First published on 6 May 2020 and updated on an ongoing basis; last updated on 29 July 2021 (changes detailed below); all the reviews in this Special Collection are free to access
This Special Collection is one of a series of collections on COVID-19. It was originally published in English and is also available in Simplified Chinese, Traditional Chinese, Farsi, French, German, Japanese, Malay, Portuguese, Russian, and Spanish.
The aim of this collection is to ensure immediate access to systematic reviews most directly relevant to remote health care through telehealth. The measures adopted internationally to curb the spread of COVID-19 have led to significant changes in how health care is accessed and provided. As face-to-face consultations between healthcare workers and patients pose a potential risk to both parties, remote care and telehealth offer alternatives.
Telehealth refers to the provision of personalized health care over a distance.[1] It embraces synchronous and asynchronous interactions including consulting by phone, instant messaging, video, text message, or web-based services.[2] Telehealth consists of three main elements: the patient provides data about their health; data is transferred to the healthcare professional electronically; and the healthcare professional uses their clinical skills and judgment to provide personalized feedback to the patient.[1,3] While telehealth has much to offer in the provision of remote care to patients, accessing it may prove a significant challenge to those most in need, including older people, those from socio-economically disadvantaged backgrounds, and those with physical or learning disabilities.
This Special Collection includes Cochrane Reviews that address using telehealth to support clinical management of various conditions, including asthma, diabetes, cardiovascular disease, dementia, reproductive health, and skin cancer. It includes reviews of using telehealth to provide carer and parent support as well as empowering patient self-management of their long-term conditions. For reviews related to quitting smoking during the pandemic, you can refer to Coronavirus (COVID-19): effective options for quitting smoking during the pandemic.
Updated 29 July 2021: added Cochrane Reviews 'Remotely delivered information, training and support for informal caregivers of people with dementia', and 'Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment' and added translation into Traditional Chinese
Communication systems to facilitate health care remotely
Automated telephone communication systems (ATCS) can deliver voice messages and collect health‐related information from patients using either their telephone's touch‐tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. This review assesses the effects of ATCS for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred, and adverse outcomes. Associated Cochrane Clinical Answers: Do automated telephone communication systems (ATCSs) improve immunization rates? and Do automated telephone communication systems (ATCSs) improve cancer screening rates?
Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Caregivers may find themselves in a caring role for which they are ill-prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location. This review evaluates the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non‐telephone‐based support interventions for providing education and psychosocial support for informal caregivers. Associated Cochrane Clinical Answer: What are the effects of telephone interventions for providing education and support to informal caregivers of ill adults?
Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support. This review explores clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health. Review summary: Mobile phones for targeted communication with clients, patients and the public: implementation considerations; Associated Cochrane Clinical Answer: What are the perceptions and experiences of targeted digital communication via mobile devices for reproductive, maternal, child, and adolescent health?
Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mobile health (mHealth), can help in its implementation. This review synthesises qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. Associated Cochrane Clinical Answer: What are health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services? Review summary: Mobile phones for health workers in primary care: implementation considerations
Interactive telemedicine: effects on professional practice and health care outcomes
Telemedicine is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. This review assesses the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face‐to‐face care, or telephone consultation). Associated Cochrane Clinical Answers: In people with diabetes, what are the effects of interactive telemedicine? and In people with heart failure, what are the effects of interactive telemedicine?
Face‐to‐face versus remote and web 2.0 interventions for promoting physical activity
Face‐to‐face interventions for promoting physical activity are continuing to be popular as remote and web 2.0 approaches rapidly emerge, but we are unsure which approach is more effective at achieving long term sustained change. This review compares the effectiveness of face‐to‐face versus remote and web 2.0 interventions for physical activity promotion in community dwelling in adults over 16 years of age.
Asthma and COPD
Home telemonitoring and remote feedback between clinic visits for asthma
Asthma self-management facilitated by a healthcare professional is important to keep symptoms controlled and to prevent exacerbations. Telephone and Internet technologies can now be used by patients to measure lung function and asthma symptoms at home. Patients can then share this information electronically with their healthcare provider, who can provide feedback between clinic visits. This review assesses the efficacy and safety of home telemonitoring with healthcare professional feedback between clinic visits, compared with usual care. Associated Cochrane Clinical Answer: What are the benefits and harms of home telemonitoring and remote feedback between clinic visits in people with asthma?
Remote versus face‐to‐face check‐ups for asthma
Regular check‐ups with a healthcare professional for asthma are essential to monitor symptoms and adjust medication. Remote check‐ups may represent an unobtrusive and efficient way of maintaining contact with patients, but it is uncertain whether conducting check‐ups in this way is effective or whether it may have unexpected negative consequences. This review assesses the safety and efficacy of conducting asthma check‐ups remotely versus usual face‐to‐face consultations. Associated Cochrane Clinical Answer: How do remote check‐ups compare with face‐to‐face check‐ups in people with asthma?
Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction due to an abnormal inflammatory response of the lungs to noxious particles or gases, for example, cigarette smoke. Research over the past decade has focused on innovative methods for developing enabling and assistive technologies that facilitate patient self‐management. This review evaluates the effectiveness of interventions delivered by computer and by mobile technology versus face‐to‐face or hard copy/digital documentary‐delivered interventions, or both, in facilitating, supporting, and sustaining self‐management among people with COPD. Associated Cochrane Clinical Answer: Do smart technology interventions facilitate self‐management for people with chronic obstructive pulmonary disease (COPD)?
Shared decision‐making for people with asthma
People with asthma may be helped to manage their condition through shared decision‐making (SDM). SDM involves at least two participants (the medical practitioner and the patient) and mutual sharing of information, including the patient's values and preferences, to build consensus about favoured treatment that culminates in an agreed action. Effective self‐management is particularly important for people with asthma, and SDM may improve clinical outcomes and quality of life by educating patients and empowering them to be actively involved in their own health. This review assesses benefits and potential harms of shared decision‐making for adults and children with asthma. Associated Cochrane Clinical Answer: For people with asthma, how does shared decision‐making affect outcomes?
Cancer
Telephone interventions for symptom management in adults with cancer
People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well‐being, and quality of life. Telephone‐delivered interventions have evolved to provide support for the management of a range of cancer symptoms. This review assesses the effectiveness of telephone‐delivered interventions for reducing symptoms associated with cancer and its treatment. Associated Cochrane Clinical Answer: For adults with cancer, what are the effects of telephone interventions aimed at reducing symptoms of cancer?
Cardiovascular conditions
Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). People with prevalent cardiovascular disease have a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Adherence to recommended treatments remains sub‐optimal. In order to influence non‐adherence, there is a need to develop scalable and cost‐effective behaviour‐change interventions. This review evaluates the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment, fatal and non‐fatal cardiovascular events, and adverse effects. Associated Cochrane Clinical Answer: Does mobile phone text messaging improve medication adherence for secondary prevention of cardiovascular disease (CVD)?
mHealth education interventions in heart failure
Adherence to medication prescribed for the prevention of cardiovascular disease (CVD) can be poor. Approximately 9% of CVD cases in the EU are attributed to poor adherence to vascular medications. Low‐cost, scalable interventions to improve adherence to medications for the primary prevention of CVD have potential to reduce morbidity, mortality and healthcare costs associated with CVD. This review aims to establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. Associated Cochrane Clinical Answer: What are the effects of mobile phone–based interventions for primary prevention of cardiovascular disease (CVD)?
Structured telephone support or non‐invasive telemonitoring for patients with heart failure
In the context of limited health funding and a rapidly expanding population of older people, it is increasingly difficult for healthcare systems to provide high‐quality care to those with heart failure. Patients may be unwilling or unable to make frequent clinic attendance due to cost, difficulty with transport or disability and frailty. Structured telephone support and telemonitoring can provide specialised heart failure care to many people with limited access to healthcare services. This review assesses randomised controlled trials of structured telephone support or non‐invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. Associated Cochrane Clinical Answer: What are the benefits and harms of structured telephone support or non‐invasive telemonitoring in patients with heart failure?
Mental health and neurological conditions
Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment
Many millions of people living with dementia around the world are not diagnosed, which has a negative impact both on their access to care and treatment and on rational service planning. Telehealth ‐ the use of information and communication technology (ICT) to provide health services at a distance ‐ may be a way to increase access to specialist assessment for people with suspected dementia, especially those living in remote or rural areas. It has also been much used during the COVID‐19 pandemic. It is important to know whether diagnoses made using telehealth assessment are as accurate as those made in conventional, face‐to‐face clinical setting, and this review assesses the diagnostic accuracy of telehealth assessment for dementia and mild cognitive impairment.
Remotely delivered information, training and support for informal caregivers of people with dementia
Caregivers of people with dementia, may experience a range of physical, emotional, financial and social harms, which are often described collectively as caregiver burden. Psychoeducational interventions might prevent or reduce caregiver burden and are intended to improve caregivers' knowledge about the disease and its care; to increase caregivers' sense of competence and their ability to cope with difficult situations; to relieve feelings of isolation and allow caregivers to attend to their own emotional and physical needs. Interventions that are delivered remotely, using printed materials, telephone or video technologies, may be particularly suitable for caregivers who have difficulty accessing face‐to‐face services because of their own health problems, poor access to transport, or absence of substitute care. During the COVID‐19 pandemic, containment measures in many countries required people to be isolated in their homes, including people with dementia and their family carers, and in such circumstances, there is no alternative to remote delivery of interventions. This review assesses the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia. Associated Cochrane Clinical Answer: For informal caregivers of people with dementia, what are the effects of remotely delivered information, training, and support?
Specialist home‐based nursing services for children with acute and chronic illnesses
Specialist paediatric home‐based nursing services have been proposed as a cost‐effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. This review evaluates specialist home‐based nursing services for children with acute and chronic illnesses. Associated Cochrane Clinical Answer: What are the effects of specialist home‐based nursing services for children with acute and chronic illness?
Psychological therapies, traditionally delivered face‐to‐face with a therapist, are efficacious at reducing pain intensity and disability. Therapies delivered remotely, such as via the Internet, computer‐based programmes, and smartphone applications, can be used to deliver treatment to children and adolescents with chronic pain. This review determines the efficacy of psychological therapies delivered remotely compared to waiting list, treatment as usual, or active control treatments, for the management of chronic pain in children and adolescents. Associated Cochrane Clinical Answer: Can remotely delivered cognitive‐behavioral therapy (CBT) help children and adolescents manage chronic pain?
Telerehabilitation for persons with multiple sclerosis
Telerehabilitation, an emerging method, extends rehabilitative care beyond the hospital, and facilitates multifaceted, often psychotherapeutic approaches to modern management of patients using telecommunication technology at home or in the community. This review investigates the effectiveness and safety of telerehabilitation intervention in persons with multiple sclerosis for improved patient outcomes. Associated Clinical Answer: What are the effects of telerehabilitation for people with multiple sclerosis?
Telerehabilitation services for stroke
The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. This review determines whether telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with in‐person rehabilitation, or no rehabilitation, or usual care. Associated Cochrane Clinical Answer: For people with stroke, how does telerehabilitation compare with usual care?
A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation‐based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption. This review assesses the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community. Associated Cochrane Clinical Answer: How do personalized digital interventions to reduce hazardous and harmful alcohol consumption compare with no/minimal intervention in community‐dwelling populations?
Assistive technology for memory support in dementia
The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. The low costs and wide availability of electronic devices also make it more feasible to use them for the benefit of disabled persons. This review assesses the efficacy of assistive technology for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living, level of dependency, and admission to long‐term care.
Efficacy and experiences of telephone counselling for informal carers of people with dementia
Informal carers of people with dementia can suffer from depressive symptoms, emotional distress, and other physiological, social, and financial consequences. This review aims to produce a quantitative review of the efficacy of telephone counselling for informal carers of people with dementia, synthesize qualitative studies to explore carers’ experiences of receiving telephone counselling and counsellors’ experiences of conducting telephone counselling, and to integrate them to identify aspects of the intervention that are valued and work well, and those interventional components that should be improved or redesigned. Associated Cochrane Clinical Answer: What are the effects of telephone counseling for informal carers of people with dementia?
Conditions related to genetic disorders
For people with thalassemia, long‐term red blood cell transfusion remains the mainstay of therapy, which may lead to iron overload causing severe complications and damage in different body organs. Long‐term iron chelation therapy is essential for people with thalassemia to minimize the ongoing iron‐loading process. In addition, suboptimal adherence can increase adverse events associated with iron overload and result in increased morbidity, mortality, healthcare utilization and cost of care. This review aims to identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia.
Abdominal and endocrine conditions
Computer‐based diabetes self‐management interventions for adults with type 2 diabetes mellitus
Structured patient education programmes reduce the risk of diabetes‐related complications four‐fold. Internet‐based self‐management programmes have been shown to be effective for a number of long‐term conditions, but it is unclear what are the essential or effective components of such programmes. This review assesses the effects on health status and health‐related quality of life of computer‐based diabetes self‐management interventions for adults with type 2 diabetes mellitus. Associated Cochrane Clinical Answer: For adults with type 2 diabetes mellitus, what are the effects of computer‐based diabetes self‐management interventions?
eHealth interventions for people with chronic kidney disease
Chronic kidney disease is associated with high morbidity and death, which increases as it progresses to end‐stage kidney disease. Worldwide there has been a tremendous increase in the use of technologies, with increasing interest in using eHealth interventions to improve patient access to relevant health information, enhance the quality of healthcare and encourage the adoption of healthy behaviours. This review aims to evaluate the benefits and harms of using eHealth interventions to change health behaviours in people with chronic kidney disease. Associated Cochrane Clinical Answer: What are the effects of eHealth interventions for people with chronic kidney disease?
Fertility, pregnancy, and neonatal conditions
Telephone support for women during pregnancy and the first six weeks postpartum
There is some evidence that telephone support may be of benefit in specific areas of maternity care, such as to support breastfeeding and for women at risk of depression. This review assesses the effects of telephone support during pregnancy and the first six weeks post-birth, compared with routine care, on maternal and infant outcomes. Associated Cochrane Clinical Answer: What are the effects of telephone support for women during pregnancy and the first six weeks postpartum?
Targeted client communication via mobile devices for improving maternal, neonatal, and child health
The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication via mobile devices may be a useful strategy to improve MNCH. This review assesses the effects of targeted client communication via mobile devices on health behaviour, service use, health, and well‐being for MNCH. Associated Cochrane Clinical Answer: For pregnant and postpartum women, does targeted client communication improve maternal and neonatal health?
Telemedicine for the support of parents of high‐risk newborn infants
As the parents and families of infants admitted to neonatal intensive care units require major support from health professionals in terms of information and time, telemedicine has the potential to increase this support. This review evaluates whether the use of telemedicine technology to support families of newborn infants receiving intensive care affects the length of hospital stay and parental/family satisfaction. Associated Cochrane Clinical Answer: May telemedicine provide support to parents of high‐risk newborn infants?
Mobile phone‐based interventions for improving contraception use
Contraception provides significant benefits for women's and children's health. Interventions delivered by mobile phone have been demonstrated to be effective in other health areas, but their effects on use of contraception have not been established. This review assesses the effects of mobile phone‐based interventions for improving contraception use. Associated Cochrane Clinical Answer: Do mobile phone–based interventions improve the use of contraception?
Self‐administered versus provider‐administered medical abortion
Medical abortion procedures involve either administering mifepristone followed by misoprostol or a misoprostol‐only regimen. In self‐administered medical abortion, drugs are administered by the woman herself without the supervision of a healthcare provider during at least one stage of the drug protocol. In settings where there is a shortage of healthcare providers, self‐administration may reduce the burden on the health system. However, it remains unclear whether self‐administration of medical abortion is effective and safe. This review compares the effectiveness, safety, and acceptability of self‐administered versus provider‐administered medical abortion in any setting. Associated Cochrane Clinical Answer: For women seeking induced abortion, how does self‐administered abortion compare with provider‐administered abortion?
Eyes and vision conditions
Telerehabilitation for people with low vision
Rehabilitative training and vision assistive equipment may help people with low vision, but some visually impaired people have limited resources to attend in‐person visits at rehabilitation clinics to receive training to learn to use vision assistive equipment. These barriers to care may be overcome through remote, web‐based consultation (i.e. telerehabilitation). This review compares the effects of telerehabilitation with face‐to‐face (e.g. in‐office or inpatient) vision rehabilitation services for improving vision‐related quality of life and near reading ability in people with visual function loss due to any ocular condition.
Reproductive and sexual health
The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low‐ and middle‐income countries. Targeted client communication delivered via mobile devices may improve the health behaviours and service use important for SRH. This review assesses the effects of targeted client communication delivered via mobile devices on adolescents' knowledge, and on adolescents’ and adults' SRH behaviour, health service use, and health and well‐being. Associated Cochrane Clinical Answers: For adults, does targeted client communication (TCC) via mobile devices help improve sexual and reproductive health? and For adolescents, does targeted client communication (TCC) via mobile devices help improve sexual and reproductive health?
Skin conditions
Teledermatology for diagnosing skin cancer in adults
Melanoma and squamous cell carcinoma are high‐risk skin cancers that have the potential to metastasize and ultimately lead to death, whereas basal cell carcinoma is usually localized with potential to infiltrate and damage surrounding tissue. Teledermatology provides a way for generalist clinicians to access the opinion of a specialist dermatologist for skin lesions that they consider to be suspicious without referring the patients through the normal referral pathway. This review determines the diagnostic accuracy of teledermatology for the detection of any skin cancer in adults, and to compare its accuracy with that of in‐person diagnosis. Associated Cochrane Clinical Answer: What is the accuracy of teledermatology using photographic images for detection of invasive melanoma or atypical intraepidermal melanocytic variants?
Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma
Melanoma accounts for a small proportion of all skin cancer cases but is responsible for most skin cancer‐related deaths. Early detection and treatment can improve survival. Smartphone applications are readily accessible and potentially offer an instant risk assessment of the likelihood of malignancy so that the right people seek further medical attention from a clinician for more detailed assessment of the lesion. This review assesses the diagnostic accuracy of smartphone applications to rule out cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with concerns about suspicious skin lesions. Associated Cochrane Clinical Answer: For adults with suspicious skin lesions, can smartphone applications (apps) accurately rule out cutaneous invasive melanoma and atypical intraepidermal melanocytic variants?
References
1. McLean S, Protti D, Sheikh A. Telehealthcare for long term conditions. BMJ 2011;342:d120. https://doi.org/10.1136/bmj.d120
2. McLean S, Sheikh A. Does telehealthcare offer a patient-centred way forward for the community-based management of long-term respiratory disease? Primary Care Respiratory Journal 2009;18(3):125-6. https://doi.org/10.3132/pcrj.2009.00006
3. Sood S, Mbarika V, Jugoo S, Dookhy R, Doarn CR, Prakash N, et al. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemedicine and e-Health 2007;13(5):573-90. https://doi.org/10.1089/tmj.2006.0073
Acknowledgements
This Special Collection was developed by Ciara Gleeson (Evidence Synthesis Ireland Fellow/Clinical Specialist Physiotherapist (respiratory), Ireland), Dr Maureen Kelly (Discipline of General Practice, NUI Galway, Ireland) working with Toby Lasserson (Deputy Editor in Chief), Robin Featherstone (Information Specialist), and Monaz Mehta (Editor) from the Cochrane Editorial & Methods Department, and Declan Devane (Cochrane Ireland). Colleagues from Cochrane Acute and Emergency Care, Cochrane Circulation and Breathing, Cochrane Mental Health and Neuroscience, and Cochrane Public Health and Health Systems also provided input on the selection of reviews for this Special Collection.
Translation
This Special Collection was translated into [language] by [name of Cochrane Group and optionally translators] on [date of the latest translation update].
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Contact
Cochrane Editorial and Methods Department (emd@cochrane.org)