Objectives, Outcomes, Facilitators, and Barriers of Telemedicine Systems for Patients with Alzheimer's Disease and their Caregivers and Care Providers: A Systematic Review.

Abstract

Alzheimer's disease is an extremely expensive chronic disease, which is rapidly becoming a major cause of mortality in adults. For over two decades, telemedicine has been used to assist patients and their caregivers to manage this disease. The present study aimed to evaluate the objectives, outcomes, facilitators, and barriers influencing the use of telemedicine systems for patients with Alzheimer's disease and their caregivers and care providers. In this systematic review, we searched for the original articles published in databases such as PubMed, Web of Science, and Scopus until November 2021 using relevant keywords. A qualitative content analysis was performed the based on the theory of planned behavior and the health belief model using the ATLAS.ti software. In total, 1191 articles were identified, and 60 articles were included in this study. While having different objectives, most of the studies compared telemedicine systems to in-person visits (21.43%) and assessed the feasibility of the implemented method (16.07%). The overall outcomes of telemedicine in the articles were classified as cost-effectiveness (e.g., reduced commute, fuel, and time to access care), clinical outcomes (e.g., lower anxiety, stress, and depression), and patient, caregiver, and healthcare provider satisfaction. In total, 19 facilitators and 12 barriers influencing the use of telemedicine for patients with Alzheimer's disease and their caregivers were identified. According to the results, telemedicine systems could be implemented for various reasons. Developing a clear framework of the drivers and barriers before the implementation of these systems could improve decision-making prior to the design and implementation of telemedicine systems.