Sepehr Metanat
1 
, Fatemeh Kazemi
2 , Shabnam Afraz
3 , Mahdiyeh Heydari
3,4* 1 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
4 Deputy for Health, Iran University of Medical Sciences, Tehran, Iran
Abstract
A health crisis can disrupt primary health care where telemedicine technology can facilitate the delivery of healthcare services. This study aimed to identify telemedicine applications in primary health care during a crisis.This research was conducted by scoping review method. All studies had been systematically searched through "Web of Science", "Embase", "PubMed", "MEDLINE", "SID", and "Magiran" databases with appropriate keywords in three groups: "telemedicine", "primary health care" and "health crises". Among 2949 screened studies, 76 were included in this research. Finally, the studies were analyzed using the framework analysis method in MAXQDA software. A total of 47 applications were found for telemedicine in primary health care in critical situations, which were classified into 6 areas including teleconsultation, e-learning, remote monitoring, source of medical information, decision support, and patient self-management. The most common medical applications were remote visits, patient consultation, patient education at home, provider screening, self-management of COVID-19 disease, and psychological and social support for patients. Telemedicine technology enables the control and management of crises that arise in health and treatment fields. By improving access, promoting interaction between specialists in urban and rural areas, reducing costs, and reducing mortality and disability, telemedicine provides socioeconomic benefits to patients, providers, and the health care system.
Extended Abstract
Background
Primary health care (PHC) can be disrupted during health crises such as epidemics, natural disasters, and wars. Telemedicine can be an effective tool for countries to ensure that basic health services are continuously provided at the first level of health care delivery during crises, regardless of time and place. Since PHC is the first point of contact between the population and the health system, where accessing equitable access to health and medical services can be challenging during crises. Meanwhile, the social and economic benefits of telemedicine for patients, providers, and the health system demonstrate that during crises, increased patient-provider communication, patient self-management education, and health promotion opportunities can be provided using this technology. Therefore, this study was conducted to identify the applications of telemedicine in PHC during health crises.
Methods
A scoping review method was used to conduct this research. The Arksey and O'Malley protocol was used for conducting the scoping review, which includes six stages: identifying the research question, identifying relevant studies, selecting studies, charting the data, collecting, summarizing, and reporting the results, and optional consultation on the findings. The research question for this scoping review was: "what are the applications of telemedicine in providing PHC during crises?" This research was conducted with a focus on published studies in Persian and English languages on the applications of telemedicine in providing PHC during crises, covering the period from 2001 to the end of 2021. The search was conducted using appropriate English and Persian keywords, including "primary health care", "community health services", "primary healthcare", "primary care", "COVID-19", "leishmaniasis", "influenza", "SARSCoV2", "coronavirus disease", "disaster", "epidemic*", "health emergency", "pandemic", "conflict", "war", "telemedicine", "telehealth", "teleconsult", "eHealth", "digital health", "phone* consult", "tele consult," and "mHealth", in electronic databases including Web of Science, PubMed, MEDLINE, Embase, SID, and Magiran. Braun and Clarke's thematic analysis method was used, which includes six stages: familiarization with the data, identifying initial codes, searching for themes, reviewing themes, defining themes, and preparing a report for qualitative data analysis. Descriptive statistics were also used to report some of the descriptive data.
Results
A total of 76 studies were conducted to investigate telemedicine applications in PHC during critical conditions. The studies were conducted in crises, including natural disasters, influenza outbreaks, COVID-19, cutaneous leishmaniasis, and war. Considering the recent COVID-19 pandemic, the majority of articles (90%) focused on telemedicine applications in PHC during critical conditions related to COVID-19.A total of 47 use cases for telemedicine application in PHC during critical conditions were identified in 6 domains, including teleconsultation, e-learning, remote monitoring, medical information resources, decision support, and patient self-management. The most common use cases of telemedicine applications included telemedicine visits, teleconsultation and answering patient questions, patient education at home, screening by providers, assistance in establishing referral systems for patients, self-management in COVID-19, psychological, social, and emotional support for patients through video sessions, and screening COVID-19 suspected cases.
Conclusion
The data from this study showed that telemedicine is applicable in PHC during emergencies, including disease outbreaks, disasters, and wars. Currently, telemedicine is a strategy for overcoming physical access barriers in health services. To optimize telemedicine in the field of PHC, countries need to consider a comprehensive digital health strategy that includes investment in infrastructure such as electronic health records, electronic prescriptions, and communication with diagnostic information systems and citizen interaction interfaces. Feedback from all stakeholders for improving the performance and ease of operation of telemedicine programs is a key consideration for managers.