Systematic review evaluating the efficacy of telehealth and mHealth interventions and explore the benefits and challenges of these interventions in patients with IBD	Telehealth and mHealth interventions	None	The majority of the participants (>75%) from many studies reported satisfaction with telehealth and mHealth interventions In contrast to these findings, there was no difference in waiting time between the telemedicine group and the usual care group in one pilot study, and satisfaction did not differ between the groups None of the qualitative studies explicitly assessed patient satisfaction with telehealth and mHealth interventions
de Boer et al. 2021	Systematic review	Multiple	37	Multiple	Patients using videoconferencing psychotherapy (VCP) as a treatment delivery	Systematic review examining the efficacy, feasibility, and acceptability of using videoconferencing psychotherapy (VCP) as a treatment delivery modality for couple and family therapy (CFT)	Videoconferencing psychotherapy (VCP)	Multiple	Generally, high satisfaction levels were reported across several of the studies and no significant differences in satisfaction were seen in a number of studies that compared VCP and in-person treatment delivery When comparing the target intervention to internet recourse comparisons, or minimal intervention groups, significant differences were seen in satisfaction
De Marchi et al. 2021	Cohort study	Italy		1 tertiary Amyotrophic Lateral Sclerosis (ALS) centre	19 adult patients scheduled to visit the centre	Testing of the feasibility of telehealth and to assess patients’ satisfaction with the service received by follow-up patients with ALS during the COVID‑19 pandemic, compared to outpatient conventional visits	Telehealth follow up patient visits	Conventional outpatient visits	All patients reported a positive perception of talking with health care professionals and were satisfied with how the team understood their problems
Diaz-Miron et al. 2022	Cross-sectional study	United States		1 university children’s hospital	73 surgeons, 616 surgical patients and caregivers (of patients <18 years old)	Evaluation of surgeon and caregiver perspectives of telemedicine (TMEs) during the pandemic	Telemedicine delivered to paediatric surgical patients	None	No significant differences were noted in the overall satisfaction An inverse relationship between surgeon age and satisfaction at the follow-up survey was identified (p = 0.007) Seventy-nine percent of patients or caregivers reported TME as similar to an in-person visit Audiovisual satisfaction of the TME was higher in greater income households (p = 0.02)
Dinuzzi et al. 2021	Retrospective cohort study	Italy		1 university hospital	65 patients who used telemedicine services 1 Jan to 29 Apr 2020	Description of the experience of the Stoma Care Center of the University Hospital Federico II, Naples, Italy, before and during the COVID‑19 lockdown	Telehealth services for trauma	None	Of the 65 patients who completed the questionnaire, 82% indicated being extremely satisfied
Dobrusin et al. 2020	Cross-sectional study	United States		2 community-based gastroenterology (GI) practices	1 492 GI patients, 503 GI providers	Exploration of the impact of the sudden increase in telehealth use during the COVID‑19 pandemic on patient and provider satisfaction within community-based gastroenterology (GI) practices	Telehealth	None	Patients were highly satisfied with their telehealth visits; with greater than 80% indicating that the provider addressed their concern and that they were willing to participate in telehealth visits in the future High satisfaction was observed in all age groups, with the highest rates in patients older than age 85 Overall, the authors found a high level of satisfaction (>90%) with telehealth services among providers
Doking et al. 2021	Case study	Netherlands		Not specified	1 colorectal cancer survivor undertaking blended cognitive‑behavioural therapy (bCBT)	Evaluation of the COloRectal canceR distrEss reduCTion (CORRECT) intervention, a blended cognitive‑behavioural therapy (bCBT) combining face‑to-face (F2F) therapy with an interactive self-management website to reduce high distress in colorectal cancer survivors	COloRectal canceR distrEss reduCTion (CORRECT) intervention	None	The total treatment satisfaction was rated high (8/10) immediately posttreatment Two questions were rated low (1/4): “The treatment was a fixed part of my daily life” and “The treatment led to less pain”
Eberle et al. 2021a	Systematic review and meta‑analysis	Canada, Italy, Spain, United Kingdom	11	Multiple	563 gestational diabetes mellitus (GDM) patients	Assessment of the current evidence regarding the clinical effectiveness of telemetric interventions in the management of gestational diabetes mellitus (GDM), addressing maternal glycaemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth, as well as foetal and neonatal outcomes	Telemetric interventions	None	Women were highly satisfied with telemetric therapy treatment (P <. 05)
Edison et al. 2020	Systematic review	Australia, Denmark, Ireland, United Kingdom, United States	18	Multiple	5 813 adult patients exposed to virtual clinics using telehealth strategies	Systematic review identifying the clinical, fiscal and environmental evidence on the use of urological telehealth and/or virtual clinic (VC) strategies, and to highlight research gaps in this rapidly evolving field	Telehealth and/or virtual clinic (VC) strategies	Multiple	Patient satisfaction was inconsistently reported, and assessments lacked prospective evaluation using validated questionnaires See Table D.2 for patient safety results
Eichberg et al. 2020	Systematic review	Multiple	52	Multiple	45 801 neurosurgical patients	Systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges	Telemedicine	None	While no studies have described patient satisfaction rates with telemedicine visits in the COVID‑19 era, prior telemedicine studies reported initially optimistic results One paper with a sample of 99 patients reported 100% satisfaction with the telemedicine appointment on post visit questionnaires.
Elsner et al. 2020	Systematic review	Italy, Germany, United States	28	Multiple	Dermatology patients receiving care during the COVID‑19 pandemic	Systematic review summarising all published studies on teledermatology during the COVID‑19 pandemic	Teledermatology	None	One paper reported a high level of patient satisfaction in the use of teledermatology in the care of acne patients
Erben et al.2021	Cross-sectional study	United States		3 neurological clinics	6 262 vascular surgery patient encounters during the COVID‑19 pandemic	Assessment of the introduction of telemedicine as an alternative to the traditional face‑to-face encounters with vascular surgery patients in the era of the COVID‑19 pandemic	Telemedicine encounters	Face‑to-face encounters	78.7% of patients rated their overall health care experience during face‑to-face encounters as very good and 80.6% of patients rated their health care experience during telemedicine encounters as very good (P =.78)
Eustache et al. 2021	Systematic review	Australia, Canada, Denmark, Italy, Norway Spain, United States	29	Multiple	Patients undergoing surgery	Systematic review investigating whether postoperative telemedicine interventions with a communication feature reduce emergency department visits and readmissions	Postoperative telemedicine interventions	None	Fifteen studies reported a metric of patient satisfaction regarding utilisation of the telemedicine intervention All studies demonstrated high levels of satisfaction (> 80%) with the telemedicine intervention
Eze et al. 2020	Systematic review	Multiple	98	Multiple – Umbrella review	Patients providers using telemedicine in Organisation for Economic Co‑operation and Development (OECD) countries	Umbrella review of systematic reviews on telemedicine use in OECD countries summarizing findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation	Telemedicine	None	Six reviews addressed patient satisfaction and enablers to the use of telemedicine interventions. For patients with mental health conditions, text-messaging interventions increased patient satisfaction with management and health care services Mental health patients who had undergone computerised cognitive behavioural therapy (cCBT) reported high treatment satisfaction rates, however more research was advised to address attrition due to dissatisfaction COPD patients reported that they were satisfied with remote monitoring, and that they found interventions useful to help manage their condition
Fraser et al. 2022	Systematic review	Canada, United States	5	Multiple	603 individuals living in rural areas with cardiovascular diseases (CVD)	Systematic review aiming to understand the types and effects of home‑based connected health technologies, used by individuals living in rural areas with cardiovascular diseases	Home‑based connected health technologies	None	One study found 36% of participants experienced anxiety towards the mobile health technology Another study reported contrasting results where participants displayed 80‑92% satisfaction
Fritsch et al. 2020	Systematic review	Australia, Denmark, Finland, France, Korea, Norway, United Kingdom, United States	11	Multiple	People with musculoskeletal pain	Systematic review appraising the literature on the effects of text messages (as an intervention or a component of an intervention) compared with any control on pain and function in people with musculoskeletal pain	Text messages	Any control	Seven studies reported patients’ satisfaction and/or feedback to researchers about the intervention received Overall, patients were satisfied with treatments when text messages were associated with usual care and would recommend text messages to other patients
Garcia-Huidobro et al. 2020	Case‑control study (using retrospective and concurrent control groups)	Chile		1 private academic health network	3 962 patients who received, and 263 clinicians who provided, telemedicine care in March/April 2019 and March/April 2020	Investigation of the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions	Telemedicine visits	In-person visits	Satisfaction was very high with both telemedicine and in-person services Patients receiving telemedicine services reported similar satisfaction with clinician’s services compared to both control groups Patients using telemedicine care reported less satisfaction with the payment process (5.3% reduction, P <. 001) and infrastructure (web portal, 3.4% reduction, P <. 001) compared to patients receiving in-person visits concurrently 244 providers reported that they were satisfied or very satisfied with telemedicine (92.8%) See Table D.3 for use by demographic results
Garfan et al. 2021	Systematic review	Multiple	86	Multiple	Patients and providers utilising telehealth during the COVID‑19 pandemic	Systematic review presenting insights into the important perspectives in telehealth utilisation during the COVID‑19 pandemic	Telehealth	None	Patient and provider satisfaction was measured in some papers included in the findings
Gomez-Roas et al. 2022	Cross-sectional study	United States		Single academic medical centre	40 low-income postpartum individuals	Identify additional challenges to health care interactions that emerged for low-income postpartum individuals during the pandemic	Telemedicine	None	Perceived disadvantages of telemedicine included technical difficulties, difficulties establishing rapport with providers, incomplete health information, and lack of resolution to health care problems Participants commonly attributed their dissatisfaction with telemedicine to incomplete health information
Gonzalez-Plaza et al. 2022	RCT	Spain		1 maternal – foetal department at a hospital clinic	120 pregnant women with obesity	Evaluation of the effectiveness of a complex digital health intervention, using a smartband and app with midwife counselling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyse its impact on maternal and perinatal outcomes	Digital health intervention, using a smartband and app with midwife counselling	Usual care	The mean of the satisfaction scale with the health counselling app and midwife support was 4.8/5 (SD 0.6) points
Gopal et al. 2022	Systematic review	Multiple	72	Multiple	Populations with chronic neurological dysfunction	Systematic review of existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction	Remote assessment	None	Two studies reported >80% of participant satisfaction with external devices to examine hand tremors Another study found that 76% of participants using a tablet-based assessment for finger tapping and reaction time found it easy to use, with an additional 63% reporting willingness to use it long term to monitor disease activity
Grau-Pellicer et al. 2020	RCT	Spain		1 hospital	41 chronic stroke survivors	Investigation of the effectiveness of a mobile‑health (mHealth) App in improving levels of physical activity (PA) in chronic stroke survivors	Exercise programme and mHealth App	Exercise programme no mHealth App	Participants’ had varying levels of satisfaction with the following items: physical condition (86.4% very satisfied), gait capacity 72.7% very satisfied), balance (36.4% very satisfied), programme satisfaction (90.9%), own effort (77.3%) and QoL (77.3%)
Greenwood et al. 2022	Systematic review and meta‑analysis	United States	12	Multiple	931 psychotherapy patients	Evidence synthesis to assess whether there is evidence of differences between telehealth and face‑to-face care for the management of less common mental and physical health conditions requiring psychotherapy	Telehealth care	Face‑to-face care	A total of 7 studies reported client satisfaction outcomes (3 meta‑analysed, n=131, immediately after treatment) No evidence of difference in satisfaction between groups (SMD 0.12, 95% CI −0.3 to 0.53; P =.58) was found
Guaiana et al. 2021	Systematic review	United States	14	Multiple	Televideo use for major depressive disorder (MDD) treatment in adults (18 years or older) in any clinical setting, and any health care professional providing care	Exploration of literature on the use of televideo to diagnose and treat major depressive disorder (MDD), particularly acceptability and patient satisfaction, efficacy, and cost-effectiveness	Televideo	None	All the studies examining acceptability and patient satisfaction showed that there either was no difference between telepsychiatry and in-person care or patients were more satisfied with telepsychiatry
Gupta et al. 2021	Systematic review	Multiple	53	Multiple	Paediatric and adult patients with ear, nose, and throat (ENT) disorders	A systematic review to synthesize the evidence base on outcomes from remote consultation in adult and paediatric ENT services	Remote consultation for paediatric or adult ENT disorder	Multiple	In most instances, remote consultation was associated with high patient satisfaction See Table D.2 for patient safety results
Hadeler et al. 2021	Systematic review	Austria, Australia, Italy, United Kingdom, United States	23	Multiple	Teledermatology patients	Analysis of which methods of teledermatology patients prefer by categorizing how recent studies have defined satisfaction, conducted surveys, and concluded patients respond to the different modalities of teledermatology	Different modalities of teledermatology	None	Definitions of satisfaction varied, but all concluded patients were satisfied with the live‑interactive and store‑and-forward modalities All studies, either through surveys or anecdotal evidence, reported overall patient satisfaction with both teledermatology modalities One study further evaluated preference between the different forms of teledermatology and face‑to-face dermatology and demonstrated preference for face‑to-face dermatology over both teledermatology modalities
Hall et al., 2022	Randomised effectiveness trial	United States		Twelve Health Centers in rural and/or underserved areas in 3 states	1 004 patients with PTSD and/or bipolar disorder	Given that both approaches were determined equally effective, this study identifies patient and clinician experiences and preferences regarding each approach	Telepsychiatry collaborative care, where telepsychiatrists provided consultation to primary care teams	Referral approach, where telepsychiatrists and telepsychologists assumed responsibility for treatment	Both Interventions Provided High-Quality Care and Patient Satisfaction Patients described symptom improvements (e.g. fewer medication side effects and fewer mania, depression, and PTSD symptoms) and satisfying relationships with new care team members (eg, telepsychiatrist, telepsychologist, CM) Receiving care from telepsychiatrists that were connected to respected institutions influenced patients’ perception about the quality of their care
Hanach et al. 2021	Systematic review and meta‑analysis	Australia, Canada, Singapore, United States	10	Multiple	2 366 mothers without history or existing mental disorders	Examination of the effectiveness of telemedicine interventions – delivered exclusively during the postnatal period, on postpartum depression symptomatology in women with no history of mental disorders.	Telemedicine interventions	None	Three studies reporting participants’ satisfaction revealed that the participants were highly satisfied with the technology-based interventions.
Harkey et al. 2021a	RCT	United States		1 large integrated health care system	289 patients undergoing laparoscopic appendectomy or cholecystectomy	Exploration of surgical patient perception of post-discharge video-based visits VVs compared with traditional in-person visits (IPVs) post-discharge	Video-based post discharge visits	In-person post discharge visits	There was no difference in patient-reported satisfaction in the VV group compared to the control group Many patients were satisfied with the care they received during their medical appointments Several patients in each group described positive experiences with clinicians and staff
Hazenberg et al. 2020	Systematic review	Multiple	61	Multiple	Not specified	Assessment of the peer-reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease	Telemedicine and telehealth approaches	None	Patients were satisfied with the treatment support because it was timesaving, nurses were capable of handling the technical skills, and physicians found the equipment easy to use and feasible for distance‑treatment Patients were satisfied and felt safe with remote treatment support, the visiting nurse felt supported, and physicians felt a good basis for decisions with using the tool
Helleman et al. 2020	Systematic review	Australia, Italy, Portugal, United Kingdom, United States	16	Multiple	429 patients with amyotrophic lateral sclerosis (ALS)	Overview of telehealth used in the care for patients with amyotrophic lateral sclerosis (ALS), and identification of the barriers to and facilitators of its implementation	Telehealth	None	Three studies reported that patients were satisfied with videoconferencing One study reported that satisfaction with telehealth was not related to disease severity or travel distance
Herrero et al. 2021	RCT	United States		Not specified	122 patients ≥18 years old, consented to isolated arthroscopic meniscal repair or meniscectomy, and were able to properly utilise telemedicine software on a computer, tablet, or smartphone with a built-in camera	Exploration to determine whether patient satisfaction with overall care is equivalent for telemedicine follow-up (i.e. synchronous face‑to-face video) and office‑based follow-up after arthroscopic meniscectomy and repair	Telemedicine follow up	Office‑based follow up	There were no significant differences between groups in terms of patient demographics or satisfaction scores Patient satisfaction with overall care was equivalent based on the results of two 1‑sided t-test analysis for equivalence (9.77 ± 0.60 in the office‑based group versus 9.79 ± 0.53 in the telemedicine group; p < 0.001)
Hopstaken et al. 2021	Systematic review	Australia, Belgium, Canada, Germany, Netherlands, Norway, United States	17	Multiple	Oncology patients	A review of the effect of a digital care platform for oncology patients on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider – reported experiences	Digital care platform	None	Patient satisfaction with the studied platform was considerably high in three intermediate/high-quality studies, with a mean rating of 3.9 (range 3.8‑4.09) on a 1‑5 scale Only two clinical studies reported the experiences by health care providers
Indraratna et al. 2021	RCT	Australia		2 sites	102 patients with acute coronary syndrome or heart failure	Description of the implementation of a novel smartphone app within an RCT, the impact of the COVID‑19 pandemic on the conduct of the trial, and how the experience with TeleClinical Care‑Cardiac (TCC-Cardiac) guided and informed the development of two telemonitoring programs during the pandemic	TeleClinical Care‑Cardiac (TCC-Cardiac) app alongside standard care	Standard care alone	User satisfaction with the app was high, with the average rating being 4.56 out of 5 There was no significant difference between the user satisfaction score in those aged 70 or above (n=16, average rating 4.62), compared to those younger than 70 (n=50, average rating 4.54) See Table D.2 for patient safety results
Itamura et al. 2021	Cross-sectional study	United States		1 medical centre	1 284 patient responses following in-person visit, 221 patient responses following virtual visit	Exploration to compare the patient experience of a virtual otolaryngology clinic visit to an in-person visit, especially with its significantly increased implementation during the COVID‑19 pandemic	Virtual otolaryngology clinic visit	In-person otolaryngology clinic visit	Some survey questions overlapped between in-person and virtual visits. In all 5 overlapping questions, there was a lower percentage of responses for virtual visits that reported more satisfactory evaluations of “Yes, definitely” and “Yes, mostly” or “10” compared to those of in-person visits Student’s t-test demonstrated that the lower overall provider rating for virtual visits (9.3 ± 1.6) compared to in-person visits (9.6 ± 1.1) was significant, P = .003
Jang et al. 2021a	Retrospective cohort study	Korea		1 telemedicine centre	2 324 patients with COVID‑19	Describes the results of the Korean Medicine (KM) telemedicine centre and the clinical possibility of using herbal medicines for COVID‑19	Telemedicine consultation	None	The patient satisfaction score for treatment was 8.3 (SD 1.78) out of 10 and the convenience of the KM telemedicine centre system was rated 9.3 (SD 1.27) out of 10 Patients gave high scores when asked about their willingness to recommend the KM telemedicine centre to acquaintances (9.2, SD 1.58) and use Korean Medicine treatments (9.1, SD 1.54)
Jang et al. 2021b	Systematic review and meta‑analysis	Australia, Denmark, Canada, Italy, Netherlands, Spain, United Kingdom, United States	22	Multiple	2 906 patients utilising telemonitoring interventions on severe chronic obstructive pulmonary disease (COPD) exacerbations	Systematic review and meta‑analysis providing current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room visits	Telemonitoring for preventing COPD exacerbations	None	All eight studies that surveyed participant satisfaction reported high satisfaction levels
Janjua et al. 2021	Systematic review and meta‑analysis	Belgium, Canada, France, Germany, Italy, Korea, Netherlands, Spain, United Kingdom, United States	14	Multiple	1 518 chronic obstructive pulmonary disease (COPD) patients	Systematic review and meta‑analysis of the benefits and harms of digital interventions for managing COPD and applying Behaviour Change Technique (BCT) taxonomy to describe and explore intervention content	Digital technology interventions with or without routine supported self‐management to usual care	None	Three studies reported the differential rates of satisfaction were unclear Evidence for participant satisfaction was limited, so no determination could be made whether participants were satisfied with digital intervention or control
Junkins et al. 2021	RCT	United States		4 HIV care outpatient clinics	22 African American female patients living with HIV aged 19 years or older	Testing of the feasibility and acceptability of a telemedicine‑administered cognitive behavioural therapy (CBT) for depression and antiretroviral therapy adherence (CBT-AD) approach using videoconferencing among African American (AA) women living with HIV in the rural South	CBT-AD intervention	Supportive psychotherapy	Participants rated their overall satisfaction as very high; the average CSQ‑8 score was 30.8 of a maximum score of 32, indicating very high satisfaction and acceptability of the intervention
Kamdar et al. 2020	Retrospective cohort study	United States		1 Academic medical centre	2 204 patients scheduled for surgery by telemedicine or evaluated in person	Description of the implementation of a telemedicine‑based anaesthesia preoperative evaluation and report the program’s patient satisfaction, clinical case cancellation rate outcomes, and cost savings	telemedicine‑based preoperative anaesthesia evaluation process	In person evaluation	The majority of patients who responded to the survey (>90%) either agreed or strongly agreed with statements regarding what to expect from the video visit, confidence heading into it, clarity of video, meeting patient needs, overall satisfaction, and having more in the future 83% of patients agreed or strongly agreed the technical process of joining was easy
Kane et al. 2020	RCT	United States		1 single subspecialised institution	66 postoperative patients following rotator cuff repair	Evaluation the safety, efficacy, and socio-economic benefits of telehealth as a platform for postoperative follow-up	Telemedicine for postoperative visits	Office‑based visits	No difference was found in patients’ level of satisfaction with quality of care (P =.304)
Khairat et al. 2021	Cross-sectional study	United States		55 prison facilities	1 584 surveys from specialty care patients and telemedicine presenters; 60 practitioners	Evaluation of the implementation of a telemedicine programme for specialty care in North Carolina prisons during the COVID‑19 pandemic	Telemedicine	None	453 patients (94.0%) reported a positive overall telemedicine experience 272 practitioners (86.1%) were satisfied with the telemedicine visits and 284 practitioners (89.9%) felt comfortable using telemedicine Physicians were significantly less satisfied with the overall telemedicine experience (mean [SD] rating, 3.68 [1.24] points) compared with physician assistants (mean [SD] rating, 4.63 [0.94] points) and NPs (mean [SD] rating, 3.76 [0.99] points) (χ24 = 20.86; P < .001). The aspect of telemedicine with the highest rating among telepresenters was telemedicine call quality (mean [SD] rating, 4.34 [0.84] points), and comfort using telemedicine was rated the lowest (mean [SD] rating, 4.17 [0.96] points)
Kolcun et al. 2020	Systematic review	Canada, Denmark, France, United States	12	Multiple	Spine surgery patients	Systematic review examining the current utilisation of telemedicine (TM) for spine surgery	Telemedicine ™	None	1 paper reported patient satisfaction In a study of 60 patients undergoing lumbar discectomy who were given a mobile app with daily postoperative questionnaires regarding pain, temperature, neurological symptoms, and wound status for 15 days, in addition to a telephone call on postoperative day 1, most patients did use the app (55/60), with a high average satisfaction rate (3.5/4)
Kraepelien et al. 2020	RCT	Sweden		None – recruited through the Parkinson’s society	77 Parkinson’s disease patients with self-reported problems with general function	Exploration of whether guided individually-tailored internet-based cognitive behavioural therapy (ICBT) provide additional value to standard medical treatment for Parkinson’s disease (PD)	Individually-tailored internet-based cognitive behavioural therapy (ICBT) combined with standard medical treatment	Standard medical treatment plus being on waitlist to ICBT	Treatment satisfaction in the intervention group was 26.25 (4.52) [24.62‑27.88] and in the control group was 22.80 (5.20) [20.66‑24.94] t = 2.67 p = 0.010
Kruse et al. 2022	Systematic review	Multiple	46	Multiple	Not specified	Systematic review evaluating the facilitators and barriers to the adoption of telemedicine worldwide, including an analysis of health outcomes and patient satisfaction	Telemedicine adoption during the first year of the COVID‑19 pandemic	None	Overall, 22% of the articles analysed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction)
La Valle et al. 2022	Systematic review	Belgium, Canada, France, Italy, Netherlands, Poland, United Kingdom, United States,	9	Multiple	Children aged 0‑5 years with developmental concerns	Assessment of study characteristics and type of diagnostic evaluation) comparison of telehealth technologies to in-person diagnostic methods; feasibility and acceptability of telehealth technologies; and methodological quality	Telehealth methods	None	Across the six studies, overall high levels of satisfaction were reported by providers and families, yet some nuanced differences were found when surveying different types of providers and specialists Studies which included telehealth methods to facilitate a psychiatric diagnosis for children with suspected mental health/social-emotional concerns found that overall providers endorsed high levels of satisfaction with tele‑psychiatric diagnostic care, indicating high acceptability Nonetheless, paediatricians were more satisfied than family physicians, suggesting that physicians felt that their patients needed more than telepsychiatry could provide
Lee et al. 2021	RCT	United States		Female pelvic medicine and reconstructive surgery (FPMRS) clinics of a tertiary academic health system	52 women undergoing surgery for pelvic organ prolapse	Exploration of whether patient satisfaction of virtual clinical encounters is noninferior to traditional in-office clinical encounters for postoperative follow-up after reconstructive surgery for pelvic organ prolapse	virtual (via video conference technology) clinical encounters for their 30‑day postoperative follow-up visits	in-office clinical encounters for their 30‑day postoperative follow-up visits	The mean patient satisfaction score was 80.7 ± 2.6 in the virtual group and 81.2 ± 2.8 in the office group (difference, −0.46 points; 95% confidence interval, −1.95 to 1.03), which was consistent with noninferiority
Legler et al. 2021	Prospective cohort study	United States		3 medical units in a dedicated COVID‑19 hospital	43 patients admitted for COVID‑19	Evaluation of an intrahospital telemedicine programme (virtual care) for patients admitted with COVID‑19, along with its impact on exposure risk and communication	intrahospital telemedicine programme (termed virtual care)	None	Patients’ perceptions of virtual care were positive overall and felt it was a good idea to continue using virtual visits in the hospital
Leibar Tamayo et al. 2020	Prospective cross-sectional study	Spain		Urology outpatient clinic of a tertiary care hospital	200 urology clinic patients	Evaluation of urological patient satisfaction with teleconsultation during the COVID‑19 pandemic	Urological teleconsultation	None	Teleconsultation overall satisfaction level was 9 (IQI 8‑10), and 61.5% of respondents would consider teleconsultation as a health care option in the future
Lemelin et al. 2020	Controlled clinical trial	Canada		Obstetric clinic at 1 university hospital	161 women with gestational diabetes mellitus (GDM)	Evaluation of the cost-effectiveness of the telehomecare (THCa) initiative by assessing the direct costs, including the related reduction in medical visits, evaluate the impact of THCa on diabetes control, GDM-related complications, and patient satisfaction	THCa system for transmission and online analysis of capillary glucose data	Usual care in the clinic	Global satisfaction with care was similar in both intervention (THCa) and control groups (8.9/10 in the THCa group and 8.5/10 in the control group, P =0.128) Satisfaction with educational support was significantly increased in the THCa group (9.0/10 for the THCa group and 8.5/10 in controls P =0.028). See Table D.5 for cost results
Lester et al. 2020	RCT	United States		1 neurofibromatosis clinic in a hospital setting	45 adolescent patients (aged 12‑17) with neurofibromatosis	Examination of the feasibility, acceptability, preliminary effect, and durability of a mind-body videoconferencing programme for youth with neurofibromatosis (Resilient Youth with NF; RY-NF) against an experimental educational control (Health Education for NF; HE‑NF)	Resilient Youth with NF (RY-NF)	Health Education for NF (HE‑NF)	Satisfaction with participation in the programme was high and similar between the intervention (RY-NF, 4.08 of 5) and the control (HE‑NF, 3.49 of 5)
Livingston et al. 2020	RCT	Australia		1 private and 2 public health services or hospitals	82 patients newly diagnosed with cancer	Trial to determine the impact of an app-based, 4‑month intervention for newly diagnosed cancer patients	The ACE smartphone app	No intervention	Nearly two‑thirds of participants (63%) reported that they strongly agreed or agreed that people would learn to use the app very quickly 74% of participants reported they found the DT easy to complete on the app 61% reported feeling confident or very confident using the app, with only one person reporting not being confident using the app
Marquez-Algaba et al. 2022	RCT	Spain		1 university hospital	150 patients aged 18 years or older discharged from the hospital after admission for COVID‑19 diagnosed by real-time polymerase chain reaction (RT-PCR)	To adapt and validate the use of Farmalarm, a smartphone application (app) originally developed by the Stroke Unit at Hospital Universitari Vall d’Hebron in Barcelona, Spain	Farmalarm app	Usual care	Satisfaction with outpatient monitoring was rated higher by the intervention group (5 vs. 4 points; p < 0.001)
Martinez et al. 2020	Cross-sectional study	Colombia		Patients using the Telepsychiatry programme On univariate analyses, the VV cohort across 8 towns	111 telepsychiatry patients	Description of the experience of physicians and patients in the Telepsychiatry programme at the University of Antioquia’s Faculty of Medicine in the first 12 months after its implementation	Telepsychiatry programme	None	The majority of respondents (82.3%) provided positive comments 1 person (5.9%) reported problems with medication delivery management on the part of the health care provider and 2 (11.8%) indicated that they would prefer an appointment in person See Table D.3 for use by demographic results
Martinez et al. 2020	Cross-sectional study	United States		Large nationwide direct to consumer telemedicine platform	Patients seeking care through a direct-to-consumer telemedicine platform	Assessment of differences in patient satisfaction by physician race/ethnicity	Telemedicine platform	None	Encounters with South Asian physicians (aOR 0.70; 95% CI 0.54‑0.91) and East Asian physicians (aOR 0.72; 95% CI 0.53‑0.99) were significantly less likely than those with White American physicians to result in top-box satisfaction Compared to encounters with White American physicians, those with Black American physicians (aOR 1.72; 95% CI 1.12‑2.64), South Asian physicians (aOR 1.77; 95% CI 1.23‑2.56), and East Asian physicians (aOR 2.10; 95% CI 1.38‑3.20) were more likely to result in patient dissatisfaction
McKeon et al. 2021	Systematic review	Australia, Canada, Netherlands, United States	28	Multiple	Patients using smart-device technology and telehealth programs to guide and monitor postoperative rehabilitation following total joint arthroplasty	Systematic review of the currently available evidence on the use of smart-device technology and telehealth programs to guide and monitor postoperative rehabilitation following total joint arthroplasty and to assess their impact on outcomes following surgery	smart-device technology and telehealth programs to guide and monitor postoperative rehabilitation	None	Seven studies assessed patient satisfaction Six studies found that patients in telerehabilitation and in-person physical therapy groups reported equivalent satisfaction levels with their physical therapy treatment
Minguez Clemente et al. 2021	RCT	Spain		1 university teaching hospital	116 patients with chronic obstructive pulmonary disease  (COPD) exacerbation	Trial to evaluate the effectiveness/efficiency of and satisfaction with a home telemedicine programme focusing on patients with COPD exacerbation after early hospital discharge and compare it with early discharge and follow-up with traditional home hospitalisation	Telemedicine with monitoring with patients required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by health care staff (intermediate and at discharge)	Daily visits	Satisfaction scores were similar across the telemedicine and control groups In the telemedicine group, on a scale 1‑5, participants felt the equipment seemed easy to use (4.62) and having the equipment at home gave them a sense of safety and security (4.57)
Mohammadzadeh et al. 2021	Systematic review	Multiple	50	Multiple	Patients with cardiovascular disease treated with cardiology interventions	Review of the effectiveness of implemented telecardiology services	Telecardiology services	None	The items studied in this as part of “patient report effects” were patient satisfaction, improving quality of life, reducing depression and anxiety, reducing waiting time, and improving patient self-care Fifteen investigations reported positive effects for this category. Three studies reported no effect of telecardiology The most effects of telecardiology in “patient reported effects” were improving the patient’s quality of life and enhancing patient satisfaction See Table D.4 for use by technology results
Moor et al. 2020	RCT	Netherlands		4 sites	90 newly treated patients with idiopathic pulmonary fibrosis (IPF)	Investigation of whether a home monitoring programme improves health related quality of life (HRQOL) and medication use for patients with idiopathic pulmonary fibrosis (IPF)	Home monitoring programme on top of standard care	Standard care	In general, patients were relatively satisfied with their antifibrotic medication, with a mean (±SD) score of 2.06 (1.89) on a scale of −5 to 5 Satisfaction with medication regarding efficacy, side effects, and ease of use was similar in both groups The number of side effects was not significantly correlated with patients’ experiences with side effects (r = 0.27; P = 0.06) and only weakly correlated with satisfaction with medication (r = 0.28; P = 0.02)
Morris et al. 2021	Systematic review	Multiple	54	Multiple	Not specified	Review of how digital technologies have been used to support rural oncology care	Digital technologies to support oncology care	None	High patient satisfaction was reported with the quality of the video consultation and in establishing rapport with the specialist Patients overall preferred video conferences to face‑to-face consultations and were satisfied with the care received Health care professionals reported high satisfaction, including patient convenience, interprofessional communication, expanded scope of practice, continuity of care, and maintenance of patient safety See Table D.4 for use by technology results.
Murase et al. 2020	RCT	Japan		17 sleep centres	473 patients who had used continuous positive airway pressure (CPAP) for >3 months and were receiving face‑to-face follow-up by physicians every 1 or 2 months	Examination of the effects of a telemedicine intervention on adherence in long-term continuous positive airway pressure (CPAP) users.	Telemedicine intervention (TM)	1M and 3M groups where patients were seen in-person every month or 3 months respectively	Satisfaction with the obstructive sleep apnea care was more frequently seen in the TM- and 3M-groups than in the 1M-group (TM-group, 55.7%; 3M-group: 53.7%; and 1M-group: 11.8%; P = 0.01)
Murphy et al. 2022	Systematic review	Canada, Germany, Italy, Spain, United Kingdom, United States	32	Hospital and community setting	Adult cancer patients	Examination of the impact of the COVID‑19 pandemic on adult cancer patients	COVID‑19 pandemic	None	Many studies found a high satisfaction rate with telehealth amongst patients, caregivers, and clinicians Telehealth reduced travel time and expenses and increased convenience Concerns about access barriers were also discussed. These included technical difficulties with internet access, costs of technologies/hardware, and communication barriers
Nelson et al. 2020	RCT	Australia		1 hospital	70 patients receiving total hip replacement	Exploration of whether outpatient physiotherapy care via telerehabilitation is as effective as in-person physiotherapy care after total hip replacement.	Remotely delivered telerehabilitation directly into their homes and a technology-based home exercise programme using an iPad application	In-person outpatient physiotherapy and a paper-based home exercise programme	Overall satisfaction was high across both groups The intervention group scored higher for ease of attending appointments (intervention 95 (10), control 86 (18), mean difference 9 (95% CI 2 to 16), P = 0.017.
Nguyen et al. 2022	Systematic review	Denmark, Ireland, Netherlands, New Zealand Spain, United Kingdom, United States	14	Multiple	Patients being treated for Inflammatory bowel diseases (IBD)	Systemic review of randomised controlled trials (RCTs) on digital health technologies in patients with Inflammatory bowel diseases (IBD)	Digital health technologies	None	Eight studies evaluated outcomes on patient/parent satisfaction, work productivity and activity of daily living, acceptability and usability of digital health technologies, self-efficacy, school absence, and knowledge base Overall, patients, parents, and providers were satisfied and willing to adopt digital health technologies
Ning et al. 2021	Systematic review	Multiple	32	Multiple	Patients and providers using telemedicine in otolaryngology	Evaluation of existing literature on telemedicine in otolaryngology and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies	Telemedicine	None	Eleven articles reported outcomes relevant to patient satisfaction In five studies evaluating satisfaction with synchronous models, 95% to 100% of patients reported being satisfied with their experience Six studies evaluated provider attitudes towards telemedicine In three studies providers reported a 92% to 100% satisfaction rate
Oatley et al. 2020	Cross sectional study	Australia		1 tertiary referral hospital	157 adult (over 16 years) medical oncology patients receiving active treatment	Investigate whether a nurse practitioner (NP)–led model of care could improve cancer service integration and reduce hospital presentations	NP-led oncology telephone helpline service, urgent assessment clinic, and a consultation service for the Day Treatment Unit (DTU)	None	The survey respondents reported being “very satisfied” with the telephone helpline service, and 43 (91.5%) reported instructions were clear
Pang et al. 2022	Systematic review and meta‑analysis	Denmark, Ireland, Netherlands, New Zealand, Spain, Türkiye, United Kingdom, United States	17	Multiple	Patients with inflammatory bowel disease (IBD)	Systematic review and meta‑analysis comparing the impact of telemedicine with that of standard care on the management of inflammatory bowel disease  (IBD)	Telemedicine	Standard care	3 studies reported patient satisfaction Patient satisfaction was not significantly different between the telemedicine and standard care groups (SMD 0.21, 95% CI −0.12 to 0.54; I2=14; P =0.21)
Peden et al. 2020	Case study	United States		15 clinics	470 patients who received services via telemedicine at one of the clinics	Description of how a large academic medical system with a high case mix index and diverse racial profile scaled up a telemedicine programme within a few weeks during the COVID‑19 pandemic, providing information on lessons learnt and patient experience	Telemedicine (synchronous live consultation)	None	83% of patients would recommend virtual visits to family and friends,77% would like to use virtual visits for other types of care, and 86% reported that virtual visits met needs and expectations for standards of care 17% of patients reported that the audio and visual communication was not appropriate for clear communication
Pers et al. 2021	RCT	France		Not specified	89 rheumatoid arthritis patients with high to moderate disease activity starting new disease‑modifying anti-rheumatic drug (DMARD) therapy	Assessment of whether use of a connected monitoring interface on a smartphone reduces the number of physical visits in a six‑month period following the initiation of a DMARD therapy compared with conventional monitoring	Connected monitoring	Conventional monitoring	There was a high satisfaction rate with all facets of the application (technical, safety, availability) Most patients (80%) were eager to continue the ‘connected monitoring’ and 93.2% of patients would recommend the ‘connected monitoring’ to their family and friends
Piro et al. 2020	Prospective cohort study	Italy		1 university hospital	1 114 with cardiac electronic implantable devices	Report the efficacy and patient satisfaction with the new cardiac implantable electronic devices (CIED) management protocol adopted during the COVID‑19‑related Italian lockdown.	Remote monitoring at home	Remote monitoring in the office (officeRM)	A trend toward a higher satisfaction and a better relationship with health care providers, even if not statistically significant, resulted from the answers of patients in Group officeRM.
Pogorzelska et al. 2022	Systematic review	Multiple	51	Multiple	Patients – not otherwise specified	Patient perspective and the level of satisfaction among patients suffering from different medical conditions with telemedicine during the COVID‑19 pandemic	Telemedicine	None	A high level of satisfaction with telehealth was observed in each study across every medical specialty In largest study, patient satisfaction with video consultations was significantly higher in comparison to in-person visits (94.9% vs. 93.0%, p < 0.001) Preference for future telehealth visits was reported by a significant number of the reviewed studies – many would like choice
Ramaswamy et al. 2020	Retrospective cohort study	United States		1 academic medical centre	38 609 patient satisfaction surveys collected at the institution	Exploration of whether patient satisfaction differs between video and in-person visits	Video visits	In-person visits	Video visit satisfaction scores were significantly higher than in-person visits (94.9% vs 92.5%; P <. 001) Video visits (parameter estimate [PE] 2.18; 95% CI 1.20‑3.16) and the COVID‑19 period (PE 0.55; 95% CI 0.04‑1.06) were associated with higher patient satisfaction Younger age (PE –2.05; 95% CI –2.66 to –1.22), female gender (PE –0.73; 95% CI –0.96 to –0.50), and new visit type (PE –0.75; 95% CI –1.00 to –0.49) were associated with lower patient satisfaction
Rametta et al. 2020	Retrospective cohort study	United States		1 paediatric specialty care network composed of an urban quaternary care hospital, an ambulatory centre, and an additional 8 satellite locations	All in-person and telehealth encounters during study period	Assessment of the rapid implementation of child neurology telehealth outpatient care with the onset of the COVID‑2019 pandemic	Telemedicine, exclusively referring to patient encounters performed through the audio and video software	In-person encounters	Clinicians considered telemedicine satisfactory in 93% of encounters and suggested telemedicine as a component for follow-up care in 89% of encounters See Table D.2 for patient safety results See Table D.3 for use by demographic results
Rassouli et al. 2021	RCT	Germany, Switzerland		6 centres in Germany and Switzerland	150 patients with chronic obstructive pulmonary disease (COPD) aged 40 or over	Investigation of the impact of a telehealth care (TC) procedure on the course of chronic obstructive pulmonary disease (COPD) and health-related quality of life (HRQOL) as assessed by the slope of individual COPD assessment test  (CAT) changes over the study periods	Telehealth care	Standard care	Satisfaction with care at baseline was 8.2; at the end of standard care (SC), 8.5 (P = 0.062); and after telehealth care (TC), 8.8 (P < 0.001)
Reid et al. 2021	Prospective cohort study	Canada		1 tertiary paediatric hospital	1 036 paediatric patients (< 18 years old) seeking Virtual Paediatric emergency department (ED) services (V-PED)	Investigation to understand the feasibility, utilisation rate, and satisfaction of the first Virtual Paediatric ED (V-PED)	Virtual Paediatric ED (V-PED)	None	Overall satisfaction with V-PED was rated as excellent (9 or 10 out of 10) in 87% of respondents
Sadeghi et al. 2022	RCT	Belgium		1 specialised Multiple Sclerosis (MS) centre	60 patients with Multiple Sclerosis (MS) and their caregiver if applicable	Assessment of the feasibility of multiple planned synchronous teleconsultations (TCs), using an audiovisual Internet platform, in the longitudinal clinical monitoring of patients with MS	Four TCs using an audiovisual Internet platform	Standard care	The proportion of patients in the intervention group – who completed the study – declaring themselves to be satisfied or highly satisfied was 26/26 for global quality of care 19/26 for technical quality of the TCs 24/26 for convenience of the TCs 24/26 for quality of care of the TCs 23/26 for added value of the TCs to medical care
Schultz et al. 2021	Cohort study	Australia		1 large metropolitan health service	238 COVID‑19 patients	Description and evaluation of the implementation of a virtual ward as a COVID‑19 hospital avoidance response strategy and identify opportunities for improvement and future applicability	Virtual ward	None	The majority of patients reported their experience was very good (61.7%) or good (34.8%) Patient experience feedback highlighted some levels of dissatisfaction with the lack of physical face‑to-face assessment and follow up
Sekhon et al. 2021	Systematic review	Australia, Canada, Korea, United States	12	Multiple	Geriatric populations affected by dementia living in rural areas	Systematic review examining the impact of telemedicine on health outcomes in elderly individuals with dementia living in rural areas	Telemedicine	None	Overall, both patients and physicians reported satisfaction with telemedicine There were mixed results regarding the reliability of cognitive tests and the infrastructure required
Shah et al. 2021a	Systematic review	Italy, Finland, United States	11	Multiple	Paediatric patients and care providers who have utilised telemedicine services	Systematic evaluation of the most recent evidence on the feasibility and accessibility of telemedicine services, patients’ and care providers’ satisfaction with these services, and treatment outcomes related to telemedicine service use among paediatric populations with different health conditions	Telemedicine services	None	Some included studies reported varying results on satisfaction, with some reporting higher satisfaction scores in telemedicine groups and others reporting little difference between telemedicine and in-person satisfaction
Shah et al. 2021b	Systematic review	Multiple	32	Multiple	Not specified	Systematic review to synthesize and analyse information regarding the feasibility, acceptability, and potential benefits of telemedicine interventions in malignant and non-malignant haematology	Telemedicine interventions	None	Seven papers reported results related to patient and/or provider satisfaction
Smith et al. 2021a	Systematic review	Multiple – umbrella review	17	Multiple	Surgeons, and patients who were undergoing or recently underwent surgery	Evaluation of patient and provider satisfaction with and perceptions towards telehealth, and to identify the barriers and facilitators associated with its utilisation both prior to and during the COVID‑19 pandemic	Synchronous telehealth modalities (e.g. live interactive videoconference or telephone consultations) used perioperatively	Multiple	Thirteen studies evaluated patient satisfaction with telehealth 80‑100% of patients rated their service as ‘good’ or ‘very good’ or were ‘very satisfied’ with delivery. Few studies reported dissatisfaction  Telehealth was generally no difference in patient satisfaction when compared to usual care via meta‑analyses or narrative syntheses Patient satisfaction was similar across surgical specialties See Table D.2 for patient safety results See Table D.5 for cost results
Stentzel et al. 2021	RCT	Germany		1 integrated telemedicine centre	118 patients a medical diagnosis of any form of schizophrenia (ICD‑10 F20), schizoaffective disorders (ICD‑10 F25), or bipolar disorders (ICD‑10 F31), and age ≥ 18 years	Examination of whether a telemedical care programme can improve QoL in patients with schizophrenia and bipolar disorder	Regular telephone calls and text messages as well as usual care	Usual care	Participants perceived the telemedical care mostly as moderately to very helpful (97.5%) 73.2% reported they would like to continue the telemedical care 34.2% could imagine, that the tele medical care could make contacts to doctors or psychologists less necessary or could partly replace them
Stephen et al. 2022	Systematic review	Australia, Czech Republic, Italy, Korea, New Zealand, Norway the Netherlands, United States	14	Multiple	Adults aged 18 years and over with type 1 diabetes in any context	Review and synthesize available evidence in the literature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote diabetes self-care, as well as facilitators and barriers to their use	mHealth app	None	Diabetes treatment satisfaction was found to significantly improve with mHealth app use
Sultan et al. 2020	Cross-sectional study	United States		Not specified	189 paediatric spinal deformity (PSD) orthopaedic patients	Evaluation of the feasibility and patient satisfaction associated with virtual visits (VV) utilisation in paediatric spinal deformity  (PSD) patients in comparison to general paediatric orthopaedic indications	Virtual PSD visits	Virtual general paediatric orthopaedic visits	PSD patients demonstrated similarly high satisfaction scores with surgeon performance (PSD: 5±0 points vs. general: 4.8±0.1 points; P =0.08) Scores with the telemedicine service were similarly comparable between the groups (3±2.4 vs. 3.5±2.1; P =0.23)
Taxonera et al. 2021	Cross-sectional study	Spain		1 university hospital	171 patients with an established diagnosis of inflammatory bowel disease (IBD) followed at an IBD referral unit in the Madrid region of Spain	Assessment of the feasibility of a strategy based on the conversion of face‑to-face visits to remote telephone consultations to improve care of patients with IBD during the COVID‑19 pandemic, and to evaluate satisfaction of patients with telephone consultations	Remote telephone consultations	None	In closed questions, patients reported a very high degree of satisfaction with telephone consultations, with no differences between scheduled (n = 123) and urgent consultations (n = 48; P = NS) 94% and 93% of patients were satisfied with teleconsultation for scheduled and urgent consultations, respectively (P < 0.82) Fewer than 20% of patients would have preferred a face‑to-face visit to the teleconsultation at the time
Tenforde et al. 2020	Cross-sectional study	United States		4 hospital systems under a single academic department	119 patients and physician	Description of a quality improvement initiative during the rapid adoptive phase of telemedicine in outpatient sports medicine practices during the COVID‑19 pandemic	Synchronous audiovisual telemedicine visits	None	Overall, patients appeared to be highly satisfied (defined as “excellent” or “very good” responses) with their telehealth visits across all patient-centred outcome measures 92.4% reported the telehealth visit addressed concerns and questions 84.9% reported they would value in having a future telehealth visit See Table D.2 for patient safety results
Thiele et al.2022	RCT	Germany		1 university outpatient clinic, 1 rheumatology practice	112 patients with rheumatoid arthritis, psoriatic arthritis or spondylarthritis without a change in therapy since the last presentation	Evaluation of the satisfaction of stable patients from clinics and practices with rheumatoid arthritis (RA), spondylarthritis (axSpA) and psoriatic arthritis (PsA) with telemedical consultation	Telemedical consultation	None	Patient satisfaction was good (mean 4.3/5.0 modified FAPI, n=88) independent of the institution, the duration of the consultation and the consultation partner Patients with a high pain intensity were the least satisfied (p = 0.036)
Tian et al. 2021	Systematic review	Australia, Korea, Spain, United Kingdom, United States	29	Multiple	Prison populations	Systematic review synthesizing the evidence base to date for the impacts of, and outcomes from, telehealth delivered in prisons	Telehealth	None	Findings were mixed in terms of participants’ satisfaction with telehealth delivered in prisons Seven studies reported that participants were generally satisfied with the delivery of telehealth consultations One study reported that their satisfied participants also felt comfortable asking questions
Tiozzo et al. 2021	Prospective cohort study	Italy		1 children’s hospital	124 paediatric cancer patients	Evaluation of the intensity and characteristics of pain, which was assessed at home by children with cancer or their parents using an app for mobile devices	Pain assessment app	None	Most patients were satisfied with the app, and the information they had received about app usage The overall opinion of the app, on a scale from 1 = very poor to 10 = excellent, was on average 8.66 (SD = 1.36)
Titov et al. 2020	Cross-sectional study	Australia		MindSpot Clinic, an online clinic funded by the Australian Department of Health	Not specified	Identification of demographic characteristics and treatment outcomes of patients registered with MindSpot over the first 7 years of clinic operation	MindSpot services	None	Patient satisfaction rates were high 12 452 [96·6%] of 12 895 respondents would recommend the course and 12 433 [96·7%] of 12 860 reported the course worthwhile See Table D.3 for patient safety results
Treskes et al. 2020	RCT	Netherlands		1 university medical centre	200 patients who were admitted with either ST-segment elevation myocardial infarction or non – ST-segment acute coronary syndrome	Investigation of whether smart technology in clinical practice can improve blood pressure (BP) regulation and to evaluate the feasibility of such an intervention	1‑month and 6‑month follow up visits facilitated electronically (e‑visits)	Follow-up visits at the outpatient clinic	General satisfaction scores were comparable across groups: 82.6 (14.1) in the intervention group and 82.0 (15.1) in the control group (P = .88)
van den Heuvel et al. 2020a	Cross-sectional study or survey	Netherlands		73 hospitals with pregnancy and childbirth care departments	57 obstetric professionals	Assessment of the current practice and attitudes concerning home‑based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and foetal monitoring in the Netherlands	Home based monitoring and telemonitoring	None	59% (10/17) of centres using telemonitoring did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation 6/17 (35%) telemonitoring centres are participating in an ongoing multicentre RCT comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission
van den Heuvel et al. 2020b	Case‑controlled study	Netherlands		2 perinatal centres in urban areas: one university hospital and one general teaching hospital	109 women at risk of developing preeclampsia	Evaluation of the use of a digital health platform for telemonitoring blood pressure and symptoms combined with a minimal antenatal visit schedule	Reduced antenatal visits enhanced with a digital platform (SAFE@HOME) for daily blood pressure and symptom monitoring	Antenatal care without the use of home blood pressure measurements	Most women were satisfied with the use of the app and platform (92%, 47/51) and especially parous participants would recommend it to other women (96.9% of multiparous vs. 73.7% of nulliparous women)
Vaughan et al. 2021	RCT	United States		1 non-profit clinic	89 low-income Latino(a) adults with type 2 diabetes	Compare HbA1c outcomes for individuals randomised to TIME, a Telehealth-supported, Integrated care with CHWs (Community Health Workers), and MEdication-access programme (intervention) versus usual care (wait-list control)	Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME)	Usual care (wait list control)	TIME participants recorded high satisfaction levels (3.8/4.0 + 0.5) Most participants agreed that the programme met their needs (3.8/4.0 + 0.4), CHW-participant interaction was beneficial (9.8/10 + 0.7), their health was better (9.7/10 + 0.7), and they would come in the future and recommend the class (3.8/4.0 + 0.5, 9.9/10 + 0.4; respectively)
Vellata et al. 2021	Systematic review	Australia, Germany, Italy, Slovenia, United Kingdom, United States	15	Multiple	421 patients with Parkinson’s disease	Systematic review investigating whether telerehabilitation leads to improvements in global or specific motor tasks (gait and balance, hand function) and non-motor dysfunction (motor speech disorder, dysphagia). The impact of TR on quality of life and patient satisfaction, were also assessed	Telerehabilitation	None	Only one study investigated satisfaction after a telehealth programme in people with PD as a primary outcome Greater satisfaction with the telehealth modality was detected in the assessments of convenience and accessibility/distance Patient satisfaction was investigated in several studies as a secondary outcome Almost all studies reported high levels of patient satisfaction, only one study found no significant difference in satisfaction level
Vimalananda et al. 2020	Systematic review	Multiple	63	Multiple	Not specified	Systematic review of on the effect of e‑consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes	e‑consults	None	Most studies reported high primary care provider (PCP) satisfaction with e‑consults Newer studies using PCP surveys supported these findings, and 2 qualitative studies also reported generally high PCP satisfaction
Vinade Chagas et al. 2021	Systematic review and meta- analysis	Canada, Colombia, United States	10	Multiple	Not specified	Systematic review and meta‑analysis evaluating whether telemedicine in the paediatric intensive care unit (PICU) has the potential to improve clinical and non-clinical outcomes	Telemedicine	None	5/10 studies evaluated PICU staff satisfaction with the use of telemedicine in patient care, while 2 studies also evaluated family satisfaction Satisfaction was mainly related to efficient communication, high quality of care, and audiovisual quality Health care teams reported satisfaction with the use of telemedicine, since the technology employed proved to be easy to use, contributed to improving the care provided to the patient, and reduced their level of anxiety
von Sengbusch et al. 2020	Quasi RCT	Germany		2 paediatric diabetes centres	240 paediatric patients (aged 1‑16 years) with type 1 diabetes	Testing of video consultation as a new care concept as the basis for consultation for children with type 1 diabetes mellitus (T1DM) who use a continuous glucose monitoring (CGM) system	Monthly video consultations in addition to regular care	Regular care for six months before starting with video consultations	Parental treatment satisfaction was significantly higher in the intervention group than that in the waitlist control group
von Sengbusch et al. 2021	Cohort study	Germany		2 paediatric diabetes centres	Parents of children aged 1 – 16 years, who have had type 1 diabetes for at least 6 months	To explore parents’ expectations of the perceived barriers to and benefits of 1 year of monthly video consultations combined with regular outpatient care of children with type 1 diabetes	Monthly video consultations in addition to regular care	None	Overall, parents expressed high satisfaction with video consultations after 12 months. The flexibility in appointments and the time saved compared with regular outpatient visits were considered to be benefits Addressing inconveniences and barriers to video consultations, such as technical problems with data or internet stability, would make this type of consultation feasible for families in rural areas with low internet speeds
Widberg et al. 2020	Systematic review	Australia, Canada, Germany, Italy, Netherlands, New Zealand, Portugal, Switzerland, United States	12	Multiple	397 palliative care patients	Description patients’ experiences of eHealth in palliative care	eHealth	None	Most participants in two studies were very satisfied with video meetings, preferring them to physical meetings Contradictory findings were found in two studies; one where patients favoured the personal encounter and found that a deeper personal connection could not be achieved, and in another study, some patients and families felt that they were satisfied with telephone calls and information by letter, since they found new technology difficult
Wignall et al. 2020	Cohort study	United Kingdom		1 university hospital	70 patients who received a urology follow-up telephone appointment	Exploration of opinions on routine telephone consultations for urological follow-up and whether they could be implemented as COVID‑19 pressures change	Telephone follow-up	None	Patient reported a positive response for the outcomes in the telephone follow-up clinic Over 95% scored the telephone appointment four or five (on a scale of one to five with five being excellent) Over 95% of patients felt listened to and that their problem was adequately addressed over the telephone
Willems et al. 2021	Cross-sectional study	Germany		16 epilepsy centres	Patients at epilepsy centres	Analysis of satisfaction with and reliability of video‑electroencephalography-monitoring systems (VEMS) in epilepsy diagnostics	Video‑electroencephalography-monitoring systems (VEMS)	None	Satisfaction with VEMS at 16 centres was low Only 50% of users were satisfied with the overall performance of their VEMS, and a low 18% were satisfied with the manufacturer’s customer service User interface, software stability, lack of regular updates, and missing customer-oriented improvements were reported as frequent problems jeopardizing diagnosis in approximately 1 in every 10 patients See Table D.2 for patient safety results
Wong et al. 2020	Systematic review	Canada, Germany, Korea, Netherlands, Sweden Switzerland, United Kingdom, United States	24	Multiple	All patients except patients with mental health conditions	Systematic review of RCTs to investigate how eHealth impacts the outcomes of patients’ self-medication management	eHealth for medication management for at least six months	None	Among the 4 studies measuring patient satisfaction, 1 observed a difference when compared with the control See Table D.2 for patient safety results
Yi et al. 2021	Systematic review	Australia, Canada, Italy, Portugal, South Korea, United States	17	Multiple	Older adults with cognitive impairment	Systematic review to understand the state of the literature on synchronous in-home or clinic video-based telemedicine visits for older adults with Alzheimer’s Disease Related Dementias or mild cognitive impairment and characterise technological barriers and facilitators in providing care that is responsive to their needs, including sensory related	Synchronous in-home or clinic video-based telemedicine	None	13 studies reported participant satisfaction with telemedicine, with favourable satisfaction ratings but overall low response rates Studies did not use uniform scoring system for satisfaction questionnaires One study reported that 65% of patients and 91% of care partners responding to surveys preferred to see the specialist via telemedicine than in person
Zhang et al. 2021	Systematic review and meta‑analysis	Australia, Belgium, Canada, Ireland, United States	12	Multiple	Patients aged 18 years and older undergoing virtual preoperative anaesthesia assessment	Systematic review and meta‑analysis reviewing the effectiveness of virtual preoperative assessment for the evaluation of surgical patients, with a focus on surgery cancellation rates and patient experience	Virtual preoperative assessment	None	One study reported that all anaesthesiologists surveyed were satisfied or highly satisfied with virtual care, while one study reported no difference in staff satisfaction
Zimmerman et al. 2021	Cohort study	United States		1 adult hospital	240 patients who were treated virtually from May 2020 to October 2020, and a comparison group of 240 patients who were treated in the in-person partial programme a year earlier	Comparison of satisfaction with partial hospital programme (PHP) services delivered via telehealth to in-person treatment provided to patients treated prior to the COVID‑19 outbreak	Telehealth treatment	In-person treatment	For both the in-person and telehealth methods, patients were highly satisfied with the initial diagnostic evaluation and were optimistic at admission that treatment would be helpful Both groups were highly satisfied with all components of the treatment programme and almost all would recommend treatment to a friend or family member
Zischke et al. 2021	Systematic review	Multiple	39	Multiple	Not specified	Determination of the current clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all areas of physiotherapy practice	Simulated or real-world physiotherapy assessments using synchronous forms of telehealth	None	Satisfaction with physiotherapy telehealth assessments was reported in 19 out of 39 studies, with most stating they were satisfied with the telehealth assessment and consultation process Nine studies conducted similar satisfaction surveys, with questions asked rated on a visual analogue scale (VAS) Most questions asked rated highly in each of these nine studies (>6/10 VAS) If given the choice, many preferred the face‑to-face method of assessment

Table D.2. Overview of included papers with results on the patient safety of telemedicine

Author	Design	OECD Country(s)	Primary studies (if applicable)	Setting	Patients/Clinicians	Description of study		Intervention	Comparator	Relevant findings and conclusions
Aiken et al. 2021	Cohort study	United Kingdom		3 largest abortion providers in England	54 142 patients who accessed an early medical abortion	Comparison of outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine		Additional dose of misoprostol provided via telemedicine	Additional dose of misoprostol provided via in-person clinic visit	Significant adverse events in both cohorts were rare No evidence that significant adverse events were higher in the telemedicine‑hybrid cohort See Table D.1 for user satisfaction results
Amkreutz et al. 2020	Prospective cohort study	Germany		1 telemedicine centre in a university hospital	103 tele‑intensive care unit (ICU) patients who received tele pharmaceutical consultation	Implementation and evaluation of an additional telepharmaceutical expert consultation as part of tele‑ICU services		Store‑and-forward-technology with real-time audio-videoconferencing for tele‑rounds	None	The additional pharmaceutical expert consultation as part of tele‑ICU services was successfully implemented A high number of previously not detected drug related problems were identified in tele‑ICU patients during the implementation period
Appleton et al. 2021	Systematic review	Multiple	77	Multiple	Staff working within the field of mental health, people receiving organised mental health care for any condition, family members or carers of people receiving mental health care	Investigation of the adoption and impacts of tele‑mental health approaches during the COVID‑19 pandemic, and facilitators and barriers to optimal implementation		Any form of spoken or written communication carried out between mental health professionals and service users/family members/unpaid carers	Any mental health communication delivered face‑to-face, digitally or remotely, waitlist control, or placebo	81% of clinical staff considered the quality of telemedicine consultations to be either good or excellent The main barriers for clinicians to deliver quality therapy were picking up on adaptability, trialability, and nonverbal cues, assessing mental health symptoms, keeping service users engaged See Table D.1 for user satisfaction results See Table D.5 for cost results
Barnett et al. 2021	Systematic review	Australia, Canada, Colombia, Denmark, France, Germany, Israel, Japan, Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, United Kingdom, United States	19	Multiple – Umbrella review	Staff working within the field of mental health, people receiving mental health care or with mental health diagnoses, family members, or carers of people receiving mental health care		Umbrella review of systematic reviews available on the literature and evidence‑based guidance on telemental health, including both qualitative and quantitative literature	Any form of spoken or written communication conducted between mental health professionals and patients, service users, family members, carers, or other mental health professionals using either the internet or the telephone	None	Patient safety while using remote interventions has been reported only in the reviews of populations with post-traumatic stress disorder (PTSD) Two reviews agreed that safety was acceptable See Table D.1 for user satisfaction results See Table D.5 for cost results
Bauer et al. 2022	RCT	Germany, Austria		33 tertiary centres	400 patients exhibiting signs of cardiac autonomic dysfunction		Prospective investigator-initiated, randomised, multicenter, open-label, diagnostic trial on early detection of subclinical but prognostically relevant arrhythmic events	Telemedical monitoring using implantable cardiac monitors	Conventional follow-up	No evidence of difference in safety outcomes between intervention and control group (thrombolysis in myocardial infarction major bleeding)
Berglund et al. 2020	Retrospective cohort study	Sweden		1 university hospital	686 patients with atypical melanocytic lesion		Retrospective analysis of electronic health records evaluating the diagnostic accuracy and safety of short-term teledermoscopic monitoring (STTM)	Short-term teledermoscopic monitoring (STTM)	None	Results show that short-term monitoring of atypical melanocytic lesions with a teledermoscopic approach is safe and provides high diagnostic accuracy
Breteler et al. 2020	Retrospective cohort study	Netherlands		Traumatology or surgical oncology wards in 1 university hospital	31 patients scheduled for major surgery with an indication for postoperative monitoring		Analysis of patients who developed adverse events during vital signs recordings during an observational methods comparison study of wearable sensors for vital signs monitoring	Wearable patch sensors and a patient- worn monitor	None	Remote patient monitoring may have potential to improve patient safety by generating early warnings for deterioration to nursing staff
Chagas et al. 2021	Systematic review and meta‑analysis	Canada, Colombia, United States	10	Multiple	Paediatric patients admitted to a general paediatric intensive care unit (PICU), cardiac PICU, or adult ICU with beds for paediatric patients		Evaluation of whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes	Telemedicine in ICU	Multiple	Satisfaction was mainly related to efficient communication, high quality of care, and audiovisual quality
Chappell et al. 2022	RCT	United Kingdom		15 maternity hospital units	850 individuals with chronic hypertension or gestational hypertension		Evaluation of the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension	Blood pressure self-monitoring and usual care	Usual care alone	There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort)
Collins et al., 2020	RCT	United States		15 academically affiliated emergency departments (ED)	479 patients with signs or symptoms of acute heart failure		Assessment of the impact of a self-care intervention on 90‑day outcomes in patients who are discharged from the emergency department (ED)	Home visit within 7 days of discharge and twice‑monthly telephone‑based self-care coaching for 3 months	Usual care	There were no significant differences in all-cause death or ED revisit or hospital admission
Corso et al. 2022	Systematic review	Multiple	9 RCTs	Multiple	Children and adults with musculoskeletal conditions		Evaluation to determine whether nonpharmacologic interventions delivered through synchronous telehealth are as effective and safe compared with in-person interventions for the management of patients with musculoskeletal conditions	Nonpharmacologic interventions used by health care providers through synchronous telehealth	Clinic-based nonpharmacologic interventions delivered in person	The available evidence suggests that synchronous telehealth alone or combined with in-person care is as effective and safe as in-person care alone for the nonpharmacologic management of chronic headaches; nonspecific low back pain; and knee, hip, and generalised osteoarthritis in adults
Cottrell et al. 2021b	Audit study	Australia		1 tertiary hospital	Patients referred to the hospital’s orthopaedic or neurosurgery department for a specialist medical consultation		Description of the economic- and service‑related outcomes of these two methods of service delivery through retrospective audit of electronic medical records	Remote delivery of “fly in fly out” model of care	In-person delivery of “fly in fly out”	No safety incidents were reported for either service delivery model during the audit time period See Table D.5 for cost results
Cox et al. 2021	Systematic review	Australia, Canada, Denmark, Greece, Italy, Korea, Netherlands, Norway, Spain, United Kingdom, United States	15	Multiple	1 904 adults with a diagnosis of a chronic respiratory disease (according to relevant established criteria) of any disease severity, in stable state		Evaluation to determine the effectiveness and safety of telerehabilitation for people with chronic respiratory disease	Telerehabilitation which makes use of information and communication technologies to provide clinical rehabilitation services from a distance	Traditional, centre-based pulmonary rehabilitation or no rehabilitation control	No safety issues have been identified
Criner et al. 2021	RCT	United States		8 research sites	138 patients aged ≥40 years with moderate to very severe chronic obstructive pulmonary disease (COPD) and ≥10 pack-year smoking history		Evaluation of the effects of medication reminders via the BreatheMate device on adherence in patients with chronic obstructive pulmonary disease (COPD)	BreatheMate device, smartphone application, and vouchers to redeem pressurised metered-dose inhalers (pMDIs) for the prescribed 2 puffs of budesonide/formoterol 160/4.5 μg twice daily, as well as twice‑daily electronic reminders to take budesonide/formoterol	BreatheMate device, smartphone application, and vouchers to redeem pressurised metered-dose inhalers (pMDIs) for the prescribed 2 puffs of budesonide/formoterol 160/4.5 μg twice daily	Similar percentages of patients who experienced adverse events (AEs) and serious AEs were observed between the control (31.3% and 11.9%, respectively) and the intervention group (30% and 7.1%, respectively) See Table D.1 for user satisfaction results
Edison et al. 2020	Systematic review	Australia, Denmark, Ireland, United Kingdom, United States	18	Multiple	5 813 adult patients exposed to virtual clinics using telehealth strategies		Systematic review identifying the clinical, fiscal, and environmental evidence on the use of urological telehealth and/or virtual clinic (VC) strategies, and to highlight research gaps in this rapidly evolving field	Telehealth and/or virtual clinic (VC) strategies	Multiple	Far from being concerned, patients welcomed the offer for virtual clinics and felt it was safe, thorough, and professional See Table D.1 for user satisfaction results See Table D.5 for cost results
Gingold et al. 2021	Retrospective cohort study	United States		1 large academic medical centre and an affiliated community hospital	464 patients discharged from hospitals		Analysis to measure the effect of a mobile integrated health community paramedicine (MIH-CP) transitional care programme	Multidisciplinary team involving real-time medication reconciliation with the pharmacist over videoconference and other videoconferencing/text messaging	Not receiving multidisciplinary team care	No difference in 30‑day inpatient readmissions between intervention and control groups See Table D.5 for cost results
Gonzales et al. 2021	RCT	United States		Not specified	136 adults (≥18 years old at time of transplant) kidney recipients 6‑36 months post-transplant		Examination of the efficacy of improving medication safety through a pharmacist-led, mobile health – based intervention	Usual care + pharmacist-led, mobile health – based intervention	Usual care	All 68 participants in both arms experienced at least one medication error during the study. In the multivariable model, total adjusted medication errors were reduced by an average of 0.11 per month in the intervention arm (95% confidence interval [95% CI], 0.05 to 0.17; P <0.001), as compared with the control arm, leading to a 61% reduction in the risk rate of medication errors over the 12‑month study (incident risk ratio [IRR], 0.39; 95% CI, 0.28 to 0.55; P <0.001) Common administrative errors included omissions, additions, and prescribing errors. Clinical errors were largely due to non- or undertreated conditions, primarily electrolyte abnormalities
Gupta et al. 2021	Systematic review	Multiple	53	Multiple	Paediatric and adult patients with ear, nose, and throat (ENT) disorders		A systematic review to synthesize the evidence base on outcomes from remote consultation in adult and paediatric ENT services	Remote consultation for paediatric or adult ENT disorder	Multiple	Safety outcomes including ethical and legal implications were reviewed Remote consultation has potential for improving patient pathway efficiency, and reducing financial and environmental costs, whilst maintaining safe practice and patient satisfaction See Table D.1 for user satisfaction results See Table D.5 for cost results
Hadar et al. 2022	Cohort study	Israel		1 maternal – foetal medicine unit in a hospital	100 women who were carrying a singleton foetus at 14 +0 to 39+ 6 gestational weeks		Evaluation of whether it is feasible to use remote foetal assessment during pregnancy	A mobile self-operated ultrasound transducer controlled through a smartphone which can record and transmit images and videos of the foetus for remote telemedicine consultation	None	Only a single event, considered to be a non-serious adverse event, was categorised as device related. This event was a heating sensation caused directly by the device that was felt briefly by the participant
Hardman et al. 2021	Prospective cohort study	United Kingdom		41 ear, nose, and throat (ENT) departments	4 568 patients who were referred on the suspected HNC pathway to secondary care		Investigation of a service evaluation of remote triage of suspected HNC referrals conducted during the initial peak of the COVID‑19 pandemic	Remote triage over a telephone consultation	None	Appropriately implemented, remote triage, augmented by risk stratification, may facilitate more targeted investigations for high-risk patients and prevent unnecessary hospital attendance for the lowest risk patients
Harkey et al. 2021b	RCT	United States		1 small community hospital and a large tertiary care hospital	432 patients who underwent minimally invasive appendectomy or cholecystectomy		Assessment of the noninferiority of post discharge virtual care visits as measured by the rate of 30‑day hospital encounters	Video-based virtual visit	In-person visit	Post discharge video-based virtual visits did not increase hospital encounter proportions and provided shorter overall time commitment but equal time with the surgical team member
Hauffman et al. 2020	RCT	Sweden		1 university psychosocial care programme	15 patients with cancer and concurrent symptoms of anxiety and depression		Exploration of the participants’ perceptions of the relevance and benefits of an internet-based stepped care programme	An internet-based interactive health communication application, including a stepped care intervention for symptoms of anxiety and depression	None	The internet-based interactive health communication application was experienced as a safe and reliable source of information and support
Hollis et al. 2021	RCT	United Kingdom		2 child and adolescent mental health services sites	224 patients aged 9‑17 years with Tourette syndrome or chronic tic disorder, and severe tics		Evaluation of the effectiveness of internet-delivered, therapist-sup‐ported, and parent-assisted Exposure and Response Prevention (ERP) for treatment of tics in children and young people	10 weeks of online, remotely delivered, therapist-supported ERP for tics	10 weeks of online therapist-supported education about tics	Two serious adverse events occurred, both in the psychoeducation group, neither of which were related to study treatment. See Table D.5 for cost results
Indraratna et al. 2021	RCT	Australia		2 sites	102 patients with acute coronary syndrome or heart failure		Description of the implementation of a novel smartphone app within an RCT, the impact of the COVID‑19 pandemic on the conduct of the trial, and how the experience with TeleClinical Care‑Cardiac (TCC-Cardiac) guided and informed the development of two telemonitoring programs during the pandemic	TeleClinical Care‑Cardiac app (TCC-Cardiac) alongside standard care	Standard care alone	All participants have been safely monitored, with no adverse events since enrolment began See Table D.1 for user satisfaction results See Table D.5 for cost results
Jansson et al. 2022	Systematic review	Australia, Canada, Spain, United States	9	Multiple	Adults		Examination of the effects of telerehabilitation on physical functioning and resource utilisation in patients following discharge from hospital	Telerehabilitation	Conventional in-person outpatient physical therapy	Patients who completed telerehabilitation showed improvement in physical functioning similar to that of patients completing conventional in-person outpatient physical therapy, without an increase in adverse events or resource utilisation
Jansson et al. 2020	Systematic review	Italy, Spain, United States	6	Multiple	Patients with orthopaedic conditions		A systematic review to describe the current literature of computer- and telephone‑delivered interventions on patient outcomes and resource utilisation in patients	Computer- and telephone‑delivered interventions	Multiple	Compared with the control group, computer- and telephone‑delivered interventions showed no significant difference in adverse events
Joshi et al. 2021	Cohort study	United States		Not specified	All telemedicine encounters between 26 March 2020, and 1 June 2020, that were followed by an encounter in the emergency department or admission within eight weeks		Assessment of neurology telemedicine visits in reducing the risk of admission to emergency room/impatient service	Home‑based telemedicine visits during COVID‑19	None	Telemedicine is safe, with a similar likelihood of emergency department or hospital admission during the pandemic in 2020 versus before the pandemic in 2019
Kim et al. 2020	RCT	Korea		3 sites	60 acute ischemic stroke patients with mean SBP > 135 mm Hg during the two consecutive days, for >24 hours after onset of stroke		Evaluation of the effects of an intensive mobile blood pressure (BP) management strategy versus usual care in acute ischemic stroke patients	Bluetooth-equipped sphygmomanometer, with behavioural intensification, telephone contacts, breakthrough visit calls, and prescription algorithm	Bluetooth-equipped sphygmomanometer only	No difference in adverse effects between intervention and control
Lewis et al. 2020	RCT	United Kingdom		2 mental health hospital groups	81 patients with schizophrenia and related disorders		Assessment of the safety and feasibility of a personalised smartphone‑based app	Smartphone‑based active symptom management	Usual care	The active symptom monitoring intervention was safe and acceptable
Lopez-Liria et al. 2020	Non-randomised controlled trial	Spain		1 hospital	55 patients implanted with a Medtronic pacemaker		Investigation to compare the long-term effectiveness and safety of RM plus a clinic visit versus clinic visits alone	Internet-based RM service for patients with Medtronic implantable heart devices	Conventional monitoring	The study concluded that it was safe and feasible with follow-up for 6 months
McGillion et al. 2021	RCT	Canada		8 acute care hospitals	905 adults to be discharged from hospital after non-elective surgery		Investigation to determine whether virtual care with remote automated monitoring (RAM) compared with standard care increases days alive at home within 31 days of discharge after non-elective surgery	Virtual care with remote automated monitoring (RAM) technology	Standard care	More participants in the virtual care group than standard care group had a drug error corrected by a doctor or nurse (102 (22.6%) v 6 participants (1.3%); absolute difference 21.3%, 17.3% to 25.3%); among these participants, 173 and nine drug errors
Metcalfe et al., 2021	Systematic review	Denmark, Finland, France, Israel, Sweden, United States	17	Multiple	Adults and children		Systematic review to describe and evaluate the current literature on remote otological assessment using videootoscopy with regards to reliability and potential applications	Video‑otoscopy for remote otological assessment	Multiple	Remote otological assessment using video‑otoscopy shows potential as a safe and effective method for detecting the presence of ear disease in a wide range of health care settings.
Nguyen et al. 2021	Systematic review	United States	19	Multiple	Not specified		Systematic review to examine how e‑visits have impacted clinical outcomes and health care quality, access, utilisation, and costs.	Electronic visits (e‑visits) involving asynchronous communication between clinicians and patients through a secure web-based platform	Multiple	The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (e.g. appropriate antibiotic prescribing) See Table D.5 for cost results
Pabinger et al. 2021	Prospective cohort study	Austria		General surgery department at 1 university hospital	225 outpatients at the department for general surgery		Evaluation of whether a mobile health care communication app could be used to identify the correct (ICD‑10) diagnosis and the correct therapy	An onsite treatment (ONSITE group) and a telemedical treatment (TELEMEDICAL group)	Each participant served as own control	There was no single wrong telemedical diagnosis related to insufficient quality of medical images or issues with the software of the viewer or browser, regardless of the device used
Rametta et al. 2020	Retrospective cohort study	United States		1 paediatric specialty care network composed of an urban quaternary care hospital, an ambulatory centre, and an additional 8 satellite locations	All in-person and telehealth encounters during study period		Assessment of the rapid implementation of child neurology telehealth outpatient care with the onset of the COVID‑19 pandemic	Telemedicine, exclusively referring to patient encounters performed through the audio and video software	In-person encounters	In 40% of encounters, the technical quality was impaired, and the most frequent single causes affecting quality were poor audio (19%), poor video (13%), and interruption of the encounter (9%). In 5% of encounters, providers documented additional technical quality problems in free‑text notes. See Table D.1 for user satisfaction results See Table D.3 for use by demographic results
Schopfer et al. 2020	Pragmatic trial	United States		3 veterans Administration (VA) medical centres	237 patients with a recent ischemic heart disease (IHD) event		Investigation to compare the effects of home‑based and facility-based cardiac rehabilitation in patients with IHD	Home‑based cardiac rehabilitation, involving telephone calls by clinical staff	Facility-based cardiac rehabilitation	Home‑based cardiac rehabilitation could be efficiently and safely provided to patients with a wide range of clinical indications and comorbidities
Smith et al. 2021a	Systematic review	Multiple – umbrella review	17	Multiple	Surgeons, and patients who were undergoing or recently underwent surgery		Evaluation of patient and provider satisfaction with and perceptions towards telehealth, and to identify the barriers and facilitators associated with its utilisation both prior to and during the COVID‑19 pandemic	Synchronous telehealth modalities (e.g. live interactive videoconference or telephone consultations) used perioperatively	Multiple	Two studies reported no difference in the number of complications between telehealth and usual care; one noted a slightly higher incidence of adverse events with telehealth compared to face‑to-face care See Table D.1 for user satisfaction results See Table D.5 for cost results
Taguchi et al. 2021	RCT	Japan		1 cognitive behavioural therapy centre	30 patients with chronic pain		Examination of the effectiveness of an integrated cognitive behavioural therapy programme with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing (videoconference‑based CBT).	Videoconference‑based CBT	Treatment as usual (TAU)	4 adverse events were reported by 4 different patients in the vCBT group. The first patient was hospitalised owning to worsening Behcet disease and declined to participate in the study for the fourth session. The second patient had sudden difficulty opening his eyes due to medically unexplained eyelid pain and declined to participate in the study for the fifth session. The third patient had a common cold and the fourth patient had temporomandibular joint disorders See Table D.5 for cost results
Tang et al. 2020	Systematic review	Canada, Germany, Sweden, United States	21	Multiple	RCT of eHealth interventions aimed at any solid organ transplant recipient		Assessment of the totality of published evidence for the benefits and harms of eHealth interventions among solid organ transplant list	eHealth interventions among solid organ transplant recipients	Multiple comparators (standard of care, or no comparator)	Adverse event: 3 trials; anxiety, electronic monitoring burdensome, experience failure of intervention, did not like pill boxes, not interested, concerned about privacy, technological failure Safety: hospitalisation / outpatient services 2‑4 trials
Tenforde et al. 2020	Cross-sectional study	United States		4 hospital systems under a single academic department	119 patients and physicians		Description of a quality improvement initiative during the rapid adoptive phase of telemedicine in outpatient sports medicine practices during the COVID‑19 pandemic	Synchronous audiovisual telemedicine visits	None	Adverse event: vasovagal syncope Safety: No relevant safety data See Table D.1 for user satisfaction results
Tune et al. 2022	Systematic review	Australia, Korea, Spain, United Kingdom, United States	7	Multiple	Multiple – umbrella review		Umbrella review to identify how quality of mHealth interventions for cancer survivors is described and measured	mHealth interventions	None	Increased adverse event reporting was among positive outcomes reported
Vimalananda et al. 2020	Systematic review	Multiple	63	Multiple	Multiple		Systematic review of the recent peer-reviewed literature on the effect of e‑consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes	e‑consults	None	Several studies reported on adverse events or emergency department (ED) utilisation following e‑consultation Several studies employing manual review of the medical record found no increase in adverse events (e.g. ED visits, hospitalisations, and/or death within 1‑6 months) following e‑consult. See Table D.1 for user satisfaction results See Table D.5 for cost results
Vodicka et al. 2020	Systematic review	Australia, Canada, Denmark, Germany, Italy, Slovenia, United Kingdom, United States	19	Multiple	Telecardiology, especially with adults that suffer from cardiovascular diseases such as heart rhythm disorders or chest pain, excluding heart failure and or observation of activity of pacemakers or defibrillators		Evaluation of the state of activity in telemedicine on the primary level in Slovenia and around the world and to review the existing literature about the use and experience of telecardiology at the primary health care level	Telecardiology at primary and secondary health care levels	None	The use of telecardiological techniques increases the quality and safety of work in managing patients with cardiovascular disease in FP practice
Willems et al. 2021	Cross-sectional study	Germany		16 epilepsy centres	Patients at epilepsy centres		Analysis of satisfaction with and reliability of video‑electroencephalography-monitoring systems (VEMS) in epilepsy diagnostics	Video‑electroencephalography-monitoring systems (VEMS)	None	Safety grading: Frequent VEMS issues and their effects on criticality and the potential to pose patient hazards are reported in table and figure See Table D.1 for user satisfaction results
Wong et al. 2020	Systematic review	Canada, Germany, Korea, Netherlands, Sweden, Switzerland, United Kingdom, United States	24	Multiple	All patients except patients with mental health conditions		Systematic review of RCTs to investigate how eHealth impacts the outcomes of patients’ self-medication management.	eHealth for medication management for at least six months	None	Among the 2 studies reporting adverse events relating to the interventions (or safety outcome), no statistically meaningful difference between the intervention and control was found See Table D.1 for user satisfaction results

Table D.3. Overview of included papers with results on telemedicine use by demographic

Author	Design	OECD Country(s)	Primary studies (if applicable)	Setting	Patients/clinicians	Description of study	Intervention	Comparator	Relevant findings and conclusions
Abrashkin et al. 2021	Retrospective cohort study	United States		1 community paramedicine programme	Not specified	Analysis of data from a telemedicine‑capable community paramedicine programme	Emergency department (ED) transport with video communication	ED transport with telephonic communication	The median patient age was 88 years, 63.3% were women, and 66.5% listed Medicare as their primary insurance status See Table D.4 for use by technology results
Ahmed et al. 2020	Retrospective cohort study	United States		Primary and specialty care practices at 2 large academic and 2 community hospitals of an integrated health system	Patients across five medical specialties	Assessment of novel metrics of e‑consult appropriateness and utility	e‑consult services	None	There were important variations in mean age, sex, and race of patients analysed in this study Dermatology e‑consult patients were younger (mean age, 38.6 years) than those with e‑consults in other specialties, and a lower percentage were female (55.3%)
Alexander et al. 2020	Cross-sectional study	United States		Stratified nationally representative audit of outpatient care	Patients accessing primary care	Analysis of national changes in the volume, type, and content of primary care delivered during the COVID‑19 pandemic, especially regarding office‑based vs telemedicine encounters	Telemedicine	Office‑based care	During the first 2 quarters of 2018, there were 158.8 million (95% CI, 152.1‑165.4 million) patient visits among White individuals (85.6% of visits among White or Black individuals) and 26.7 million (95% CI, 24.6‑28.7 million) patient visits among Black individuals (14.4%) Visits for Black individuals accounted for between 14.4% and 17.4% of visits of the period examined, and increases in telemedicine visits were similar among White individuals and Black individuals, with telemedicine visits accounting for 19.3% of 2020 treatment visits among White individuals and 20.5% of those of Black individuals Whereas individuals aged 19 to 35 years and aged 36 to 55 years accounted for 12.4% and 19.8% of office‑based visits, respectively, in Q1/Q2 of 2020, they accounted for 17.8% and 26.1% of telemedicine visits, respectively, during this period, indicating substantial adoption of telemedicine compared with their younger or older counterparts The proportion of visits delivered by telemedicine varied from a low of 15.1% in the East North Central region to a high of 26.8% in the Pacific region
Bhargava et al. 2021	Cohort study	United States		Not specified	21 070 patients	Evaluation of patients’ adoption and success of primary care e‑visits within an integrated health care delivery system	Primary care e‑visits	None	Among 21 070 total patient e‑visits, 17 014 (80.75%) were women, 10 728 (50.92%) were White, and they had a mean (SD) age of 36 (12.6) years Patient characteristics varied significantly by e‑visit concern (all P <. 001)
Bohm et al. 2020	Cohort study	United States		Not specified	9 051 app users	Analysis of the extent to which users engage with mHealth for diabetes and identification of patient characteristics that are associated with engagement	mHealth diabetes support app	None	Among app users who shared information about their gender, 56.86% (2075/3649) reported to be female More than half of the users were aged 50 years or older, and the average age of users was 50.4 years
Bourdon et al. 2020	Prospective cohort study	France		1 primary and 1 secondary emergency ophthalmology clinic	500 patients	Description of the population and diagnoses and evaluation of the main judgment criteria, defined as the ‘ability of teleconsultation to properly indicate a physical consultation for fair diagnosis and treatment in eye emergencies’	Emergency ophthalmology teleconsultation	None	Among 500 patients, 303 (60.6%) were men and 197 (39.4%) The distribution based on age was: 105 (21%) under 25, 184 (37%) 25‑45, 151 (30%), 45‑65, 60 (12%) over 65 434 (87%) lived in Paris and surrounding suburbs, 66 (13%) lived in the rest of France
Brenk-Franz et al. 2022	Cross-sectional study	Germany		1 family medicine practice	192 patients treated by general practitioners	Investigation of whether attachment and patient activation are potential predictors of the interest in and the use of e‑health applications in primary care patients	eHealth applications	Usual care	There was no influence of age, education or gender or influences of health factors in interest in telehealth applications Younger patients and patients with a higher degree of avoidant attachment reported more e‑health usage behaviour
Cantor et al. 2021	Cross-sectional study	United States		8 860 outpatient treatment facilities	n/a	Examination of the availability of telehealth services at outpatient mental health treatment facilities in the United States at the outset of the COVID‑19 pandemic, and identification of facility-level characteristics and state‑level policies associated with the availability	Telehealth services at outpatient mental health treatment facilities	None	Controlling for other factors, regression adjusted means indicate that telehealth services were more prevalent in the South (53.7%), West (47.8%), and Midwest (40.6%) compared with Northeast (26.8%, P <0.001), and in nonmetropolitan (53.2%) compared with metropolitan counties (40.3%, P <0.001) Facilities with public sector ownership (59.4%) versus non-profit (41.0%) or for-profit (36.2%) private facilities, facilities providing care to children and adults (45.2%) versus adults only (38.2%, P <0.001), and facilities not accepting Medicaid (54.0%) were also more likely to provide telehealth services (P <0.001)
Cho et al. 2021	Systematic review	Multiple	33	Multiple	7 382 patients with cancer using electronic symptom self-reporting systems (e‑SRS)	Exploration of the acceptance and use of home‑based electronic symptom self-reporting systems (e‑SRS) by patients with cancer and identification of associated facilitators and barriers	Electronic symptom self-reporting systems (e‑SRS) for patients with cancer	None	Younger age, higher education level, White race, and male sex were associated with higher acceptance and use of e‑SRS. Evidence regarding the influence of employment status was mixed See Table D.1 for user satisfaction results
Chunara et al. 2021	Prospective cohort study	United States		1 academic medical centre	494 322 patients	Assessment of disparities in those who accessed health care via telemedicine for COVID‑19 in a large academic health care system	Telemedicine clinical visits	In-person clinical visits	The mean age of patients using telemedicine in 2020 went up from 40.7 years (standard deviation [SD]: 13.7) in 2019 to 47.3 years (SD: 19.8) a difference of 6.5 years (95% CI, 5.6‑7.4 years) The proportion of men using telemedicine increased from 33.3% to 39.3% a difference of 5.9% (95% CI, 2.9% to 9.0%) The proportion of telemedicine visits by white patients decreased from 2019 to 2020, from 53.3% to 51.1%, a difference of −2.2% (95% CI, −5.5% to 1.0%), while those by Black patients increased from 8.0% to 12.9%, a difference of 4.9% (95% CI, 3.1% to 6.7%) respectively
Coley et al. 2022	RCT	Finland, France, Netherlands		Multiple	1.389 dementia-free community dwellers aged ≥65 years with at least basic computer literacy and either 2 or more CVD risk factors	Description of older adults’ engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors	eHealth intervention (a multicomponent internet-based platform to encourage lifestyle changes, with remote support from a lifestyle coach)	Simple static internet platform containing only basic health information and no coach support	At baseline, participants in the low engagement category were younger, had a lower level of education, had poorer cognitive and physical performance, and had more depressive symptoms than those who engaged more. Participants were more often from the Netherlands, more likely to be smokers, and less likely to have used a computer in the preceding 4 weeks or be planning or already acting on lifestyle change
Creedon et al. 2020	Cross-sectional study	United States		Claims data from the IBM MarketScan Multi-State Medicaid Database	1 335 138 unique beneficiaries aged 18‑64	Exploration of rural-nonrural trends in the prevalence and amount of mental and substance use disorder telemedicine received by adult Medicaid beneficiaries	Telemedicine for mental and substance use disorder	None	In 2012, 5.8% of rural beneficiaries had a telemedicine visit for mental disorder treatment, compared with 7.0% of nonrural beneficiaries. By 2017, rural beneficiaries overtook their nonrural counterparts, with 11.7% and 10.8%, respectively, having any telemedicine visits for mental disorder treatment Rural beneficiaries were more likely than nonrural beneficiaries to be non-Hispanic white (81.8% and 63.5%, respectively) and less likely to have a Medicaid managed care health plan (57.4% and 62.3%, respectively)
Daniel et al. 2020	Retrospective cohort study	United States		Data from Planned Parenthood Association of Utah (PPAU)	Not specified	Evaluation of demographic and service delivery differences between patients using telemedicine  before abortion	Telemedicine for informed consent visit prior to abortion	In-person visit for informed consent visit prior to abortion	Compared to in-person patients, telemedicine patients were slightly older (27 vs 25 median years, p < 0.001), more likely to live out of state (47% vs 4%, p < 0.001) and further away from PPAU clinics offering informed consent visits (104 miles vs 10 median miles, p < 0.001)
El-Nahal et al. 2022	Cohort study	United States		1 academic HIV centre	5 773 patients	Exploration of the impact of telemedicine on access to care for people with HIV (PWH) by comparing the proportion of PWH engaged in care prior to and during the COVID‑19 pandemic	Telemedicine visits	In-person visits	Participants age at least 60 years were 0.60 (95% CI 0.49‑0.75) times as likely as those aged 20‑39 years to complete a video visit (23 vs. 42%) Male participants were 0.76 (95% CI 0.62‑0.94) times as likely as female participants to complete a video visit Video visit completion among black participants was 0.60 (95% CI 0.42‑0.87] times as likely as among white participants (25 vs. 46%)
Eruchalu et al. 2022	Retrospective cohort study	United States		1 academic medical centre	4 908 patients	Investigation of racial/ethnic and socio-economic disparities in telemedicine compared with in-person surgical consultation during the COVID‑19 pandemic	Telemedicine visits	In-person visits	There were no significant differences demonstrated in virtual compared with in-person visit use across racial/ethnic groups Among patients using virtual visits, Latinx patients were less likely to have video compared with audio‑only visits than White patients (OR, 0.46; 95% CI 0.22‑0.96) Black race and insurance type were not significant predictors of video use. During Phase II, multivariable modelling demonstrated that Black patients (OR, 1.52; 95% CI 1.12‑2.06) were more likely to have virtual visits than White patients No significant differences were observed across insurance types
Garcia-Huidobro et al. 2020	Case‑control study (using retrospective and concurrent control groups)	Chile		1 private academic health network	3 962 patients who received, and 263 clinicians who provided, telemedicine care in March/April 2019 and March/April 2020	Investigation of the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions	Telemedicine visits	In-person visits	Patients accessing telemedicine were more likely to be female and have private insurance, and less likely to be children or older adults, or residents of the Santiago Metropolitan Region compared to both in-person control groups (P <. 01 for all comparisons) See Table D.1 for user satisfaction results
Haynes et al. 2021	Retrospective cohort study and cross-sectional study	United States		1 academic medical centre	1 292 patients	Identification of patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the COVID‑19 pandemic	Video telemedicine visits	In-person or telephone visits	Patients over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22‑0.52, P <. 001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31‑0.91, P =.02), and patients with public insurance (OR: 0.64, 95% CI: 0.49‑0.84, P =.001)
Hsueh et al. 2021	Cross-sectional study	United States		1 regional, multi-centre medical group	642 370 patients	Exploration of video use compared with telephone, for patients with limited English proficiency (LEP) self-scheduling a primary care visit during the COVID‑19 pandemic	Video telemedicine visits	Telephone telemedicine visits	Across all telemedicine visits, 454 741 patients were with (47.6%) White patients, 216 788 (22.7%) Asian patients, and 196 483 (20.6%) Hispanic patients 409 632 (42.4%) patients were with men 195 612 (20.2%) patients were from low socio‑economic status (SES) neighbourhoods. 2.4% telemedicine visits were with EHR-documented interpreter need. After multivariate adjustment, LEP vs no LEP was associated with lower video visit use (OR, 0.77; 95% CI, 0.74‑0.80; adjusted video visit frequency of 34.7% for LEP vs 39.8% for no LEP)
Jain et al. 2020	Cross-sectional study	United States		Users of a direct-to-consumer (DTC) telemedicine service	n/a	Exploration of the use of a direct-to-consumer (DTC) telemedicine service	DTC telemedicine service	None	Among the 35 131 DTC telemedicine visits in our sample, 25 162 (73.9%; 95% CI, 73.4%‑74.4%) were from female users, and the mean (SD) user age was 36 (12) years Compared with the overall population in these 20 states, direct-to-consumer (DTC) telemedicine patients were more likely to live in urban areas (85.0% vs 75.4%; P < .001) and areas with a higher income (32.8% vs 25.0% of the top quartile of zip code median household income; P < .001)  Of all DTC telemedicine visits, 14.4% (95% CI, 14.0%‑14.8%) were for patients living in a primary care health professional shortage area
Jiang et al. 2021	Case study	United States		1 paediatric otolaryngology clinic	3 478 patients	Assessment of equal access to telemedicine for specialty care and identification of potential barriers that may negatively impact telemedicine utilisation	Paediatric otolaryngology service telemedicine visits	Paediatric otolaryngology service in-person visits	There was no difference in patient age and gender between telemedicine and in-person groups. The proportions of Spanish-speaking families were similar (15.8% in 2019 vs. 14.4% in 2020, P =.96), though Spanish-speaking families were statistically more likely to require rescheduling of their telemedicine visits (17.2%) when compared to the overall rescheduling rate of 11.9% (P =.0083) The percentage of Medi-Cal-insured patients (51.4% in 2019 vs. 49.8% in 2020, P =.73) and the mean poverty level (12.6% in 2019 vs. 12.2% in 2020, P =.38) also remained the same
Lattimore et al. 2021	Prospective cohort study	United States		1 academic tertiary care centre	14 792 patients	Examination of demographic and socio-economic differences in surgical patient telemedicine usage during the COVID‑19 pandemic	Telemedicine visits during the pandemic	In-person visits pre‑pandemic and during the pandemic	Compared to visits before the pandemic, telemedicine visits during COVID‑19 were more likely to be with patients from the least socio-economically distressed communities (OR, 1.31; 95% CI, 1.08,1.58; P = 0.005), and with non-government or commercial insurance (OR, 2.33; 95% CI, 1.84‑2.94; P <. 001) Adjusted comparison of telemedicine visits to in person visits during COVID‑19 revealed telemedicine users were more likely to be female (OR, 1.38, 95% CI, 1.10‑1.73; P = 0.005) and pay with non-government or commercial insurance (OR, 2.77; 95% CI, 1.85‑4.16; P <. 001)
Martinez et al. 2020	Cross-sectional study	Colombia		Patients using the Telepsychiatry programme across 8 towns	111 telepsychiatry patients	Description of the experience of physicians and patients in the Telepsychiatry programme at the University of Antioquia’s Faculty of Medicine in the first 12 months after its implementation	Telepsychiatry programme	None	Patients seen by telepsychiatry were predominantly 27‑59 years old (55.9%), women (69.4%), educated to the secondary school level (33.4%), and living in an urban area (93.8%) See Table D.1 for user satisfaction results
Moss et al. 2021	Retrospective cohort study	United States		3 neuro‑ophthalmology outpatient practices	1 167 patients	Evaluation of the impact of COVID‑19 on outpatient neuro‑ophthalmic care by comparing clinical visits in 3 practices	Neuro‑ophthalmic care delivery during the early COVID‑19 pandemic	None	Synchronous telehealth visits were more likely to be accessed by older patients (51.0±18.3) as compared to in office visits (49.7 ± 18.9), and patients who lived closer. See Table D.4 for use by technology results
Nguyen et al. 2020	Retrospective cohort study	Australia		Rural and remote communities in Western Australia	Not specified	Exploration of observational trends related to the availability of on-call telehealth services for Aboriginal and Torres Strait Islander	On-call telemedicine services with a specialist ophthalmologist	Online booking with in-person teleophthalmology consultation	The proportion of Aboriginal and Torres Strait Islander patients in the on-call telehealth cohort was 51.4% (n = 147), compared to the online‑booking telehealth group at 8.7% (n = 65) (p < 0.01). This represents an odds ratio for Aboriginal and Torres Strait Islanders accessing on-call services compared to online booking of 11.03 (7.82‑15.56) Remoteness of the patient increased with the availability of on-call telehealth
Omboni et al. 2021	Retrospective cross-sectional study	Italy		Telehealth platform used at scale to manage chronic disease patients in the Italian community	13 613 patients	Outlining of the experience of a telehealth platform used at scale to manage chronic disease patients in the Italian community during the COVID‑19 pandemic	Remote monitoring of blood pressure, heart rate, blood oxygen saturation, body temperature, body weight, waist circumference, blood glucose, and lipids at home through a dedicated smartphone app	None	During the lockdown period, patients performing tests and transmitting readings were older (mean 49.1) and more often males (68.2%) than during the period preceding the lockdown
Rametta et al. 2020	Retrospective cohort study	United States		1 paediatric specialty care network composed of an urban quaternary care hospital, an ambulatory centre, and an additional 8 satellite locations offering child neurology care	All in-person and telehealth encounters during study period	Assessment of the rapid implementation of child neurology telehealth outpatient care with the onset of the COVID‑19 pandemic	Telemedicine, exclusively referring to patient encounters performed through the audio and video software	In-person encounters	Self-reported ethnicity and race were not different between the cohorts except for a small increase in the number of individuals self-reporting as multiple races in the telehealth cohort. MHI was identical between the cohorts. There were no differences in age, self-reported ethnicity, race, and MHI when the in-person cohort was compared to only the telemedicine component of the telehealth cohort (excluding telephone encounters) See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Rastogi et al. 2020	Cross-sectional study	United States		Large, national, direct-to-consumer telemedicine system	20 600 patients	Description of urinary tract infection (UTI) management in a large nationwide direct to consume (DTC) telemedicine platform	direct to consume (DTC) telemedicine service	None	The majority of patients were female (96%), and 53% were between the ages of 18‑39 years, and 1% were 65 years and older. Most patients (34%) were from the South, followed by the Midwest (31%), West (22%), and Northeast (12%) Eighty-eight percent reported insurance information
Rodriguez et al. 2021	Retrospective cohort study	United States		1 tertiary care centre	Not specified	Examination of the patient characteristics associated with completion of in-person (IPV) and telemedicine visits in a high-volume gastroenterology (GI) clinic	Videoconferencing visits (VV) and telephone visits (TV)	In person visits (IPV)	Comparing in-person visits (IPV) from 2019 and all telemedicine visits, videoconferencing visits (VV) and telephone visits (TV) in 2020, there were no significant differences in mean age, racial/ethnic distribution, median income by zip code, insurance, or appointment type (new vs return) On univariate analyses, the VV cohort was significantly younger than the IPV group (46.0 ± 17.0 vs 53.1 ± 17.8 years; P < .0001) The VV cohort had a lower proportion of black (3.48% vs 7.02%; P < .0001) and Latino (3.48% vs 9.92%; P <. 0001) patients, more private commercial insurance coverage (74.1% vs 54.6%; P = 0.0001), and higher income by zip code (USD 75 850 vs USD 72 292; P < .0001) compared with the IPV group
Rowe et al. 2021	Cohort study	Australia		1 tertiary hospital	1 515 patients	Identification of characteristics contributing to choosing telephone (TP) versus video consultation (VC) and assess patient outcomes between telehealth modalities	Video consultations (VC)	Telephone consultations (TP)	Patients choosing TP over VC were older (P < 0.001), more likely to be female (P = 0.005), non-English-speaking (P = 0.041), living in metropolitan Melbourne (P < 0.0001), undertaking a first appointment (P = 0.002) and seeing particular cardiologists (P < 0.001) See Table D.4 for use by technology results
Sammour et al. 2021	Retrospective cohort study	United States		1 institute	3 570 patients with heart failure	Identification of telehealth visits for patients with primary or secondary diagnosis of heart failure or cardiomyopathy	Telehealth interventions for heart failure or cardiomyopathy patients	None	The mean age of patients seen via outpatient telehealth visits was 70.8 ± 14.1 years, 55% were males, 82% were Caucasians Older age, African American race, lack of spouse or significant other (i.e. single, divorced, or widowed), lack of college education, and lower median household income by zip code were predictors of decreased use of video capabilities See Table D.4 for use by technology results
Sen et al. 2022	Retrospective cohort study	United States		1 largest private insurance provider	Patients enrolled in Alabama’s s Children’s Health Insurance Program (CHIP), ALL Kids	Examination of disparities in telehealth utilisation in a population of publicly insured children	Telehealth	In person care	Compared to the reference category of Non-Hispanic (NH) White, NH Black and Hispanic children had lower odds of telehealth use (odds ratio [OR]: 0.81, 95%confidence interval [CI] [0.76‑0.86]; OR: 0.68, 95% CI[0.60‑0.76], respectively) Compared with NH White, NH Black and Native American children had higher odds of no medical claims (OR: 1.11, 95% CI [1.08‑1.19];OR: 1.73, 95% CI [1.46‑2.10], respectively).Compared with children with an Urban RUCA (Rural Urban Communing Area) designation, those in Large Rural, Small Rural, and Isolated designations had lower odds of telehealth use (OR: 0.76, 95%CI [0.71‑0.81]; OR: 0.71, 95% CI [0.65‑0.75]; OR: 0.68,95% CI [0.65‑0.71], respectively), and those in Large Rural designations also had lower odds of no medical claims (OR:0.88, 95% CI [0.85‑0.91]) In comparison to the reference low-fee group, the expansion and no-fee groups had statistically higher odds of telehealth use (OR: 1.10, 95%CI[1.06‑1.20]; OR: 1.43, 95% CI [1.16‑1.78], respectively); the fee, expansion, and no-fee groups all had statistically lower odds of no medical claims (OR: 0.84, 95% CI [0.80‑0.88]; OR: 0.68, 95% CI [0.65‑0.71]; OR: 0.45, 95% CI[0.37‑0.55], respectively). There were no significant differences between female and male children in telehealth use, but female patients had lower odds of no medical claims
Smith et al. 2021b	Retrospective cohort study	United States		1 academic centre	18 278 adult patients	Assessment of quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the COVID‑19 pandemic.	Virtual urgent care (VUC) visits	None	The virtual urgent care (VUC) median age was 40 years (interquartile range [IQR] = 32‑53 years), which was slightly older than the median age of 39 years (IQR = 31‑50 years, p = 0.006) in the VUC cohort from one year prior The VUC median age was slightly younger than the age of ED discharged patients (43 years; IQR = 31‑58 years, p < 0.001)
Stephen et al. 2022	Systematic review	Australia, Greece, Italy, Korea, Netherlands, New Zealand, Norway, United States	14	Multiple	Diabetes patients	review of literature on changes in patient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care	mHealth apps	None	In one study, the lowest percentage of app users was found in the age group 56 years or above. However, another study found that increased mHealth app usage has been positively correlated with increasing age One study reported that mHealth app interventions that did not cater to diverse socio-economic backgrounds including those who have access to fewer resources would lead to lower rates of use
Titov et al. 2020	Cross-sectional study	Australia		MindSpot Clinic, an online clinic funded by the Australian Department of Health	Not specified	Identification of demographic characteristics and treatment outcomes of patients registered with MindSpot over the first 7 years of clinic operation	MindSpot Services	None	The mean age of patients in the total sample was 35.7 years (SD 13·8) and 88 702 (72·9%) were women During the 7 years of clinic operation, small but significant changes were observed in the age, sex, Indigenous status, employment, education, and marital status of people initiating an assessment See Table D.1 for user satisfaction results
Xiong et al. 2021	Retrospective cohort study	United States		2 academic medical centres	11 056 patients	Evaluation of changes in patients’ use of telemedicine for elective orthopaedic care based on race or ethnicity, primary language, and insurance status	Telemedicine use of orthopaedic services among new patients in 2020	In-person use of orthopaedic services in 2019	After adjusting for age, gender, subspecialty, insurance, and median household income, patients who were Hispanic (odds ratio 0.59 [95% confidence interval 0.39 to 0.91]; p = 0.02) or Asian were less likely (OR 0.73 [95% CI 0.53 to 0.99]; p = 0.04) to be seen through telemedicine than were patients who were white Speakers of languages other than English or Spanish were less likely to have a telemedicine visit than were people whose primary language was English (OR 0.34 [95% CI 0.18 to 0.65]; p = 0.001) Patients insured through Medicaid were less likely to be seen via telemedicine than were patients who were privately insured (OR 0.83 [95% CI 0.69 to 0.98]; p = 0.03)
Yuan et al. 2021	Cohort study	United States		1 multi-site health system	Not specified	Exploration of whether remote visits for heart failure care were associated with different patient usage, clinician practice patterns, and outcomes	Remote care visits for heart failure care	In-person heart failure care	During the COVID‑19 era, video and telephone visits were more likely to be with non-White patients (35.8% video, 37.0% telephone versus 33.2% in-person) Those seen by video visits were more likely to be younger (64.7 years old [14.5] video versus 74.2 [14.1] in-person), male (68.3% versus 61.4%), and privately insured (45.9% versus 28.9%), while those seen by telephone visits were more likely to be female (42.4% telephone versus 38.6% in-person; P<0.05 for all comparisons) See Table D.4 for use by technology results
Zachrison et al. 2022	Retrospective cohort study	United States		National emergency department (ED) Inventory data	n/a	Examination of data to determine an association between emergency department (ED) payer mix and receipt of telehealth services	Telemedicine services	No telemedicine services	Rural location, academic status, and annual ED visit volume were not significantly associated with odds of ED telehealth receipt in the adjusted model Medicaid and self-pay patients had decreased odds of telehealth receipt (odds ratio 0.87 per 5% increase, 95% CI, 0.77‑0.99)

Table D.4. Overview of included papers with results on telemedicine use by type of technology

Author	Design	OECD Country(s)	Primary studies (if applicable)	Setting	Patients/clinicians	Description of study	Intervention	Comparator	Relevant findings and conclusions
Agastiya 2022	Systematic review	Korea, Netherlands	6	Multiple	Patients with type 2 diabetes (T2D)	Investigation of the impact of telehealth on self-management among patients with type 2 diabetes	Telehealth	None	The application of telehealth as a treatment for patients with T2D was conducted using e‑health and mHealth, either developing a particular application, online platform, or text/video messages
Abrashkin et al. 2018	Retrospective cohort study	United States		1 community paramedicine programme	Not specified	Analysis of data from a telemedicine‑capable community paramedicine programme	Emergency department (ED) transport with video communication	ED transport with telephonic communication	Of 1 707 community paramedicine responses between 2015 and 2017, 899 (53%) successfully used video; 808 (47%) used telephonic communication See Table D.3 for use by demographic results
Behmanesh et al. 2022	Systematic review	Multiple	77	Multiple	Multiple	Systematic identification and classification of tele‑orthopaedic applications and services	Tele‑orthopaedic applications and services	None	Most of the articles (36%) discussed the use of tele‑orthopaedic services after orthopaedic interventions Telemonitoring (telemetry and teleconsultation) have always been used in all periods of care. Robotics, virtual reality (VR) and augmented reality (AR) technologies in telesurgery (telemetry and telementoring) have been used in the perioperative period
Ben-Assuli 2022	Systematic review	Australia, Canada, Denmark, Finland, Germany, Israel, Japan, Mexico, Spain, United Kingdom, United States	22	Multiple	Diabetes patients	Survey of the recent literature on the implementation of telehealth for diabetes management that incorporates cost-effectiveness analyses	Telehealth	None	The main type of telemedicine was the telephone followed by teleopthalmology and telemonitoring Two articles focused on teleconsultations and apps or mobile software apps. One paper explored the use of telemedicine via the web
Berlin et al. 2021	Cohort study	Canada		1 hospital cancer centre	3 507 cancer patients and 284 practitioners	Examination of the outcomes of a cancer centre – wide virtual care programme in response to the COVID‑19 pandemic	Cancer centre – wide virtual care programme	None	During the study period, 22 085 virtual care visits occurred, including 17 888 telephone visits and 4 197 video visits See Table D.1for user satisfaction results
Bertini et al. 2022	Systematic review	Australia, Canada, Israel, Italy, Korea, Norway, Spain, Switzerland, United Kingdom, United States	28	Multiple	Patients with gestational diabetes mellitus	Evaluation of the impact of remote monitoring technologies in assisting patients with gestational diabetes mellitus to achieve glycaemic goals	Remote monitoring technologies for patients with gestational diabetes mellitus	None	11 articles did not specify which device they used The glucometer BlueTooth was used in 6 articles (22.2%) of the total number of articles chosen. Three articles (11%) used the Smart Glucometer, two articles used a glucometer with an infrared port, which emits the information to a device reader, and two articles used a continuous glucose monitor See Table D.1 for user satisfaction results
Cher et al. 2021	Cohort study	United States		1 university medical centre	n/a	A longitudinal study to describe the COVID‑19 telephone triage hotline used by a large academic medical centre in the midwestern the United States	A telephone hotline to triage inbound patient calls related to COVID‑19	None	Callers were most often directed to the institutional patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or Occupational Health Services (709/3929, 18%) Incoming call volumes were highest between 6 AM and 11 AM and steadily decreased throughout the remainder of the day with the exception of a brief resurgence between 6 PM and 12 AM Hourly call volumes were lower on the weekends than during weekdays, but volumes were similarly distributed throughout the day
Haimi et al. 2022	Systematic review	Ireland, Italy, Netherlands, Poland, Türkiye, United States,	11	Multiple	Multiple	Exploration of the availability, application, and implementation of telehealth services during the COVID‑19 era, designed for the aged population (age 65 and more)	Telehealth services for the aged population	None	In the included studies, different types of telehealth applications were applied, including telephone calls (n = 1), live video conferencing (n = 3), both telephone and video (n = 3), online programme (n = 1), smartphone application (n = 1), IoT (internet of things) and cloud computing (n = 1), and “regular” social networks (n = 1)
Jacomet et al. 2020	Case‑controlled study	France		46 co‑ordinated care clinics	288 patients	Evaluation of use and perceived benefits and barriers to health/wellness applications (apps) and smart devices among people living with HIV (PLHIV) and their physicians	Health/wellness applications (apps) and smart devices	None	10% of participants (30/288) used wellness apps and 18% (52/288) used fitness tracking apps Only 12 patients (4%) used health-related apps (HIV and/or others) to feel more confident in their health and have more firmly documented discussions with their physician (67%), or to improve their general health and be more self-managing (58%)
Khoo et al. 2021	Systematic review	Australia, Canada, France, Germany, Netherlands, Korea, Spain, United Kingdom, United States	31	Multiple	1 977 patients	Identification and evaluation of scientific literature on mobile health (mHealth) interventions to promote physical activity (PA) or reduce sedentary behaviour (SB) in cancer survivors	mHealth interventions for physical activity promotion in cancer survivors	None	The most commonly used mHealth technology was activity trackers with ten studies using only activity trackers, six studies using activity trackers and affiliated app, and four studies combined activity trackers with text messages Eight studies featured a smartphone app in their interventions, whereas three studies used text messages One study combined multiple mHealth components, e.g. activity trackers, app, and text messages
Kirakalaprathapan 2022	Systematic review	Germany, Greece, Israel, Italy, Japan the Netherlands, Spain, Switzerland, United States	12	Multiple	Multimorbid, older adults with cardiovascular disease (CVD)	Assessment of the comparative efficacy of integrated telehealth versus other strategies of chronic disease management in older, multimorbid adults with heart failure in primary care and community settings	Telehealth	Other strategies	All studies used telephones in their integrated care (n = 22), with most also using remote monitoring (RM; n = 17) and computers (n = 11) Fewer studies incorporated video (n = 6), electronic patient records (EPR; n = 5), websites (n = 2), or wearable technologies (n = 1) The most common combination of telehealth modalities was telephone and RM (n = 5) Out of the six studies demonstrating negative effects of integrated telehealth, almost all of these studies (n = 5) considered multimodal interventions
Mohammadzadeh et al. 2021	Systematic review	Multiple	50	Multiple	Patients with cardiovascular disease treated with cardiology interventions	Review of the effectiveness of implemented telecardiology services	Telecardiology services	None	Telecardiology has been used in most studies for Tele‑monitoring (n = 21, 42%) and tele‑consultation (n = 17, 34%) In 29 studies (58%), telemedicine technology was applied for ECG transmission and in 13 studies (26%) for echocardiogram transmission See Table D.1 for user satisfaction results See Table D.5 for cost results
Morris et al. 2021	Systematic review	Multiple	54	Multiple	Not specified	Review of how digital technologies have been used to support rural oncology care	Digital technologies to support oncology care	None	Technology utilised in the 54 articles was categorised as Telemedicine (n=32), phone calls (n=11), Internet (n=9), and mobile phone (n=2) See Table D.1 for user satisfaction results See Table D.5 for cost results
Moss et al. 2021	Retrospective cohort study	United States		3 neuro‑ophthalmology outpatient practices	1 167 patients	Evaluation of the impact of COVID‑19 on outpatient neuro‑ophthalmic care by comparing clinical visits in 3 practices	Neuro‑ophthalmic care delivery during the early COVID‑19 pandemic	None	Nine hundred 60‑nine (83%) of visits were in-office, 179 (15.3%) were synchronous video + audio, 15 (1.3%) were synchronous audio only, and 4 (0.3%) were asynchronous interprofessional consults See Table D.3 for use by demographic results
Ning et al. 2021	Systematic review	Multiple	32	Multiple	Multiple	Evaluation of existing literature on telemedicine in otolaryngology and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies	Telemedicine	None	Nineteen studies employed asynchronous or store‑and-forward models Eleven studies used synchronous telemedicine The remaining two articles compared both types
Philippe 2022	Systematic review	Multiple	304	Multiple	Patients with mental health conditions	Systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions	Digital health interventions	None	Synchronous contact remains the primary form of treatment where other forms of digitally enabled treatment are only supplementary
Rowe et al. 2021	Cohort study	Australia		1 tertiary hospital	1 515 patients	Identification of characteristics contributing to choosing telephone (TP) versus video consultation (VC) and assess patient outcomes between telehealth modalities	Video consultations (VC)	Telephone consolations (TP)	Overall, 1 188 (78.4%) patients were seen by telephone (TP) and 327 (21.6%) patients by video consultation (VC) appointment See Table D.3 for use by demographic results
Sammour et al. 2021	Retrospective cohort study	United States		1 institute	3 570 patients with heart failure	Identification of telehealth visits for patients with primary or secondary diagnosis of heart failure or cardiomyopathy	Telehealth interventions for heart failure or cardiomyopathy patients	None	30% of the telehealth visits were videos, while 70% were telephone visits, with increasing use of video visits throughout the study period See Table D.3 for use by demographic results
Snoswell et al. 2021	Systematic review and meta‑analysis	Australia, Canada, Denmark, Korea, Netherlands, Portugal, United Kingdom, United States	17	Multiple	2 015 patients	Examination of the change in quality of life for patients with asthma who use interactive telehealth interventions	Telehealth interventions used by asthma patients	None	The type and duration of the telehealth interventions varied in the included studies. Seven studies evaluated interactive web-based portals that combined a number of strategies and provided feedback Four studies described an asthma management intervention that was delivered through a smartphone app Remote monitoring with asynchronous management was used in 5 studies that describe 4 different interventions
Turk et al. 2022	Systematic review	United States	7	Multiple	1 347 986 patient visits for acute respiratory tract infections (ARTIs)	Systematic review exploring antibiotic prescribing patterns for ARTIs among adults in virtual urgent care settings	Virtual visits	None	One study conducted virtual visits with an audio and video – enabled monitor In three studies, virtual visits were preferentially performed using live interactive video; however, visits were conducted by phone if patients were unable to connect by video One study conducted virtual visits using a text-based format available from a smartphone or computer Two studies assessed Teladoc, which primarily conducts telephone visits
Yuan et al. 2021	Cohort study	United States		1 multi-site health system	Not specified	Exploration of whether remote visits for heart failure care were associated with different patient usage, clinician practice patterns, and outcomes	Remote care visits for heart failure care	In-person heart failure care	7 775 (70.0%) outpatient cardiology visits were conducted in person, 1 009 (9.1%) by video, and 2 322 (20.9%) by telephone See Table D.3 for use by demographic results
Zachrison et al. 2021	Cross-sectional study	United States		1 multi-site health system	1 530 772 patients	Evaluation of the association between the growth of virtual care and health care utilisation in an integrated delivery network	Virtual ambulatory care visits	In-person at home and in-person on site ambulatory care visits	811 309 (53%) patients had only in-person ambulatory visits; 627 617 (41%) had in-person and virtual; and 91 846 (6%) had only virtual visits Among patients with both in-person and virtual visits, most conducted fewer than half of the visits virtually (median, 33%; IQR, 20%‑50%) Of all encounters, 23.8% were virtual, 8.2% were in-person at home, and 68.0% were in-person onsite

Table D.5. Overview of included papers with results on the cost of telemedicine

Author	Design	OECD Country(s)	Primary studies (if applicable)	Setting	Patients/Clinicians	Description of study	Intervention	Comparator	Relevant findings and conclusions
Absolom et al. 2021	RCT	United Kingdom		1 cancer centre	508 consenting patients and 55 health professionals	Evaluation of the impact of eRAPID on symptom control, health care use, patient self-efficacy, and quality of life (QOL) in a patient population treated predominantly with curative intent	Mobile health app	Usual care	Impact on hospital services led to high cost-effectiveness of the use of an mHealth app The analysis of hospital workload showed that improved patients’ physical well-being in the curative treatment setting can be achieved in a cost-effective way
Amici et al. 2021	Cohort study	Italy			21 automated peritoneal dialysis (APD) patients aged 69 ± 13 years	Exploration of the impact of Remote patient monitoring (RPM) compared to traditional technology, in clinical, organisational, social, and economic terms in a single centre	Remote patient monitoring (RPM)	Usual care	The analysis highlighted how the RPM system led to relevant economic savings, which for the health system have been calculated EUR  335 (mean per patient-month) With the social costs represented by the waste of time of the patient and the caregiver, we calculated EUR 685 (mean per patient-month)
Andrees et al. 2020	Systematic review	Canada, Norway, New Zealand, Spain, United Kingdom, United States	23	Multiple	Dermatology patients	Overview of effectiveness, costs, feasibility, and accuracy of live interactive (LI) applications compared to standard care is missing. The present systematic review provides this overview on LI teledermatology.	Live interactive teledermatology	None	LI applications can be a time effective substitute of or supplement to standard dermatological care Results demonstrated that LI and standard care are comparable regarding feasibility and accuracy No clear tendencies can be reported regarding costs. However, there is a lack of current comparative studies
Appleton et al. 2021	Systematic review	Multiple	77	Multiple	Staff working within the field of mental health, people receiving organised mental health care for any condition, family members or carers of people receiving mental health care	Investigation of the adoption and impacts of tele‑mental health approaches during the COVID‑19 pandemic, and facilitators and barriers to optimal implementation	Any form of spoken or written communication carried out between mental health professionals and service users/family members/unpaid carers	Any mental health communication delivered face‑to-face, digitally or remotely, waitlist control, or placebo	Initial evidence suggests remote care is not a costly intervention, with 1 paper stating that telemental health is “cost-effective”, while another mentions the use of “low-cost technologies” by clinicians There was limited information about costs of implementation of remote care in the included studies and no actual costs of telemental health were reported in the papers See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Aquilanti et al. 2020	Systematic review	Australia, France, Germany	13	Multiple	Patients and health practitioners	Assessment of the feasibility of teledentistry in communities or in a domiciliary setting where elderly people live	Teledentistry	None	Three studies reported a cost analysis and cost description; one study showed that 28% of the residents asserted that the most valuable element of Teledentistry was convenience in terms of costs savings and disruption and difficulty avoidance The application of Teledentistry in the provision of the oral care of elderly people could allow savings in terms of travel (via car or ambulance), caregiver escort time to accompany the patient, and patient disruption The additional cost of Teledentistry is associated with training, increasing the total cost amount. However, new skill development among caregivers and the strengthening of health team capacities could be achieved through supportive environments and remote learning sessions See Table D.1 for user satisfaction results
Auener et al. 2021	Systematic review	Canada, Belgium, Denmark, Finland, Israel, Italy, Japan, Netherlands, Spain, Sweden, United Kingdom, United States	29	Multiple	Patients with chronic heart failure	This systematic review aims to study the effect of telemonitoring programs on health care utilisation and costs in patients with chronic heart failure	Telemonitoring programs	None	Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences Health care cost reductions were realised through a reduction in hospitalisations, whereas increases were caused by the high costs of the telemonitoring programme or increased health care utilisation
Avidor et al. 2020	Systematic review	Canada, United States	7	Multiple	Not specified	Review of the most recent published literature on economic evaluations of telemedicine in diabetic retinopathy (DR) screening and summarise the evidence on the cost-effectiveness of this technology	Telemedicine for DR	None	DR telemedicine technology has the potential to provide significant cost savings, especially in low-income populations and rural patients with high transportation costs
Barnett et al. 2021	Systematic review	Australia, Canada, Colombia, Denmark, France, Germany, Israel, Japan, Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, United Kingdom, United States	19	Multiple – Umbrella review	Staff working within the field of mental health, people receiving mental health care or with mental health diagnoses, family members, or carers of people receiving mental health care	Umbrella review of systematic reviews available on the literature and evidence‑based guidance on telemental health, including both qualitative and quantitative literature	Any form of spoken or written communication conducted between mental health professionals and patients, service users, family members, carers, or other mental health professionals using either the internet or the telephone	None	2 reviews reported cost-effectiveness, one on this topic only and the other in combination with clinical effectiveness One review concluded that telepsychiatry can be cost-effective as compared with face‑to-face interventions, particularly in rural areas The second review reported that 60% (15/25) of the included studies found telepsychiatry programs to be less expensive than standard in-person care, due to savings such as the travel time and reduced need for patients and their families to take time off work The cost-effectiveness analyses suggested telepsychiatry was less cost-effective than face‑to-face alternatives. Accordingly, the review concluded that variation was due to a large disparity in the reporting of costs See Table D.2 for patient safety results
Basit et al. 2020	Systematic review	Germany, Spain, United Kingdom, United States	17	Multiple	Persons with depression, bipolar disorder, or schizophrenia	Assessment of the evidence for telemedicine interventions for pharmacologic adherence in persons with depression, bipolar disorder, or schizophrenia	Telemedicine	Usual care	Cost information was reported for 2 studies One showed telephone calls instead of face‑to-face appointments for a year resulted in costs of USD 239.5 per participants, not including overheads The 2nd reported that a telemonitoring and telephone consultation programme resulted in the average cost of treatment per patient per month to be USD 180 for PharmCAT and USD 130 for an electronic medication monitor
Bautista-Mesa et al. 2020	Clinical trial	Spain		1 hospital	83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients completed the study	A cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant	Remote monitoring (RM)	Conventional monitoring (CM)	After the five‑year follow-up period results revealed that total costs per patient were 23.02% lower for the RM group than the CM group, corresponding to a saving of EUR  82.10 per patient
Ben-Assuli 2022	Systematic review	Australia, Canada, Denmark, Finland, Germany, Israel, Japan, Mexico, Spain, United Kingdom, United States	22	Multiple	Diabetes patients	Survey of the recent literature on the implementation of telehealth for diabetes management that incorporates cost-effectiveness analyses	Telehealth	None	Most (9 papers) of the cost-effectiveness analyses dealt with direct cost care per patient The measurement approaches to evaluating telemedicine also considered system costs, health coaching and prospective analyses, and time spent by medical staff on treatment The Markov model was most often used, followed by Decision trees 4 papers did not describe the models
Ben-Zeev et al. 2021	Cost analysis nested in an RCT	United states		3 pychiatric centres	163 participants	Comparison of the costs of implementing a smartphone‑delivered mobile health (mHealth) intervention (called FOCUS) with the costs of implementing a clinic-based group intervention (Wellness Recovery Action Planning [WRAP]) for serious mental illness	mHealth intervention (FOCUS) / Wellness Recovery Action Planning (WRAP)	Usual care	The average annual cost to providers was USD 78 212 for WRAP and USD 40 439 for FOCUS In both groups, labour accounted for the largest cost, followed by indirect costs and overhead costs When indirect costs were excluded, WRAP cost USD 520 per client per month, compared with USD 256 for FOCUS
Brown et al. 2021	Systematic review	Australia, Netherlands, United Kingdom, United States	13	Multiple	Not specified	Evaluation of the evidence for telegenetics and its applicability to future service development	Videoconferencing to deliver consultations in any area of clinical genetics	None	Considering the costs to set up virtual consultation platforms and their maintenance, as well as the labour time, virtual methods were reportedly more cost effective See Table D.1 for user satisfaction results
Cabrera et al. 2021	Systematic review	Australia, United States	9	Multiple	Not specified	Evaluation of published literature for cost related to the implementation of telemedicine across otolaryngology, and to determine cost minimisation (CM) when compared to in-person visits	Telehealth	None	CM in the United States ranged from USD 68 to USD 900 per visit Cost was evaluated in general otolaryngology, sleep medicine, otology, and head and neck cancer surgery, the latter had the most benefit
Cartwright et al. 2021	Systematic review	Canada, Italy, Mexico, Spain, United Kingdom, United States	15	Multiple	1 334 patients on peritoneal dialysis	Identification and assessment of ‘active’ eHealth-based interventions to support patients and their caregivers in delivering and managing -peritoneal dialysis (PD)	eHealth interventions	None	eHealth interventions in PD have shown to lower hospitalisation costs with decreased visits See Table D.1 for user satisfaction results
Chen et al. 2022	Systematic review	Multiple	112	Multiple	3 825 children and adolescents diagnosed with autism spectrum disorder (ASD)	Systematic review to verify the efficacy and validity of Extended Reality (XR) and Telehealth interventions for children and adolescents with ASD	Extended Reality (XR) and Telehealth interventions	None	There were 3 articles conducted to address cost reduction with children with ASD, and one article was conducted to address Insomnia with autistic children and adolescents. For cost reduction, the main technology used was home‑based telehealth. One study pointed out that home‑based telehealth was the least costly treatment intervention compared to clinic-based and in home therapy
Chua et al. 2022	Systematic review	Australia, Belgium, Italy, Korea, Norway, United Kingdom, United States	11	Multiple	Patients with chronic diseases	Systematic review to describe the willingness to pay (WTP) for telemedicine interventions and to identify the factors influencing WTP among patients with chronic diseases in high-income settings	Telemedicine interventions	None	The proportion of people willing to pay for telemedicine ranged from 19% to 70% across the studies, whereas the values for WTP amounts ranged from USD 0.89 to USD 821.25 A statistically significant correlation was found based on age and distance to a preferred health facility with the WTP for telemedicine Higher age was associated with a lower WTP, whereas longer travel distance was associated with a higher WTP
Colomina et al. 2021	Implementation trial	Spain		1 university hospital	59 patients undergoing primary total hip or knee arthroplasty	Assessment of the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)-enabled integrated care (IC) model for complex chronic patients undergoing primary total hip or knee arthroplasty	Mobile health enabled integrated care model	Usual care	The IC programme generated savings from EUR 109.88 (USD 132.96) to EUR 126.99 (USD 153.66) per patient, depending on the nature of unplanned visits and hospitalisations The IC programme was cost-effective according to incremental cost-effectiveness ratio, performing similar in terms of QoL gain while reducing overall expenses because of the reduction of unplanned visits and hospital admissions
Cottrell et al. 2021b	Audit study	Australia		1 tertiary hospital	Patients referred to the hospital’s orthopaedic or neurosurgery department for a specialist medical consultation	Description of the economic- and service‑related outcomes of these two methods of service delivery through retrospective audit of electronic medical records	Remote delivery of “fly in fly out” model of care (FIFO)	In-person delivery of “fly in fly out” (FIFO)	An estimated cost-savings of 13% for the telehealth model could be achieved when compared to the FIFO model See Table D.2 for patient safety results
Cuadrado et al. 2021	Retrospective cohort study	Spain		1 tertiary hospital 43km from 1 prison	75 prison inmate patients who received anti-HCV treatment (May 2016–November 2017)	A cost-minimisation analysis comparing two strategies of HCV treatment in a prison: telemedicine clinical practice (TCP) and the usual clinical practice (UCP)	Telemedicine clinical practice (TCP)	Usual clinical practice (UCP)	Telemedicine consultation practice produced savings of EUR 516 (30.6%) per patient, with total savings of EUR 38 677 The transfer costs from prison to hospital represented the most important saving item, accounting for 99.3% of the TCP-related savings See Table D.1 for user satisfaction results
de Jong et al. 2020	RCT	Netherlands		2 academic and 2 non-academic hospitals	909 patients with IBD	Economic evaluation of telemedicine interventions in patients with inflammatory bowel disease (IBD), comparing the cost-utility of telemedicine vs standard care	Telemedicine (myIBDcoach)	Usual care	Telemedicine resulted in lower mean annual costs of EUR 547/patient [USD 612]; mean costs of EUR 9 481 for standard care and EUR 8 924 for telemedicine) without changing quality adjusted life years At the Dutch threshold of EUR 80 000 per quality adjusted life year, the intervention had increased incremental cost-effectiveness over standard care in 83% of replications and an incremental net monetary benefit of EUR 707/patient
Dear et al. 2021	RCT	Australia		Not specified	490 chronic pain patients	Examination of the cost-effectiveness of an internet delivered PMP for a mixed group chronic pain patients provided with different levels of clinician support	Internet-delivered pain management programs	Usual care	The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety, and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: −AUD 404–−AUD 808) or an optional-guided format (ICER range: −AUD 314–−AUD 541), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: AUD 88–AUD 225) The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed
Dineen-Griffin et al. 2020	RCT	Australia		30 community pharmacies	894 patients	Assessment of the cost utility of minor ailment service (MAS) compared with usual pharmacist care (UC)	Video consultation minor ailment service (MAS)	Usual care (UC)	On average, MAS was more costly but also more effective (in terms of symptom resolution and quality adjusted life year (QALY) gains) compared to UC MAS patients (n = 524) gained an additional 0.003 QALYs at an incremental cost of AUD 7.14, compared to UC (n = 370) which resulted in an incremental cost-effectiveness ratio of AUD 277
Duiverman	RCT	Netherlands		1 university medical centre	67 stable hypercapnic Chronic Obstructive Pulmonary Disease (COPD) patients	Investigation to explore whether home initiation of non-invasive ventilation (NIV) with the use of telemedicine in stable hypercapnic COPD is non-inferior to in-hospital NIV initiation	Home initiation of non-invasive ventilation via telemedicine	Hospital non-invasive ventilation	Home initiation of chronic NIV in stable hypercapnic COPD patients, with the use of telemedicine reduces costs by over 50%. Home NiV initiation was significantly cheaper (home: median EUR 3 768 (IQR EUR 3 546–EUR 4 163) vs in-hospital: median EUR 8 537 (IQR EUR 7 540 to EUR 9 175)
Eberle et al. 2021b	Systematic meta-revies	Germany, Greece, Italy, Israel, Netherlands, Spain, United States	17	Multiple	Type 1 diabetes mellitus (T1DM) patients	Review to summarise the current evidence available on the effectiveness of telemetric approaches in type 1 diabetes management	Telemedicine for type 1 diabetes management	None	2 studies reported a cost reduction through telemedicine (no significance reported) Direct expenses were 24% lesser in the intervention group, while indirect costs diminished by 22% One studies also mentioned that patients saved time for each visit (mean 115 [SD 86] min)
Eberle et al. 2021c	Systematic review	Australia, Greece Israel, United Kingdom, United States	31	Multiple	Patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM)	Examination of whether telemedical interventions effectively improve diabetes control using studies that pooled patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in patients diagnosed with T2DM than in those diagnosed with T1DM	Telemedical interventions	None	According to 4 papers telemedical interventions can be viewed cost effectively. 1 paper noted an incremental cost-effectiveness ratio (ICER) in 3 studies of USD 490, USD 29 869, and USD 464, per capita for each unit reduction in HbA1c. 1 paper found a moderate cost-effectiveness in 7 telephone interventions of USD 4744.32‑ USD 86 276.50/quality-adjusted life year (ICER) Only 1 paper reported that telemedicine was not cost effective at all (based on 3 studies)
Edison et al. 2020	Systematic review	Australia, Denmark, Ireland, United Kingdom, United States	18	Multiple	5 813 adult patients exposed to virtual clinics using telehealth strategies	Systematic review identifying the clinical, fiscal, and environmental evidence on the use of urological telehealth and/or virtual clinic (VC) strategies, and to highlight research gaps in this rapidly evolving field	Telehealth and/or virtual clinic (VC) strategies	Multiple	Direct cost analysis demonstrated median (IQR) annual cost savings of GBP 56 232 (GBP 46 260‑GBP 61 116) See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Eze et al. 2020	Systematic review	Multiple	98	Multiple – umbrella review	Patients providers using telemedicine in Organisation for Economic Co‑operation and Development (OECD) countries	Umbrella review of systematic reviews on telemedicine use in OECD countries summarising findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation	Telemedicine	None	39% of cost-effectiveness reviews found telemedicine to be cost saving or cost-effective Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement See Table D.1 for user satisfaction results
Farabi et al. 2020	Systematic review	Australia, Belgium, Netherlands, New Zealand, United Kingdom, United States	20	Multiple	Patients with cardiovascular disease	Systematic review of economic evaluation studies that compared telemedicine with usual care for cardiovascular patients	Telemedicine	None	Telemedicine improves the clinical outcomes and results in considerable saving in costs The highest and lowest values of Incremental Cost-effectiveness Ratio were USD 515 082 and USD 2099 that had been reported in the UK and New Zealand, respectively Utilising telemedicine concurrent with the usual care for service delivery is more cost-effective
Flemming et al. 2021	Systematic review	United States	17	Multiple	Care home residing adults	Assessment of the cost-effectiveness of alternative programs within home care	Enhanced home care interventions	None	Cost-effective interventions were found in two areas including alternative nursing care and reablement/restorative care
Fraser et al. 2022	Systematic review	Canada, United States	5	Multiple	603 individuals living in rural areas with cardiovascular diseases (CVD)	Systematic review aiming to understand the types and effects of home‑based connected health technologies, used by individuals living in rural areas with cardiovascular diseases (CVD)	Home‑based connected health technologies	None	All interventions which used a form of telehealth found a reduction in overall health care utilisation resulting in cost savings, and one study found improvements in CVD risk factors See Table D.1 for user satisfaction results
Gingold et al. 2021	Retrospective cohort study	United States		1 large academic medical centre and an affiliated community hospital	464 patients discharged from hospitals	Analysis to measure the effect of a mobile integrated health community paramedicine (MIH-CP) transitional care programme	Multidisciplinary team involving real-time medication reconciliation with the pharmacist over videoconference and other videoconferencing/text messaging	No multidisciplinary team care	A trend toward fewer emergency department visits but increased cost among programme participants Some studies report large effects on readmissions and/or cost, but frequently these evaluations either lack a control group and compare treatment groups to implausible counterfactuals, or have poorly matched controls that are subject to selection bias and regression to the mean See Table D.2 for patient safety results
Guaiana et al. 2021	Systematic review	United States	14	Multiple	Televideo use for major depressive disorder (MDD) treatment in adults (18 years or older) in any clinical setting, and any health care professional providing care	Exploration of literature on the use of televideo to diagnose and treat MDD, particularly acceptability and patient satisfaction, efficacy, and cost-effectiveness	Televideo	None	Despite increased cost upfront for televideo due to the technology required, televideo would eventually be more cost-effective due to reducing travel expenses See Table D.1 for user satisfaction results
Gupta et al. 2021	Systematic review	Multiple	53	Multiple	Pediatric and adult patients with ear, nose and throat (ENT) disorders	A systematic review to synthesize the evidence base on outcomes from remote consultation in adult and pediatric ENT services	Remote consultation for pediatric or adult ENT disorder	Multiple	In most instances, remote consultation reduced costs Two head and neck studies reported cost analysis, with one reporting savings of GBP 306 per patient (and 123 kg CO2 emissions), but the other demonstrating no cost reduction One study on remote preoperative assessment found Mean travel costs were reduced by USD 900 per patient See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Hazenberg et al. 2020	Systematic review	Multiple	61	Multiple	Not specified	Assessment of the peer-reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease	Telemedicine and telehealth approaches	None	Two randomised controlled trials show no benefit in costs between the telemedicine and control groups See Table D.1 for user satisfaction results
Hollis et al. 2021	RCT	United Kingdom		2 child and adolescent mental health services sites	224 patients aged 9‑17 years with Tourette syndrome or chronic tic disorder, and severe tics	Evaluation of the effectiveness of internet-delivered, therapist-sup‐ported, and parent-assisted Exposure and Response Prevention (ERP) for treatment of tics in children and young people	10 weeks of online, remotely delivered, therapist-supported ERP for tics	10 weeks of online therapist-supported education about tics	Remotely delivered, online ERP with minimal therapist contact time represents a cost efficient public mental health approach to improve access to behavioural therapy for tics in children and adolescents The fixed yearly cost of delivering the intervention was GBP 103·64 per participant (yearly cost of online platform GBP 8 494 and total cost of supervision and training GBP 14 719·78) See Table D.2 for patient safety results
Indraratna et al. 2021	RCT	Australia		2 sites	102 patients with acute coronary syndrome or heart failure	Description of the implementation of a novel smartphone app within an RCT, the impact of the COVID‑19 pandemic on the conduct of the trial, and how the experience with TeleClinical Care‑Cardiac (TCC-Cardiac) guided and informed the development of two telemonitoring programs during the pandemic	TeleClinical Care‑Cardiac app (TCC-Cardiac) alongside standard care	Standard care alone	The intervention cost AUS 6 028 (USD 4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately AUS 100 000 (approximately USD 70 000) annually See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Jang et al. 2021b	Systematic review and meta‑analysis	Australia, Denmark, Canada, Italy, Netherlands, Spain, United Kingdom, United States	22	Multiple	2 906 patients utilising telemonitoring interventions on severe chronic obstructive pulmonary disease (COPD) exacerbations	Systematic review and meta‑analysis providing current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room (ER) visits	Telemonitoring for preventing COPD exacerbations	None	Most studies reported no benefit in mortality, quality of life, or cost-effectiveness The review found that adding telemonitoring to usual care reduced unnecessary ER visits but was unlikely to prevent hospitalisations due to COPD exacerbations See Table D.1 for user satisfaction results
Joseph et al. 2020	Retrospective cohort study	United states		6 urban skilled nursing facilities (SNFs)	4 606 patients were evaluated in both the SNF-based intervention and emergency departments (ED)-based comparison groups	Investigation of skilled nursing facility (SNF)-based telemedicine services provided by emergency physicians (EP). The study compared this on-site emergency care option to traditional ED-based care, evaluating hospital admission rates following care by an EP	Skilled nursing facility telehealth	Traditional emergency department-based care	The average cost of the telemedicine service in this study was USD 816 per episode Considering the added expenses of ambulance transportation and EP fees, this enhanced telemedicine service would be cost-effective if it averted 10% of hospitalisations. The data from this programme suggests an 80% reduction in care escalation, suggesting this is a worthwhile investment, irrespective of the clinical benefits from avoiding unnecessary admissions
Kamdar et al. 2020	Retrospective cohort study	United States		1 Academic medical centre	2 204 patients scheduled for surgery by telemedicine or evaluated in person	Description of the implementation of a telemedicine‑based anaesthesia preoperative evaluation and report the program’s patient satisfaction, clinical case cancellation rate outcomes, and cost savings	telemedicine‑based preoperative anaesthesia evaluation process	In person evaluation	Patients experienced time‑based savings, particularly from traveling across a metropolitan area, which amounted to USD 67 of direct and opportunity cost savings. See Table D.1 for user satisfaction results
Kolcun et al. 2020	Systematic review	Canada, Denmark, France, United States	12	Multiple	Spine surgery patients	Systematic review examining the current utilisation of telemedicine (TM) for spine surgery	Telemedicine	None	One study looked at costs finding that TM visits were approximately one‑third the average cost of in-person clinic visits This model was sustainable even if 50% of the TM visits were failures requiring subsequent in-person evaluation See Table D.1 for user satisfaction results
Lee et al. 2020	Retrospective cohort study	United states		1 large integrated health system	Mohs micrographic surgery (MMS) patients	Evaluation of the use of teledermatology for preoperative consultation for MMS	Telemedicine	Usual care	Teledermatology resulted in average travel savings of 162.7 minutes, 144.5 miles, and USD 60.00 per person
Lemelin et al. 2020	Controlled clinical trial	Canada		Obstetric clinic at 1 university hospital	161 women with gestational diabetes mellitus (GDM)	Evaluation of the cost-effectiveness of the telehomecare (THCa) initiative by assessing the direct costs, including the related reduction in medical visits, evaluate the impact of THCa on diabetes control, GDM-related complications, and patient satisfaction	THCa system for transmission and online analysis of capillary glucose data	Usual care in the clinic	Direct cost analysis revealed savings of 16% in patients followed by THCa compared with the control group See Table D.1 for user satisfaction results
Longacre et al. 2020	RCT	United states		3 academic medical centres	516 patients	Determination of the cost-effectiveness of a Collaborative Care Model (CCM)-based, centralised telecare approach to delivering rehabilitation services to late‑stage cancer patients experiencing functional limitations	Tele‑rehabilitation (arm B) and tele‑rehabilitation plus pharmacological pain management (arm C)	Usual care (arm A)	Tele‑rehabilitation was found to be cost saving compared to enhanced usual care once downstream hospitalisation costs were considered In the total cost analysis, total inpatient hospitalisation costs were significantly lower in both tele‑rehabilitation (arm B) and tele‑rehabilitation plus pain management (arm C) compared to control (arm A)
Lopez-Liria et al. 2020	Systematic review	France, Netherlands, Spain, United States	8	Multiple	16 539 patients	Comparison of the cost-effectiveness of two follow-up methods (face‑to-face and telemedicine) used in dermatology in the last ten years	Telemedicine in dermatology	Face‑to-face care	All of the included articles indicate that teledermatology lowers costs and proves satisfactory care to both patients and professionals
Lopez-Villegas et al. 2020	RCT	Norway		Not specified	50 patients	Economic assessment to determine whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics	Telemonitoring	Conventional monitoring	Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: EUR 2079.84 [CI: 0.00 to 4 610.58] vs. EUR 271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: EUR 2 295.91 [CI: 0.00 to 4 843.28] vs. CM: EUR 430.39 [CI: 0.00 to 4 841.48]), although these large differences –mainly due to a few patients being hospitalised in the TM group, as opposed to none in the CM group –did not reach statistical significance The Incremental Cost – Effectiveness Ratio (ICER) from the Norwegian NHS perspective (EUR 53 345.27/QALY) and including the patient/caregiver perspective (EUR 55 046.40/QALY), as well as the Incremental Net Benefit (INB), favors the CM alternative, albeit with very broad 95%CIs
Lopez-Villegas et al. 2021	Systematic review		11	Multiple	3372 enrolled patients with pacemakers	Systematic review to explore the differences in the medium-and long-term effectiveness of telemonitoring ™ and conventional monitoring (CM) in relation to costs and health outcomes	Telemonitoring (TM)	Conventional monitoring (CM)	The cost of TM was up to 87% lower than that of CM Both formal and informal costs are significantly reduced in the medium and long term
Lovell et al. 2020	Cross-sectional study	United states		1 national university hospital	1531 virtual visit claims	Review of a virtual care programme using insurance claims data for virtual, urgent, primary, and emergency care delivered between 1 April 2016 – 31 March 2017	Virtual telemedicine	Usual care	This study affirmed lower cost for virtual care without an associated increase in overall follow-up rates or antibiotic use when compared with urgent or primary care This suggests that virtual visits can be used to lower the total cost of care for applicable conditions The implications are that virtual visits help lower operational costs of providing care, particularly in integrated systems with capitated reimbursement Under the right circumstances, the increased adoption of virtual care should lead to greater savings
Minguez Clemente et al. 2021	RCT	Spain		1 university teaching hospital	116 patients with chronic obstructive pulmonary disease (COPD) exacerbation	Trial to evaluate the effectiveness/efficiency of and satisfaction with a home telemedicine programme focusing on patients with COPD exacerbation after early hospital discharge and compare it with early discharge and follow-up with traditional home hospitalisation	Telemedicine with monitoring with patients required to transmit data twice per day, with a subsequent telephone call and 2 home visits by health care staff	Daily visits	A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations which resulted in cost savings However, overall the cost of either strategy not significantly different See Table D.1 for user satisfaction results
McKeon et al. 2021	Systematic review	Australia, Canada, United States	28	Multiple	Not specified	Systematic review of the currently available evidence on the use of smart-device technology and telehealth programs to guide and monitor postoperative rehabilitation following total joint arthroplasty and to assess their impact on outcomes following surgery	Virtual physical therapy	None	Virtual physical therapy resulted in cost savings ranging from USD 206 to USD 4 100 per patient compared with in-person physical therapy Telerehabilitation following lower-extremity joint replacement is less expensive compared with in-person physical therapy, with equivalent outcomes and patient satisfaction Telerehabilitation and electronic health adjuncts can be used to substitute for traditional rehabilitation and augment postoperative care following total joint arthroplasty, respectively
McManus et al. 2021	RCT	United Kingdom		76 general practices	622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet.	Testing of a digital intervention (HOME BP) for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management	HOME BP Digital intervention	Usual care	The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to low incremental costs Within trial costs showed an incremental cost effectiveness ratio of GBP 11 (USD 15, EUR 12; 95% confidence interval GBP 6 to GBP 29) per mm Hg reduction
Mohammadzadeh et al. 2021	Systematic review	Multiple	50	Multiple	Patients with cardiovascular disease treated with cardiology interventions	Review of the effectiveness of implemented telecardiology services	Telecardiology services	None	The economic effects of telecardiology were examined in 50% of the included studies Telecardiology reduced the cost of care and cost savings, the number of travels, the number of visits, and the number of patients referred to specialised centres See Table D.1 for user satisfaction results See Table D.4 for use by technology results
Morris et al. 2021	Systematic review	Multiple	54	Multiple	Not specified	Review of how digital technologies have been used to support rural oncology care	Digital technologies to support oncology care	None	The studies conducted were able to establish that tele‑oncology was feasible, acceptable to patients and health care workers, and cost-effective See Table D.1 for user satisfaction results See Table D.4 for use by technology results
Mosquera et al. 2021	RCT	United States		1 university health centre	422 medically complex children	Assessment of whether telemedicine can further improve outcomes and reduce costs of comprehensive care (CC) for medically complex children	Telemedicine with comprehensive care	Comprehensive care (CC alone)	The probability that telemedicine reduced mean total health system costs per child-year was 91% (USD 33 718 with telemedicine vs USD 41 281 with CC alone; Bayesian cost ratio, 0.85 [0.67‑1.08]), owing mainly to reduced costs for hospital and emergency department services (USD 26 759 with telemedicine vs USD 34 419 with CC alone; cost ratio, 0.77 [0.54‑1.10])
Mourad et al. 2022	RCT	Sweden		Cardiac clinics in 4 hospitals	144 participants	Evaluation of cost-effectiveness of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD)	internet-delivered cognitive behavioural therapy (iCBT)	Online discussion forum (ODF)	Incremental cost-effectiveness ratio (ICER) for iCBT versus ODF was EUR 18 865 per QALY saved The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared with ODF
Murphy et al. 2021	Prospective cohort study	Ireland		1 large paediatric hospital	1002 patients	Description of a virtual developmental dysplasia of the hip (DDH) clinic and provide an overview of DDH referral reasons, treatment outcomes, and adverse events associated with it	Virtual developmental dysplasia of the hip (DDH) clinic	Face‑to-face	This clinic has encountered cost savings of EUR 588 504 based upon the virtual model of delivery over the 3.5 years it has been running Changing the method of initial review can result in savings of EUR 168 144 per year on initial visits only
Murphy et al. 2020	Systematic review	Ireland, United Kingdom	18	Multiple	Fracture patients	Review to determine if virtual fracture clinics can provide an acceptable alternative in these challenging times	Virtual clinic	None	Cost reductions compared with estimates derived from conventional fracture clinics varied from USD 53 to USD 297 and USD 39 125 to USD 305 876 compared with traditional fracture clinic visits
Mustonen et al. 2020	RCT	Finland		Not specified	1 535 patients (≥45 years)	Evaluation of the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients	Telephone health coaching	Usual care	Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect EUR 1 248 [3% reduction]) in the intervention compared to the control group
Nelson et al. 2021	RCT	Australia		1 hospital	70 patients receiving total hip replacement	Exploration of whether outpatient physiotherapy care via telerehabilitation is as effective as in-person physiotherapy care after total hip replacement	Remotely delivered telerehabilitation directly into their homes and a technology-based home exercise programme using an iPad application	In-person outpatient physiotherapy and a paper-based home exercise programme	The estimated mean difference in cost of telerehabilitation versus in-person was USD ‑28.90, favouring the telerehabilitation group Telerehabilitation in the total hip replacement population incurred similar costs and yielded similar effects to traditional in-person care Telerehabilitation significantly reduced the time burden for patients and carers See Table D.1 for user satisfaction results
Nguyen et al. 2022	Systematic review	Denmark, Ireland, Netherlands, New Zealand Spain, United Kingdom, United States	14	Multiple	Patients being treated for Inflammatory bowel diseases (IBD)	Systemic review of randomised controlled trials (RCTs) on digital health technologies in patients with Inflammatory bowel diseases (IBD)	Digital health technologies	None	Ten studies evaluated the impact of digital health technologies on health care utilisation and cost-effectiveness, with many of the studies evaluating these outcomes as secondary aims Digital health interventions were associated with lower rate of health care utilisation and health care costs (low certainty of evidence) See Table D.1 for user satisfaction results
Nguyen et al. 2021	Systematic review	United States	19	Multiple	Not specified	Systematic review to examine how e‑visits have impacted clinical outcomes and health care quality, access, utilisation, and costs	Electronic visits (e‑visits) involving asynchronous communication between clinicians and patients through a secure web-based platform	Multiple	Three studies found e‑visit usage was associated with lower overall treatment costs than those for in-person visits See Table D.2 for patient safety results
Nordh et al. 2021	RCT	Sweden		Child and adolescent mental health services	103 young people	Assessment of the efficacy and cost-effectiveness of therapist-guided internet-delivered cognitive behavioural therapy (ICBT) for SAD in youths vs an active comparator, internet-delivered supportive therapy (ISUPPORT)	Internet delivered support therapy	Usual care	The average societal cost was EUR 2426.2 for the ICBT group and EUR 3502.5 for the ISUPPORT group The incremental cost-effectiveness ratio regarding total societal cost differences and differences in remitter status was EUR ‑17 900.7, indicating that ICBT was associated with cost savings while generating more participants free of SAD compared with ISUPPORT Subtotal cost analyses demonstrated that the main drivers of the cost differences between the groups were decreases in medication use and decreases of school productivity losses in the ICBT group
Petersen et al. 2021	Systematic review	Australia, Canada, Denmark, Finland, Germany, Norway, Spain	14	Multiple	Orthopaedic patients	Systematic review to explore scientific evidence for the use of telemedicine in the orthopaedic field	Telemedical applications in orthopaedics	None	Two studies showed that cost effectiveness of telemedicine applications for video consultations depends on the workload. In the Norwegian study, video consultation was more cost effective after 151 patient consultations per year and in the Finish study, the cost of the video consultation was lower after a workload of more than 80 patients per year One study examined the cost effectiveness of telerehabilitation for knee arthroplasty and showed that the cost of telerehabilitation was lower than face‑to-face treatments when the distance to the hospital was 30 km or more
Rasmussen et al. 2020	Cohort study	Denmark		1 children’s hospital	374 preterm infants and their parents who met the inclusion criteria	Assessment of the costs of neonatal homecare (NTH) compared to regular neonatal hospital care, from the health service perspective	Telehealth service (My Hospital app)	Usual care	The costs of NTH resource utilisation were, on average, EUR 695 per infant, and the total costs per infant, on average, were EUR 12 200 and EUR 4 200 for infants at/under and over 32 weeks, respectively The corresponding costs of the control group were EUR 14 300 and EUR 4 400 The difference in total costs showed statistical significance for the group of infants under 32 weeks (p < 0.001)
Raso et al. 2021	RCT	Italy		1 institution	22 traumatic brain injury patients	Exploration of the effectiveness of a new telemonitoring system, for monitoring Vegetative State (VS) and Minimally Conscious State (MCS) patients	Telemonitoring	Usual care	The mean total cost per patient in the LSH group was EUR 262, whereas in the telemonitoring group cost was approximately EUR 93 The major component of cost for the LSH programme was human resources focused on staff time dedicated to patient care, whereas for telehealth programme approximately half of the health costs relied on the equipment (i.e. medical devices)
Rinaldi et al. 2020	Systematic review	United Kingdom, others not specified	23	Multiple	Type 2 Diabetes Mellitus (T2DM) patients	Systematic review to summarise and evaluate the quality of the published evidence on cost and cost-effectiveness of mHealth interventions for Type 2 Diabetes Mellitus (T2DM)	mHealth Interventions	None	The studies which presented cost effectiveness results demonstrated highly cost-effective interventions, with cost per QALY gained ranging from 0.4% to 62.5% of GDP per capita of the country The quality of partial economic evaluations was on average lower than that of full economic evaluations The cost of mHealth interventions varied substantially based on type and combination of technology used, however, where cost-effectiveness results were reported, the intervention was cost-effective
Romjin et al. 2021	RCT	Netherlands		Outpatient departments of 4 specialised mental health care centres	Patients with panic disorder, social phobia or generalised anxiety disorder in routine specialised mental health care	Examination of the acceptability, effectiveness and cost-effectiveness of blended CBT (bCBT) versus Face‑to-face (ftfCBT) in outpatient specialised care to patients with panic disorder, social anxiety disorder and generalised anxiety disorder	Blended CBT (bCBT)	Face‑to-face CTB (ftfCBT)	The modelled point estimates of societal costs (bCBT EUR 10 945, ftfCBT EUR 10 937) were higher and modelled point estimates of direct medical costs (bCBT EUR 3 748, ftfCBT EUR 3 841) were lower in bCBT. The acceptability curves showed that bCBT was expected to be a cost-effective intervention
Sellars et al. 2020	Prospective cohort study	United Kingdom		1 hospital	50 patients attending a video consultation (VC) clinic appointment as a new colorectal referral between March 2019 to February 2020	Assessment of outcomes, including the economic and environmental impact, of a video consultation (VC) clinic for new colorectal referrals	Video consultations (VC)	Face‑to-face care	The use of VC resulted in significant savings related to travel and reduced time and costs for patients who chose to use the service However, there is no conclusive evidence of cost benefit for the service provider
Sequeira et al. 2020	Systematic review and meta‑analysis	Australia, Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Hungary, Italy, Israel, Latvia, Netherlands, Spain, Switzerland, United Kingdom, United States	17	Multiple	Patients with implantable cardioverter-defibrillators (ICDs)	Assessment of the economic burden, and to develop an integrated economic model evaluating the efficiency of the remote monitoring (RM) strategy vs. current standard of care (SC) in the context of French health care	Remote monitoring (RM)	Standard of care (SC)	A three‑state Markov Model showed that RM resulted in cost-savings of EUR 4 142 per patient over a 5‑year time horizon, with a quality-adjusted life year (QALY) gain of 0.29 The incremental cost-effectiveness ratio was −14 136 EUR/QALY, in favour of RM
Serhal et al. 2020	Cost-minimisation analysis	Canada		1 province	Residents who received psychiatric services through telepsychiatry, the outreach psychiatry programme (OPP), and/or the primary care provider (PRP) between 1 April 2014 and 31 March 2016	Determination of the cost difference between three programme models: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist	Telepsychiatry	Psychiatrists travelling to patients and reimbursing patients to travel to psychiatrists	Costs per visit were lowest in telepsychiatry (CAD 360) followed by traveling physicians (CAD 558) and patient reimbursement (CAD 620) Among the 100 000 Monte Carlo simulations, results showed telepsychiatry was the least costly programme in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively The break-even analysis found telepsychiatry was the least costly programme after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients)
Smith et al. 2021a	Systematic review	Multiple – umbrella review	17	Multiple	Surgeons, and patients who were undergoing or recently underwent surgery	Evaluation of patient and provider satisfaction with and perceptions towards telehealth, and to identify the barriers and facilitators associated with its utilisation both prior to and during the COVID‑19 pandemic	Synchronous telehealth modalities (e.g. live interactive videoconference or telephone consultations) used perioperatively	Multiple	Telehealth was generally associated with reduced resource utilisation and costs Reduced health care resource utilisation was attributed to a greater ability to triage patients, and reductions in wait times, delays from initial consultation to follow-up care and unnecessary visits. It was unclear whether consultation time was altered by telehealth, with some studies demonstrating a reduction and others, no effect A reduction in unnecessary visits underscored much of the cost-savings Additional cost-savings were attributed to reduced administration and nursing costs See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Stanimirovic et al. 2020	Cohort study	Canada		Toronto tele‑retina screening programme	566 patients accessing tele‑retina services	Assessment of the cost-effectiveness of the pilot Toronto tele‑retina screening programme in comparison with existing standard of care (SOC) diabetic retinopathy screening for patients with diabetes mellitus and in a simulated Pan-Ontarian cohort	Tele‑retina screening	Existing standard of care (SOC)	The cost per case correctly detected was USD 281.10 with tele‑retina and USD 982.00 with SOC, and the cost per case correctly diagnosed was USD 82.21 and USD 314.14, respectively For both pilot and Pan-Ontarian sensitivity analyses, tele‑retina remained the dominant strategy (ICER <0) Comparing tele‑retina with SOC was shown to be more cost-effective with USD 16 514 per 18.73 QALYs gained versus USD 17 590 per 18.58 QALYs gained for non-tele‑retina In a rural health clinical environment tele‑retina would save USD 150 per patient over 7 years
Tabaei et al. 2020	RCT	United States		City borough	816 cases of health care utilisation for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State	Assessment of the impact of telephonic diabetes self-management intervention (Bronx A1C) in reducing health care utilisation and costs over 4 years	Telephonic diabetes intervention (Tele/Pr)	Print-only (PrO)	The Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; P < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; P = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; P = 0.01) Reductions in hospital use and costs were even stronger for diabetes-related hospitalisations
Taber et al. 2021	RCT	United States		1 university hospital	136 adult (≥18 years) kidney transplant recipients Adult (≥18 years) kidney recipients 6 months to 3 years posttransplant	Economic analysis of a 12‑month, parallel arm, randomised controlled trial in adult kidney recipients 6 to 36 months posttransplant	Usual care + clinical pharmacist-led medication therapy monitoring and management, via a smartphone‑enabled mHealth app, integrated with risk-based televisits	Usual care	From a payer or societal perspective, the net estimated cost savings, after accounting for intervention delivery costs, was USD 368 839 There was a return on investment (ROI) of USD 4.30 for every USD 1 spent These results demonstrate that a mHealth-enabled, pharmacist-led intervention significantly reduced hospitalisation costs for payers over a 12‑month period and has a positive ROI
Taguchi et al. 2021	RCT	Japan		1 cognitive behavioural therapy centre	30 patients with chronic pain	Examination of the effectiveness of an integrated cognitive behavioural therapy programme with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing (videoconference‑based CBT).	Videoconference‑based CBT	Treatment as usual (TAU)	A cost-benefit analysis based on the data showed that the incremental cost-effectiveness ratio (ICER) was almost 2.9 million (yen/QALY=96 000 yen divided by 0.033 QALY) Previous research that used willingness to pay (WTP) to obtain the criterion of the ICER showed that 5.0 million yen (USD 48 158) per QALY gained is considered an acceptable threshold in Japan Therefore, it was suggested that vCBT is more cost-effective than TAU, even though it was a minimum effect case, as the improvement in quality of life returned to the baseline in 1 year See Table D.2 for patient safety results
Theiler et al. 2021	RCT	United states		1 tertiary academic centre	300 expectant mothers between 18 and 36 years old, < 13 weeks gestation, who had their pregnancy documented as low risk by an obstetrician and had the ability to provide informed consent	Investigation of whether the use of OB Nest, a telemedicine‑enhanced programme with a reduced frequency of in-person prenatal visits, would decrease the cost of prenatal care delivery	Telemedicine prenatal service (OB Nest)	Usual care	Total provider cost was decreased caring for the OB Nest participants, but nursing cost was increased OB Nest care required an average of 160.8 (+/− 45.0) minutes provider time and 237 (+/− 25.1) minutes nursing time, compared to 215.0 (+/− 71.6) and 99.6 (+/− 29.7) minutes for traditional prenatal care (P < 0.01) This translated into decreased provider cost and increased nursing cost (P < 0.01). Supply costs increased, travel costs declined, and overhead costs declined in the OB Nest model
Tian et al. 2021	Systematic review	Australia, Korea, Spain, United Kingdom, United States	29	Multiple	Prison populations	Systematic review synthesizing the evidence base to date for the impacts of, and outcomes from, telehealth delivered in prisons	Telehealth	None	The findings on costs associated with implementation of telehealth in prisons were mixed One study indicated an overall increased service utilisation across all cost measures after using telehealth, suggesting increased cost associated with telehealth. This was corroborated with a 2nd study in which the cost associated with telecardiology consultations was higher than the in-person cardiology service during the first year, but cost savings occurred with increased use of telecardiology in the second and third year of implementation Another 4 studies showed a net saving per visit of using telehealth compared to conventional care Cost savings accumulated as a result of averted trips (to local specialists) and transfers (by aircraft) associated with using telehealth See Table D.1 for user satisfaction results
Treskes et al. 2022	RCT	Netherlands		1 university medical centre	200 patients	Description of a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI)	eHealth intervention (The Box)	Usual care	Mean costs per patient were EUR 2 417±2043 (USD 2 657±2246) for the intervention and EUR 2 888±2961 (USD 3 175±3255) for the control group. This yielded a cost reduction of EUR 471 (USD 518) per patient but it was not statistically significant (95% CI EUR ‑275 to EUR 1217; P =.22, USD ‑302 to USD 1 338) The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference –0.05, 95% CI –0.09 to –0.01; P =.01)
Tully et al. 2021	RCT	Ireland		1 weight management service	109 adolescent participants with clinical obesity	Assessment of the direct costs of delivering the mHealth intervention to participants in the trial relative to usual care participants to inform future designs of mHealth trials to assess effectiveness and cost-effectiveness within this population as well as contribute to the evidence base for the economic viability of integrating mHealth into paediatric weight management services	mHealth app	Face‑to-face care	Accounting for partial completion and attrition costs, the mean cost incurred for those in the usual care arm was EUR 142 (SD 23.7) (group participants: mean EUR 133, SD 12.2; one‑to‑one participants: mean EUR 177, SD 22.4). The mean cost for those randomised to use mHealth was estimated to be EUR 722 (SD 221) Although this mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs
Ullah et al. 2020	Systematic review and meta‑analysis	Multiple	33	Multiple	Diabetic retinopathy (DR) patients	To determine cost-effectiveness and the diagnostic accuracy of teleophthalmology (TO) in the detection of macular-edema (ME) and various grades of diabetic retinopathy (DR)	Teleophthalmology	None	A total of 28 studies were identified assessing the cost-effectiveness of teleophthalmology screening of DR and ME in these clinical settings Populations screened at a younger age, higher blood glucose, using insulin, or with high transportation costs derive most of the benefit from Teleretinal screening Compared with conventional screening, Teleretinal screening was cost-effective at a high workload, but teleophthalmology (TO) was not economic in patients >80 years of age and in population >3 500 patients
van den Biggelaar et al. 2020	RCT	Netherlands		1 centre for home mechanical ventilation (HMV)	96 patients with a of diagnosis neuromuscular disease (NMD) or thoracic cage disorder	Investigation of whether home mechanical ventilation (HMV) initiation at home, using a telemonitoring approach is noninferior to in-hospital initiation	Home mechanical ventilation with telemonitoring	Usual care	Starting HMV at home saves over EUR 3 200 (USD 3 793) per patient over a 6‑month period
Vimalananda et al. 2020	Systematic review	Multiple	63	Multiple	Multiple	Systematic review of the recent peer-reviewed literature on the effect of e‑consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes	e‑consults	None	e‑consult programs are generally cost-saving to payers Costs were reduced for patients associated to travel Costs were shown to be reduced compared to face‑to-face referrals See Table D.1 for user satisfaction results See Table D.2 for patient safety results
Wallut et al. 2020	Retrospective cohort study	France		13 local hospitals (spokes) and two stroke units (hubs).	742 adult patients hospitalised for ischemic stroke, confirmed by imaging or a neurologist	Evaluation of the cost-effectiveness of a French Telestroke network	Telestroke	Usual care	The Telestroke strategy was more effective and slightly more costly than the reference strategy (25 disability cases avoided per 1 000 at 3 months, 6.7 avoided hospital deaths, and 13 avoided deaths at 3 months for an extra cost of EUR 97, EUR 138, and EUR 154, respectively)
Watanabe et al. 2020	RCT	Japan		85 academic and non-academic hospitals	1274 pacemaker patients	Exploration of the safety and resource consumption of exclusive remote follow-up (RFU) in pacemaker patients for 2 years	Remote monitoring for cardiac implantable electronic devices (RFU)	Conventional follow-up (CFU)	The median (IQR) patient-individual follow-up costs per year were 18 800 Yen in RFU and 21 400 Yen in CFU Total costs connected to pacemaker follow-up were reduced by 11.0% Follow-up reimbursement per year in RFU was slightly higher because of the slightly higher rate of total (remote and in-office) follow-ups, but the costs associated with additional diagnostic procedures were lower
Winward et al. 2021	Retrospective cohort study	United Kingdom		358 practices and 49 primary care networks	Patients registered to a 24/7, digital-first model of NHS primary care (Babylon GP at Hand) and patients registered to all other practices in Northwest London Collaboration of Clinical Commissioning Groups	Evaluation of the impact of highly accessible, digital-first primary care on acute hospital spending	Digital-first primary care	Usual care	The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (GBP 93, P =.047; GBP 223, P <. 001; and GBP 389, P <. 001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (GBP 114, P =.006; GBP 246, P <. 001; and GBP 362, P <. 001) lower The Babylon GP at Hand population had lower costs of GBP 1.37, GBP 4.40 million, and GBP 11.6 million, respectively, in FY18/19; and GBP 3.26 million, GBP 9.54 million, and GBP 18.8 million, respectively, in FY19/20
Zhang et al. 2021	Systematic review and meta‑analysis	Australia, Belgium, Canada, Ireland, United States	12	Multiple	Patients aged 18 years and older undergoing virtual preoperative anaesthesia assessment	Systematic review and meta‑analysis reviewing the effectiveness of virtual preoperative assessment for the evaluation of surgical patients, with a focus on surgery cancellation rates and patient experience	Virtual preoperative assessment	None	Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% so resources were not saved in this way There was a high success rate in using the information collected with virtual care, in the range of 92‑100%, to diagnose and manage patients resulting in time and cost savings in the range of 24‑137 min and USD 60‑67 per patient See Table D.1 for user satisfaction results
Zischke et al. 2021	Systematic review	Multiple	39	Multiple	Not specified	Determination of the current clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all areas of physiotherapy practice	Simulated or real-world physiotherapy assessments using synchronous forms of telehealth	None	The economic impact was investigated in two utility studies. One study involved a cost audit comparing a video conference telehealth physiotherapy service with a fly-in, fly-out physiotherapy service Telehealth appeared to be a cost-effective option for rural services, with an estimated 12‑month cost of AUD 66518.00 compared to AUD 76384.00 for a fly-in, fly-out service The other study compared cost-effectiveness of a telephone‑based telehealth physiotherapy service (PD) with usual face‑to-face care (UC). The authors found the difference between the PD and UC groups was minimal in terms of cost, finding PD is probably more cost-effective if the physiotherapist’s time is productive See Table D.1 for user satisfaction results