Article type
Abstract
Background: Access to healthcare remains a challenge in LMICs. Teleconsultation may enhance access in particular for people living in remote areas. However, implementing teleconsultation is challenging, requiring tailored approaches to address implementation barriers and so enhance healthcare practices in LMICs. This scoping review aims to help advance teleconsultation implementation in LMICs by systematically analysing the barriers and facilitators.
Objective: To identify the barriers and facilitators of teleconsultation implementation in LMICs and identify them according to the Expert Recommendations for Implementation Change (ERIC) strategies.
Methods: The review followed the Johanna Briggs Institute methodology. We searched three indexed databases, including grey literature, for primary studies of synchronous teleconsultation in LMICs. Only research papers published in English and Spanish were considered. Three reviewers conducted the selection process independently. A meta-aggregation was used to analyse the data, and findings were identified according to the ERIC strategies.
Results: Of 8,525 articles identified, 35 were included. Facilitators for implementation were related to collaboration between institutions, well-established organisational processes for teleconsultation, and reduction of financial expenses for users and providers. The main challenges of teleconsultation implementation were infrastructural and financial barriers related to governance and resource management. A total of 168 barriers and 164 facilitators were identified and organised according to the ERIC strategies. This allowed for the identification of core themes, such as "Promote adaptability," "tailor strategies," "build a coalition," "conduct local consensus," and "conduct ongoing training," among others. These core themes guided the development of questions for implementing teleconsultation in LMICs (Table 1).
Conclusions: The research findings indicate that introducing teleconsultation presents challenges at various levels within the healthcare system, with various factors affecting the success or failure of teleconsultation programmes. While some obstacles and supports may be common, they do not all have the same effects. It is essential to consider local needs and regulatory requirements before implementation. Using a set of questions to address the key issues could aid understanding and developing strategies to tackle implementation challenges, and ultimately inform countries on how to enhance healthcare access in LMICs.
Objective: To identify the barriers and facilitators of teleconsultation implementation in LMICs and identify them according to the Expert Recommendations for Implementation Change (ERIC) strategies.
Methods: The review followed the Johanna Briggs Institute methodology. We searched three indexed databases, including grey literature, for primary studies of synchronous teleconsultation in LMICs. Only research papers published in English and Spanish were considered. Three reviewers conducted the selection process independently. A meta-aggregation was used to analyse the data, and findings were identified according to the ERIC strategies.
Results: Of 8,525 articles identified, 35 were included. Facilitators for implementation were related to collaboration between institutions, well-established organisational processes for teleconsultation, and reduction of financial expenses for users and providers. The main challenges of teleconsultation implementation were infrastructural and financial barriers related to governance and resource management. A total of 168 barriers and 164 facilitators were identified and organised according to the ERIC strategies. This allowed for the identification of core themes, such as "Promote adaptability," "tailor strategies," "build a coalition," "conduct local consensus," and "conduct ongoing training," among others. These core themes guided the development of questions for implementing teleconsultation in LMICs (Table 1).
Conclusions: The research findings indicate that introducing teleconsultation presents challenges at various levels within the healthcare system, with various factors affecting the success or failure of teleconsultation programmes. While some obstacles and supports may be common, they do not all have the same effects. It is essential to consider local needs and regulatory requirements before implementation. Using a set of questions to address the key issues could aid understanding and developing strategies to tackle implementation challenges, and ultimately inform countries on how to enhance healthcare access in LMICs.