Mathew Supriya, Green Danielle, Newton Nicki, Powell Rachel, Wakerman John, Russell Deborah J
Remote Health Systems and Climate Change Centre, Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia.
Independent Researcher, Darwin, Australia.
Mhealth. 2025 Jun 30;11:34. doi: 10.21037/mhealth-24-75. eCollection 2025.
Telehealth is an important tool for improving access to health care in underserved areas. This scoping review explores the evidence for implementing telehealth as a mode for delivering primary health care (PHC) consultations by general practitioners (GPs) to rural and remote patients in high income countries.
Peer reviewed publications were sourced from CINAHL, PubMed, and the Web of Science. The Joanna Briggs Institute's (JBI) methodology for scoping reviews was followed. Data from each paper were coded deductively to five themes: (I) telehealth structures and processes; (II) patient and provider preferences for telehealth; (III) positive and negative outcomes of telehealth; (IV) characteristics of providers, practices and patients affecting telehealth adoption; and (V) barriers and enablers to the use of telehealth.
Sixty papers were included. Rural and remote populations accept telehealth because of profound impacts on their otherwise long travel times, high travel costs, logistical difficulties and overcoming the generally lower availability of GPs in these locations. Providing face-to-face GP care to isolated small populations is also resource intensive and limited by GP availability, with provider travel time, travel costs and accommodation costs adding to the overall costs of service provision. The main concerns about telehealth were reduced ability to conduct physical examinations, privacy and data security, heavier clinic workloads and poorer relationships. Telehealth was most acceptable for after-hours and follow-up consultations. Effective telehealth required adequate connectivity and digital infrastructure and training of staff to support the patient and PHC provider, which was especially important if there were cultural differences or communication difficulties. Few studies focussed on the experience of telehealth for First Nations people or use of telehealth for PHC service delivery in remote locations.
Telehealth can be used as a supplementary mode for delivering PHC services to improve access and continuity of care in rural and remote locations, especially when there is a pre-existing relationship between the PHC provider and the patient. We recommend identifying contextual indicators and putting in place adequate monitoring and evaluation frameworks if introducing telehealth in rural and remote contexts and in the context of First Nations peoples.
远程医疗是改善医疗服务可及性的一项重要工具，尤其适用于医疗服务欠缺地区。本综述探讨了在高收入国家，全科医生（GP）通过远程医疗为农村和偏远地区患者提供初级卫生保健（PHC）咨询服务的相关证据。
通过CINAHL、PubMed和Web of Science检索同行评审的出版物。遵循乔安娜·布里格斯研究所（JBI）的综述方法。每篇论文的数据被归纳为五个主题进行编码：（I）远程医疗的结构和流程；（II）患者和提供者对远程医疗的偏好；（III）远程医疗的积极和消极结果；（IV）影响远程医疗采用的提供者、医疗机构和患者的特征；（V）远程医疗使用的障碍和促进因素。
纳入60篇论文。农村和偏远地区居民接受远程医疗，因为它对原本漫长的出行时间、高昂的出行成本、后勤困难有显著影响，还能克服这些地区全科医生普遍较少的问题。为偏远小群体提供面对面的全科医疗服务资源消耗大，且受全科医生可用性限制，提供者的出行时间、出行成本和住宿成本增加了整体服务成本。对远程医疗的主要担忧包括体格检查能力下降、隐私和数据安全、诊所工作量增加以及医患关系变差。远程医疗在非工作时间和随访咨询中最易被接受。有效的远程医疗需要足够的网络连接、数字基础设施以及对工作人员进行培训以支持患者和初级卫生保健提供者，若存在文化差异或沟通困难，这一点尤为重要。很少有研究关注原住民的远程医疗体验或在偏远地区使用远程医疗提供初级卫生保健服务的情况。
远程医疗可作为提供初级卫生保健服务的补充模式，以改善农村和偏远地区的医疗服务可及性和连续性，尤其是在初级卫生保健提供者与患者之间已有关系的情况下。我们建议，如果在农村和偏远地区以及原住民背景下引入远程医疗，应确定相关背景指标并建立适当的监测和评估框架。
