Telehealth for primary healthcare delivery in rural and remote contexts in high-income countries-a scoping review.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.