Abstract
BackgroundEmergency telehealth has been used to improve accessibility of rural and remote patients to specialist care. Evidence to date has demonstrated effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments within a variety of contexts. However, systematic reviews to date have not focused on the rural and remote emergency departments. The purpose of this study is to review the outcome measures used in evaluations of emergency telehealth in rural and remote settings and assess evidence relating to their effectiveness and cost-effectiveness.MethodsRandomised controlled trials, non-randomised controlled trials, and full and partial economic evaluations (e.g. cost-effectiveness, cost-benefit, and cost-utility analyses) of telehealth in rural and remote emergency departments will be included. Comprehensive literature searches will be conducted in multiple electronic databases (from 1990 onwards): MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, EconLit, CRD databases (e.g. NHS Economic Evaluation database), and Tufts Cost-Effectiveness Registry. Two authors will independently screen all citations, full-text articles, and abstract data. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. A systematic narrative synthesis will be provided with information presented in the text and tables to summarise and explain the characteristics and findings of the studies. If feasible, we will conduct random effects meta-analysis.DiscussionThis review will identify gaps in the current body of evidence relating to the effectiveness and cost-effectiveness of rural and remote emergency telehealth services. By confining to articles written in the English language, this analysis may be subjected to publication bias and results need to be interpreted accordingly. We believe the results of this review could be valuable for the design of future economic evaluations of emergency telehealth services implemented in the rural and remote context.Systematic review registrationPROSPERO CRD42019145903
Highlights
Emergency telehealth has been used to improve accessibility of rural and remote patients to specialist care
The cost-effectiveness of telehealth in the rural and remote emergency settings have been reported in the context of pre-hospital patient care enabled by telehealth [8, 9], telemetry for chest pain patients presenting to the emergency departments [10], and acute ischemic stroke presentations to rural hospitals [11]
The purpose of this study is to review the outcome measures used in evaluations of emergency telehealth in rural and remote settings and to assess evidence relating to their effectiveness and cost-effectiveness
Summary
Emergency telehealth has been used to improve accessibility of rural and remote patients to specialist care. The purpose of this study is to review the outcome measures used in evaluations of emergency telehealth in rural and remote settings and assess evidence relating to their effectiveness and cost-effectiveness. Cost-effectiveness studies to date have reported evidence in rural and remote medical emergencies within a wide variety of contexts; systematic reviews on effectiveness and costeffectiveness of telehealth in the emergency departments to date have not focused on the rural and remote settings [5]. The cost-effectiveness of telehealth in the rural and remote emergency settings have been reported in the context of pre-hospital patient care enabled by telehealth [8, 9], telemetry for chest pain patients presenting to the emergency departments [10], and acute ischemic stroke presentations to rural hospitals [11]
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