Adoption of Telemedicine during the COVID-19 pandemic in Ibero-America: A Systematic Literature Review

Copy igh © 2023 by Au ho /s and Licensed by IADITI. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Jou nal o In o ma ion Sys ems Enginee ing and Managemen 2023, 8(1), 19138 e-ISSN: 2468-4376 h ps://www.jisem-jou nal.com/ Li e a u e Re iew Adop ion o Telemedicine du ing he COVID-19 pandemic in Ibe o-Ame ica: A Sys ema ic Li e a u e Re iew Agos inho Sousa Pin o 1, An ónio Ab eu 1, Eusébio Cos a 2, Je ónimo Pai a 1 *, Laís Viei a3 1 CEOS.PP, Poly echnic o Po o / ISCAP, Po ugal 2 Technology School o Fa e, Fa e, Po ugal 3 EPIUni - Ins i u e o Public Heal h, Uni e si y o Po o, Po ugal * Co esponding Au ho : je [email protected] Ci a ion: Pin o, A. S., Ab eu, A., Cos a, E., Pai a, J., & Viei a, L. (2023). Adop ion o Telemedicine du ing he COVID-19 pandemic in Ibe o- Ame ica: A Sys ema ic Li e a u e Re iew. Jou nal o In o ma ion Sys ems Enginee ing and Managemen , 8(1), 19138. .h ps://doi.o g/10.55267/iad .07.12742 ARTICLE INFO ABSTRACT Recei ed: 30 No 2022 Accep ed: 15 Dec 2022 The ou b eak o COVID- 19 caused a majo in e na ional public heal h c isis and led o he imposi ion o social dis ancing measu es o con ain he sp ead o he i us. In his con ex , he use o eleheal h sky ocke ed as he only way o deli e heal hca e o pa ien s du ing a lockdown was emo ely. The coun ies o La in Ame ica and he Ibe ian Peninsula we e se e ely hi by he pandemic and he p ospec s and challenges associa ed wi h widesp ead adop ion o eleheal h a e unique. The goal o his sys ema i c li e a u e e iew is o explo e how eleheal h has been used du ing he pandemic o p e en , diagnose, ea and con ol diseases in Ibe o- Ame ica. Thus, we sough o iden i y he main keywo ds, hemes, heo e ical amewo ks and me hodologies used by e sea che s in his a ea. We used se e al ools o bibliog aphic managemen like Rayyan, VOSViewe and NVIVO and ollowed he PRISMA p o ocol. Ou analysis o hemes showed he exis ence o 3 nodes wi hin he li e a u e: s uden s, eache s and educa ion. A e sea ching in 6 da abases, 1826 a icles we e ound. A e excluding he duplica es (231 a icles), we sc eened and ead he i les and abs ac s o 1595 a icles. Only 119 a icles me he inclusion c i e ia. Finally, a e a ull- ex analysis, a ina l sample o 106 a icles was selec ed o analysis. Spain and B azil a e he coun ies who ha e p oduced he g ea es olume o esea ch in he egion. The public sec o is he la ges unde o esea ch on his opic by a especially a na ional le el . Ou indings show ha he esea ch ou pu in he egion o Ibe o- Ame ica (La in Ame ica and Ibe ia) on his opic is s ill ela i ely small when compa ed o egions like No h Ame ica. Keywo ds: Telemedicine, eHeal h, Sys ema ic Li e a u e Re iew, COVID-19 INTRODUCTION The mo i a ion behind he choice o his opic o esea ch ela es o he g owing impo ance o elemedicine in a pos - pandemic wo ld. By analyzing he exis ing li e a u e on he adop ion o elemedicine in Ibe o-Ame ica, he goals o his SLR a e:  Iden i y he main esea ch hemes, keywo ds and opics;  Re eal he main esea ch me hodologies;  Highligh he mos ele an au ho s, jou nals and coun ies Telemedicine is he use o In o ma ion and communica ion echnology (ICT) o deli e heal hca e emo ely (WHO Global Obse a o y o eHeal h, 2010). Some sys ema ic li e a u e e iews ollowing he PRISMA p o ocol on he opic o eHeal h ha e been w i en (Table 1). (Alonso e al., 2021) iden i ied China and he Uni ed Sa es as he wo coun ies wi h he la ges numbe o pape s on he opic. The au ho also iden i ied 10 di e en agencies ha a e suppo ing esea ch on elemedicine and 35 di e en o ganiza ions ha a e in ol ed in he applica ion o elemedicine sys ems. The mos p ominen o ganiza ions ha we e esea ching elemedicine applied o COVID-19 we e Huazhong Uni e si y o Science Technology, he Uni e si y o Queensland and he Uni e si y o Sou he n Denma k. Telemedicine whose implemen a ion equi es a c oss-domain esea ch app oach: 58% o he analyzed a icles we e published in heal h ca e sciences jou nals, 16% in medical in o ma ics jou nals and 11% in he public and occupa ional heal h domain. Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138 2 / 6 Table 1. P e ious Sys ema ic Li e a u e Re iews abou elemedicine du ing COVID-19 based on PRISMA S udy Sea ch Te m Da abases Pape s (Alonso e al., 2021) ((co ona i us o COVID-19 o SARS-CoV-2) and ( elemedicine o eHeal h o Tele- heal h o mHea lh o mobile heal h)) Web o Science 85 (Bokolo An hony Jn ., 2020) S ings comp ised o he e ms: ele- heal h, elemedicine, COVID-19, co ona i us disease 2019, pandemic, digi al heal h, emo e ca e, hospi al- a - home, digi alized heal h ca e, digi alized medical ca e, i ual heal h ca e, i ual medical ca e. PubMed, Google schola , Scopus, Web o science, ScienceDi ec , P oQues , Eme ald, Taylo & F ancis, Inde science, Sp inge , Sage, ACM, Wiley, and IEEE Xplo e 87 (Monaghesh and Hajizadeh, 2020) Combina ion o keywo ds: COVID19, COVID-19, Co ona i us, No el co ona i us, 2019-nCoV, Wuhan co ona- i us, SARS-CoV-2, SARS2, Tele*, Telemedicine, Tele-medicine, Tele- heal h, Tele-heal h, Teleca e, Mobile Heal h, mHeal h, Elec onic heal h, and eheal h PubMed, Scopus, Embase, Web o Science, and Science Di ec 142 (Monaghesh and Hajizadeh, 2020) concluded ha he use o eleheal h imp o es he p o ision o heal hca e especially du ing he pandemic. I allows pa ien s and heal hca e wo ke s who a e sel -isola ing o educe he isk o COVID-19 in ec ion, mo bidi y and mo ali y du ing he pandemic. By using elecommunica ions ools o iaging ( ideocon e ence, phone call, e c…), assessing and ca ing o pa ien s, he numbe o pa ien s who ecei e ace- o- ace heal hca e se ices can be educed. Teleheal h also can also p o ide men al online heal h se ices o isola ed pa ien s o help hem cope wi h he s ess, dep ession and anxie y o lockdown. Alle gy and immunology se ices can also be ende ed a a dis ance. The e a e many easy- o-se -up li e ideo con e encing se ices ha a e use ul o people who wan consul a ion on COVID-19, medica ion checks, iage when elephone is no enough and pa ien s ha a e pa icula ly anxious abou isi ing he doc o . Ano he g oup ha could po en ially bene i om hese echnologies a e he elde ly. Howe e , (Monaghesh and Hajizadeh, 2020) highligh s ha he e a e ba ie s o la ge scale use o eleheal h ha equi e u he in es iga ion namely he changes in billing and coo dina ion o se ices. Finally, (Bokolo An hony Jn ., 2020) showed ha elemedicine is no hing new and ha his echnology is now widely a ailable, low-cos and accep ed by heal hca e wo ke s and pa ien s. In he con ex o he COVID-19 pandemic, he use o elemedicine became a necessi y and exploded. The po en ial o his echnology is ha i allows o examine a pa ien ’s heal h, i ually educa e pa ien s and s o e heal h in o ma ion o pa ien s ha is use ul o u u e examina ion. (Bokolo An hony Jn ., 2020) ci es he US, China and Aus alia as success s o ies in using elemedicine and ocuses on he guide- lines o he use o elemedicine and i ual applica ions. P i acy and consen laws a y widely among coun ies. As a esul , physicians should unde s and he p i acy and con iden iali y policies ha should be ollowed du ing online consul a ions. Physicians should d ess p o essionally, make eye con ac wi h he pa ien s, be wa m and iendly and ensu e p ope ligh ing in he examina ion posi ions. In addi ion, physicians should con i m ha he pa ien has wo king mic ophones/cama a, ha elemedicine a e co e ed by he pa ien s’ heal h insu ance and , i necessa y, help hem use he i ual pla o m. To ensu e p i acy, he i ual consul a ion should be in a quie place wi h a s ong in e ne connec ion. Howe e , he adop ion o elemedicine is a dis up i e p ocess ha s ill has many ba ie s ela ed o he lack o in as uc u e, inadequa e unds and inexpe ience. Ano he conce n ela es o pa ien p i acy policies. De eloping coun ies (like hose o La in Ame ica) may also no be able o ully adop elemedical se ices in emo e and u al a eas whe e access o he In e ne is limi ed and e ec i e elemedicine egula ion is lacking. Ano he challenge is educing he inancial bu den o accessing eleheal h du ing heal h c isis especially o low-income use s. Imp o ing he quali y o in e ne access is also c ucial as slow in e ne may hinde he use o ideocon e encing. METHODOLOGY We conduc ed a sys ema ic li e a u e e iew ollowing he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a- Analysis (PRISMA) amewo k o (Mohe e al., 2014). PRISMA is an e idence-based minimum se o i ems o epo ing in sys ema ic e iews and me a-analyses. We sea ched o a icles in July o 2021 in i e da abases (SCOPUS, Js o , Eme ald, SciELO, Science Di ec , IEEE) using he ollowing e ms: ("Telemedicine" OR "Teleca e" OR "eHeal h") AND ("COVID-19" OR "Co ona i us") AND ("Accep ance" OR "Adop ion") AND DOCTYPE (a ) AND PUBYEAR>2019. In addi ion, o ob ain mo e a icles w i en in Ibe o-Ame ica we also used he ollowing sea ch e ms: ("Telemedicina" OR "Telessáude" OR "eHeal h" OR "Telesalud") AND ("COVID-19" OR "Co ona i us") AND DOCTYPE (a ) AND PUBYEAR>2019. We excluded duplica es, hesis, disse a ions, monog aphies, books and o he non- pee e iewed a icles. Likewise, we only included a icles published a e 2019, w i en in Po uguese, English and Spanish ha ocus on elemedicine. Ini ially, 1826 a icles we e ound. Endno e, a bibliog aphic-managemen so wa e, was used o compile and manage he da abases. Each ci a ion included he abs ac , keywo ds and he ull ex . A e using Endno e o exclude he duplica es (231 a icles), wo e iewe s sc eened he i les and abs ac s o 1595 a icles using Rayyan QCRI. All disc epancies we e esol ed by consensus be ween esea che s. Only 122 a icles me all he c i e ia o inclusion and we e expo ed o a RIS. ile con aining he inal sample ha was made up o po en ially ele an s udies wi h hei ull ex s. A icles wi hou he ull ex and all pape s whose ull ex did no ocus on elemedicine in he egion o Ibe o- Ame ica we e excluded. Finally, a e e iewing he ull ex s, 106 a icles we e selec ed o a e iew and analysis (Figu e 1). Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138 3 / 6 We impo ed he RIS. ile con aining his inal sample o 106 a icles o VOSViewe o isualize and c ea e maps o he main keywo ds and au ho . Au oma ic coding was used o ob ain a dend og am ha allows us o iden i y he mos used e ms. Finally, we also analyzed he ci a ions o iden i y he mos ele an au ho s and jou nals, as well as coun ies in Ibe o- Ame ica whe e mos esea ch has been conduc ed. DISCUSSION OF RESULTS Resea ch Keywo ds, Themes and Sub hemes In Figu e 2, we can see a co-occu ence analysis o he keywo ds made using VOS iewe . O he 466 keywo ds de ec ed, only 27 mee he minimum h eshold o 4 and all o hem we e selec ed. 5 dis inc clus e s can be iden i ied in ed (12 i ems), g een (8 i ems), blue (5 i ems), yellow (1 i em) and pu ple (1 i em). The 3 nodes wi h he g ea es o al link s eng h we e elemedicine (190), elemedicina (164) and co id- 19 (158). NVIVO12 was used o make a dend og am ha shows in he ele ance o each o he keywo ds (Figu e 3). The 3 mos men ioned hemes we e heal h (577 men ions), ca e (416) and pa ien (310). Telemedicine con o e sial subjec , we ca ied ou a sen imen analysis o see i he au ho s ha e a posi i e o nega i e ou look on his heme. O e all, he au ho s main ain a mos ly neu al one as one could expec om a scien i ic publica ion (Figu e 4). Howe e , he e a e mo e nega i e e e ences (3998) han posi i e ones (2307). Figu e 1. PRISMA Flow diag am Figu e 2. Ne wo k isualiza ion o main keywo ds using VOSViewe 1 1 Analysis conduc ed based on bibliog aphic da a om a RIS ile wi h he selec ed e e ences o analysis (n=106). Full coun ing was used and a minimum h eshold o 4 occu ences pe keywo d was se . Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138 4 / 6 Resea ch Me hodologies In e ms o me hodologies, quali a i e s udies make up o e 55% o he inal sample. S udies ha used a mixed and quan i a i e me hodologies make up 23% and 20% espec i ely. In quali a i e s udies, he mos common ypes o a icles a e li e a u e e iews (14 a icles) and case s udy analysis. Many au ho s sough o e iew he li e a u e on he use o elemedicine in managing a speci ic disease like Pa kinson (Mo eno López e al., 2020), pedia ic epilepsy (Gómez e al., 2020) and ch onic obs uc i e pulmona y disease (Ba bosa e al., 2020). The mos s udied s akeholde s in elemedicine a e pa ien s (28 a icles) ollowed by heal hca e wo ke s (13 a icles). The e a e a ew s udies ha analyze his complex phenomenon he poin o iew o bo h pa ien s and heal hca e wo ke s. The mos widely used da a ga he ing ins umen s a e online su eys/ques ionnai es (27 a icles). Besides su eys, o he da a ga he ing ins umen s used we e in e iews and exis ing da abases. In quan i a i e empi ical s udies, esea che s used s a is ical so wa e o analyze he da a like SPSS. In mixed and quan i a i e s udies, 19 a icles used jus desc ip i e s a is ics (dis ibu ion, dispe sion and cen al endency) o p o ide basic desc ip ions o da a om a sample. Howe e , in 16 a icles, he au ho s use mo e ad anced in e en ial s a is ics me hods (ANOVA, -squa e, Chi-Squa e). One a icle used S uc u al Equa ion Modeling (SEM) echniques. By a , he mos common limi a ion o hese s udies ela es o he size and ep esen a i eness o he sample (especially when samples o con enience a e used). Figu e 3. Ne wo k isualiza ion o main keywo ds using VOSViewe 2 Figu e 4. Sen imen Analysis using NVi o123 2 Analysis conduc ed based on he ull ex s o he inal sample. NVi o sc eened e e y sen ence o all ex s. A ew Spanish e ms deemed edundan we e excluded. 3 Analysis conduc ed based on he ull ex s o he inal sample. NVi o sc eened e e y sen ence o all ex s. 5 / 6 Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138 Rega ding unding, o e 78% o au ho s decla ed no sou ces o unding. As o he a icles ha ecei ed unding, we can classi y he unding o ganiza ions in o se e al g oups: uni e si ies; public ins i u ions (a egional, na ional and EU le els) and p i a e ins i u ions. In Ibe o-Ame ica, he public sec o has been he mos ac i e in sponso ing esea ch on his opic (17 ou o 21 a icles had, a leas , one public sponso ), especially a na ional le el. Uni e si ies and he p i a e sec o unded only 4 a icles ou o 21. I is also wo h s essing ha some a icles we e unded by mo e han one ins i u ion. Howe e , o he 21 a icles ha ecei ed unding, 81% ecei ed unding om only one sponso and no a icle had mo e han 3 sponso s. Au ho s, Jou nals and Coun ies . The mos ele an jou nal was Ac as De mo-Si iliog á icas (4 a icles). No o he jou nal had mo e han 2 a icles. We only included s udies ca ied ou in La in Ame ica o o m a g oup o na ions ha a e cul u ally and geog aphically close, ha e simila le els o de elopmen and we e hi by he pandemic a he same ime. We also included Po ugal and Spain due o hei cul u al p oximi y o La in Ame ica. The coun ies in Ibe o- Ame ica wi h he mos a icles we e Spain (42 a icles), B azil (28) and Colombia (8). In e ms o languages, e en hough he esea ch was conduc ed by na i e Po uguese o Spanish speaking au ho s om Ibe o-Ame ica, he mos widely used language e- mains English (ci ca 66% o a icles in he inal sample had a e sion in English), ollowed by Spanish (ci ca 50%) and Po uguese (ci ca 15%). I ´s also wo h no ing ha many au ho s w o e se e al e sions o hei a icles in mo e han one language: 23 we e w i en in English and Spanish, 10 in English and Po uguese and 1 in Po uguese, Spanish and Po uguese. A possible sou ce o bias de i es om he ac ha NVi o so wa e was designed o analyze ex s in English. Whene e possible we included he English e sion o he a icle, howe e some a icles we e only in Po uguese o Spanish meaning hey may no ha e been p ope ly analyzed. A co- au ho ship analysis made using VOS iewe (Figu e 5). O he 665 au ho s, only 8 me he minimum h eshold o 2 a icles. In he inal sample, no schola w o e mo e han 2 a icles. The low le els o clus e ing shows ha co-au ho ship be ween au ho s on his opic is ela i ely a e. The only was clus e composed o 6 Spanish au ho s (Bel ís, .; Ga cíaazo ín,d.; González- o ia,c.; La o e, g.;López-b a o, a.; San os-lasoasa,s.) who published 2 a icles oge he and ha e he highes link o al link s eng h (10). Figu e 5. Co-au ho ship analysis using VOSViewe 4 4 Analysis conduc ed based on bibliog aphic da a om a RIS ile wi h he selec ed e e ences o analysis (n=106). Full coun ing was used and a minimum h eshold o 2 documen s pe au ho was se . 6 / 6 Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138 CONCLUSIONS The aim o his sys ema ic e iew was o analyze he exis ing li e a u e on elemedicine in Ibe o-Ame ica du ing he COVID-19 pandemic. Mos schola s who published on his opic, as one migh expec , ha e a backg ound in Medicine and Heal h sciences. Howe e , schola s om o he ields like Managemen , Psychology, Enginee ing and In o ma ion Sys ems ha e also con ibu ed o esea ch on his complex opic. Al hough se e al s udies ha e been ca ied ou in Ibe o- Ame ica, esea ch in Ibe o-Ame ica on his opic lags behind o he egions like Asia and No h Ame ica. Telemedicine has bo h p os and cons and has eme ged as a key al e na i e o manage heal h ca e sys ems du ing a pandemic. In Ibe o-Ame ica, he e a e speci ic challenges ela ed o he egions legal, cul u al and social con ex . Many o he de eloping na ions o Ibe o-Ame ica should de elop a na ional s a egy o expand he use o elemedicine and se ice p o ide s should communica e he bene i s o hese echnologies o consume . Finally, i is impo an o discuss some o he limi a ions o his e iew. Fi s ly, we could only include s udies om a limi ed numbe o da abases (6). Secondly, we only included s udies conduc ed in Ibe o-Ame ica, so cau ion needs o be aken be o e gene alizing he indings o o he con ex s. Due o ime cons ain s, he e iew p o ocol was no egis e ed. Since he opic o esea ch is complex and e y ecen , u he esea ch is needed o s ay up o da e wi h he la es de elopmen s o he pandemic. Fu he esea ch should also ocus on he adop ion and use o elemedicine by ulne able and unde se ed popula ions namely hose li ing in u al and emo e loca ions, indigenous peoples, acial, sexual, and e hnic mino i ies. REFERENCES Alonso, S.G., Ma ques, G., Ba achina, I., Ga cia-Zapi ain, B., A amba i, J., Sal ado , J.C., de la To e Díez, I., 2021. Telemedicine and e-Heal h esea ch solu ions in li e a u e o comba ing COVID-19: a sys ema ic e iew. Heal h and Technology 11, 257–266. h ps://doi.o g/10.1007/s12553-021-00529-7 Ba bosa, M.T., Sousa, C.S., Mo ais-Almeida, M., Simões, M.J., Mendes, P., 2020. Telemedicine in COPD: An O e iew by Topics. COPD: Jou nal o Ch onic Obs uc i e Pulmona y Disease 17, 601–617. h ps://doi.o g/10.1080/15412555.2020.1815182 Bokolo An hony Jn ., 2020. Use o Telemedicine and Vi ual Ca e o Remo e T ea men in Response o COVID-19 Pandemic. Jou nal o Medical Sys ems 44, 132. h ps://doi.o g/10.1007/s10916-020-01596-5 Gómez, N.G., Ga cía, A.M.G., Ga cía, S.G., 2020. Pedia ic epilepsy and elemedicine: An al e na i e in imes o co id-19. Re is a Cubana de Pedia ia 92, 1–11. Mohe , D., Libe a i, A., Te zla , J., Al man, D., An es, G., A kins, D., Ba bou , V., Ba owman, N., Be lin, J., Cla k, J., Cla ke, M., Cook, D., D’Amico, R., Deeks, J., De e eaux, P.J., Dicke sin, K., Egge , M., E ns , E., Gø zsche, P.C., Tugwell, P., 2014. P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses: The PRISMA S a emen . Re is a Espanola de Nu icion Humana y Die e ica 18, 172–181. Monaghesh, E., Hajizadeh, A., 2020. The ole o eleheal h du ing COVID-19 ou b eak: a sys ema ic e iew based on cu en e idence. BMC Public Heal h 20, 1193. h ps://doi.o g/10.1186/s12889-020-09301-4 Mo eno López, C.L., Be nal-Pacheco, Ó., Ba ios Vincos, G., Ce que a Cle es, S.C., 2020. En e medad de Pa kinson y co id-19: una pandemia en medio de o a. Ac a Neu ol Colomb. 36, 39–46. h ps://doi.o g/10.22379/24224022292 WHO Global Obse a o y o eHeal h, 2010. Telemedicine: oppo uni ies and de elopmen s in Membe S a es: epo on he second global su ey on eHeal h. Global Obse a o y o eHeal h Se ies, 2.