Using the attached Chapter 3 - Methods (TEMPLATE), write the methods section for your proposed research study 4-5 pages.

A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF TELEHEALTH/TELEMEDICINE

IN IMPROVING ACCESS TO CARE AND PATIENT SATISFACTION

Student Name

Capstone Project

In partial fulfillment of the degree Master of Public Health

National University

End of Course Date

I accept this capstone project on behalf of the Community Health Department, School of Health and Human Services, National University. Below the faculty who taught the capstone course, and the MPH Program Director will sign.

__________________________________________ ___________

Faculty/Professor of Capstone Date

Brandon Eggleston PhD

__________________________________________ ___________

MPH Program Director Date

Tyler Smith PhD

iii

CHAPTER 3. METHODOLOGY

Introduction

This chapter provides a structure, particularly in conducting the systematic review to find equivalent answers to the study’s research questions. Furthermore, this describes how the related studies were collected and the methods used to collect research articles.

Research Questions

This systematic review of articles aims to answer the following research question: How effective is Telehealth/Telemedicine in addressing access to care problems and increasing patient satisfaction before, during, and maybe after the pandemic? What are the possible barriers and other benefits it brings to health care systems?

Description of Participants

The included articles related to the main topics of this systematic review consisted of medical-related services provided through telehealth or telemedicine to the general population; for example, routine check-ups, mental health counseling sessions, follow-up care, prescription refills, and COVID-19 triage care. There were no other criteria used to determine target groups.

Instrumentation

This systematic review was conducted from January to February 2022 using comprehensive and general searches throughout the National University Smart Search, EBSCO Host, ProQuest, and Google Scholar databases. General and extensive searches were performed in the National University Smart Search, EBSCO Host, ProQuest, and Google Scholar databases using the following keywords: ‘virtual medical appointment,’ ‘virtual appointment,’ ‘virtual versus face-to-face appointments’, ‘telehealth’, ‘telemedicine’, ‘telehealth in COVID-19’, ‘telemedicine in the military’, ‘virtual medicine’, ‘virtual pharmacy’, ‘virtual clinic’, ‘group virtual mental health appointment’, ‘patient satisfaction measures,’ ‘military access to care,’ ‘virtual medical appointment in the military,’ ‘history of telehealth’ and ‘telehealth as access to care.’ The publication date range was from 2008 to 2022. After collecting articles from databases, further selection was performed by reading the abstract and results. The chosen articles were further studied by reading the entire text to analyze the research questions.

Ethical Considerations

The study did not require institutional review board (IRB) approval as the study was a systematic literature review. To achieve the highest level of credibility when conducting the review, only peer-reviewed and scholarly research articles were chosen for analysis.

CHAPTER 4. DATA COLLECTION, ANALYSIS AND RESULTS

Introduction

This chapter discusses the methods and procedures undertaken to gather and examine published articles and related data pertinent to this study. Additionally, this section includes the details of the results from the careful review of included articles.

Data Collection Procedures

This comprehensive study is regarding the effectiveness of telehealth/telemedicine in improving access to care and increasing patient satisfaction. Included in the process was the gathering of articles to build a group of related research studies available to support the idea that telehealth and telemedicine have contributed to improving access to care and increasing patient satisfaction of several medical services. At the early gathering stage, aggregate articles were pulled from searchable terms related to this study and subjected to further screening ( n = 108). Furthermore, articles subject to a more detailed analysis were selected after reading each abstract, results, and discussion section ( n = 66). Some articles were excluded for not meeting the criteria stated for this review ( n = 16). The remaining articles ( n = 50) were grouped into three; one group talked about access to care ( n = 28); the second group was all about patient satisfaction ( n =16); the third group tackled access to care and patient satisfaction ( n = 6). Figure 1 provides a detailed description of the process of selecting the articles for this project (Appendix A). Table 1 contains the list of articles used for this study (Appendix B). In general, all authors concluded that telehealth and telemedicine increased access to care and significantly improved patient satisfaction. A few articles stated suggestions and recommendations on how telehealth and telemedicine can positively impact providing care to patients; however, subject to further studies. Some articles also stated various barriers that hinder telehealth and telemedicine from maximizing positive impact in patient care. The role of telehealth and telemedicine in every included research presents a unique avenue where these system/s were used to address patient needs, but the focus of this study was access to care and patient satisfaction.

Data Analysis and Results

The list of reviewed articles has been provided in Appendix A, including the authors, publication year, and title. Based on the articles studied for this systematic review, the authors strongly expressed and magnified that telehealth and telemedicine play an essential role in widening access to care and high satisfaction rate for the care of patients. However, they pointed out many barriers to utilizing the full potential of the systems. During the COVID-19 pandemic, telehealth and telemedicine were deployed unprecedentedly, providing continuous care for patients with pre-existing conditions, follow-up care, counseling, referrals, triage, and others. Some of the included articles are highlighted in this section, citing the authors' views regarding telehealth and telemedicine's positive impact on access to care and patient satisfaction.

Pre COVID-19 Pandemic

Globally, telehealth and telemedicine offer potential benefits for better health outcomes by increasing access to healthcare, collaboration, timely care, and reduced costs. According to Jong et al. (2019), in a study conducted in northern Canada, telehealth significantly enhanced care availability for many people in the area. In the survey conducted in Newfoundland and Labrador, Canada, it was found that physician users of telemedicine consistently reported that telehealth resulted in improved patient care, reduced transfers, and collaboration and support for the patients and remote health providers (Jong et al., 2019). Furthermore, the authors explained that the cost of providing health care in northern Canada is higher than the rest of Canada, and telehealth can reduce health care expenditures.

Telehealth may be particularly well-suited to patients who have difficulty accessing timely, convenient care (Polinski et al., 2016). A study conducted by Polinski et al. (2016) compared face-to-face visits and telehealth visits in eleven clinics in Texas and California to measure patient satisfaction. With 1,734 telehealth patients surveyed, 32% expressed a preference for receiving care via telehealth. An additional 57% rated a telehealth visit as just as good as a traditional visit, while only 1% of patients rated the telehealth visit as worse than a traditional visit (Polinski et al., 2016). Furthermore, over half of the patients expressed shorter to no wait time as their primary motivation for using telehealth, 95% of all patients were very satisfied, 98% rated the assisting nurse as highly capable, and 94% were very satisfied with the treatment plan and educational materials they received (Polinski et al., 2016).

A study conducted by Dean et al. (2019) between September 2014 and November 2017 for 80 patients seen in 19 remote telehealth centers, 23 as new referrals, and 57 in follow-up consultation. This study showed that almost all 98% of patients who used telehealth indicated high overall satisfaction with their experience. Additionally, the providers' satisfaction was similarly high in terms of both the technology user interface and clinical effectiveness. The authors also noted that overall pediatric surgical consultation wait times were unaffected and that implementation of telehealth technology in a pediatric surgical practice offered high value to patients/families and, from the provider's perspective, yielded an acceptable alternative to in-person assessment (Dean et al., 2019).

Powell et al. (2018) conducted a study describing implementing a scheduled synchronous video visit program over 18 months. The authors used 3,018 scheduled and completed video visits across multiple clinical departments. The authors provided that 91.6% reported satisfaction with the planned visits among survey respondents, and 82.7% reported perceived quality similar to an in-person visit. According to the research, 86.0% responded that the scheduled video visit made it easier to access healthcare. The study concluded that an extensive urban multihospital health system that implemented an enterprise-wide scheduled telehealth video visit program across various clinical specialties provided a positive patient experience and expanded access to care (Powell et al., 2018). Lastly, the authors mentioned that the use of scheduled video visits made it easier to get the care and that the majority perceived time-saved, suggesting that the use of telehealth for scheduled visits can potentially improve access to care across a range of clinical scenarios with favorable patient experiences (Powell et al., 2018).

During COVID-19 Pandemic

The study conducted by O’Donovan et al. (2020) about the delivery of hemophilia comprehensive care during the pandemic described an increase in the implementation of digital care pathways by 52% since 2019, which was attributed to the heightened restrictions due to COVID-19. However, the authors noted high satisfaction and patient engagement with a 60% reduction in non-attendance. On the research, they also stated that patients who had participated in medical/nursing teleconsultations displayed an improvement in access by 79%, reduced inconvenience by 82%, ease of use at 94%, and facilitation of good communication with the HCP at 97% (O’Donovan et al., 2020). In closing, O’Donovan et al. (2020) expressed that telehealth has enabled continued access to specialized hemophilia comprehensive care with the COVID-19 pandemic as an unprecedented public health emergency.

Garvin et al. (2021) presented a study following veterans issued telehealth tablets for video visits. The study found out that about 45.9% of Veterans experiencing homelessness who received a tablet had a video visit within six months of receipt, most frequently for telemental health. The authors have solidified that telehealth provides a connection for vulnerable populations to avail themselves of medical care, particularly during the COVID-19 pandemic and beyond (Garvin et al., 2021). They mentioned that the VA’s distribution of video telehealth tablets offers healthcare access to Veterans experiencing homelessness; however, barriers remain for subpopulations. The study recommended tailored training and support for these patients to optimize telehealth tablet use and effectiveness.

According to Layfield et al. (2020), telemedicine is an increasingly important option for ambulatory patient care during COVID‐19 with implications for medical practice beyond the end of the pandemic. The authors defined telemedicine as an effective means to conduct a variety of outpatient encounter types of care with high patient satisfaction, including new patient, return, postoperative, and oncologic follow‐up visits in a head and neck otolaryngology practice (Layfield et al., 2020). They stated that patients reported high satisfaction with interaction quality, indicating that the telemedicine visit was effective for provider‐patient interactions.

In the study conducted by Jhaveri et al. (2020) about the conversion to telehealth of cancer survivorship program during COVID-19, they highlighted that the participation surged as the program became instantly accessible to more survivors. Furthermore, they identified that the average attendance to the mandatory monthly orientation tripled when it moved online, with the highest recorded orientation attendance in May 2020 over the 2.5-year history of the program (Jhaveri et al., 2020). There were fundamental aspects that the research elaborated on; it was mentioned that telehealth removed previously cited barriers of distance and dependent care scheduling conflicts. The increase in attendance also coincided with patient reports regarding a greater need for behavioral health and social support services in the context of COVID-19, and high satisfaction ratings were sustained across the transition to telehealth (Jhaveri et al., 2020).

Telehealth and telemedicine positively impact the issues of access to care and patient satisfaction, which is well highlighted during the pandemic to keep people safe in the corners of their home while getting the care they need, and all the authors of the included articles emphasized this idea. Virtual care can become an efficient way to provide remote access to quality healthcare services.

CHAPTER 5. CONCLUSIONS AND RECOMMENDATION

Introduction

This chapter provides the implications for the research hypothesis: Telehealth or Telemedicine has improved access to care and increased patient satisfaction in various health care services before, during, and maybe after COVID 19 Pandemic.

The systematic review consisted of 50 articles that acknowledged a number of evidence that telehealth and telemedicine contributed to the expansion of access to healthcare in various locations and health services. Additionally, telehealth and telemedicine elevated patients' satisfaction in many aspects of healthcare. In rural health areas, telehealth can assist healthcare systems, organizations, and providers expand access to and improving healthcare quality. The use of telehealth in rural areas as a healthcare delivery avenue can reduce or minimize challenges and burdens patients encounter, such as transportation issues related to travel for specialty care (Fortney et al., 2013). Hence, telehealth can also improve monitoring, timeliness, and communications within the healthcare system.

Telehealth became a more prominent platform for providing healthcare during the COVID -19 pandemic when patients and providers sought to decrease in-person contact for routine visits. The implementation and continued expansion of telehealth services assist various healthcare organizations in delivering care during the COVID-19 global pandemic.

The study conducted by Bate et al. (2021) in Melbourne, Australia, revealed an excellent overall acceptance, satisfaction, and willingness for patients, parents, and clinicians to use telehealth in the future. The authors then added that as more and more people are exposed to telemedicine and the rapid cyclical disruption of COVID‐19 eventually plateaus, telehealth should be looked at for further mass expansion in the digital era (Bate et al., 2021).

According to Demeke et al. (2021), while the resumption of in-person health care visits is anticipated when COVID – 19 pandemic subsides, telehealth will still be a critical factor in improving access to health care, especially among populations with limited access to care and enhancing the U.S. health care system's capacity to continue in future pandemics. For example, funded health centers have played a critical role as primary care providers by providing testing, treatment, and preventive care, including vaccination. Sustaining expanded use of telehealth visits in health centers during and after the pandemic might require continuation of existing flexibilities provided under Centers for Medicare & Medicaid Services telehealth reimbursement policies and local level considerations of additional support and resources (Demeke et al., 2021).

Sundstrom et al. (2019) conducted a study about the role of telehealth in providing access to women needing contraceptives in Rural South Carolina. Telehealth paved the way for health communicators to inform rural women of their choices in contraceptive methods, implementing effective campaigns and interventions to decrease unplanned pregnancy through improved access. They found out that telehealth initiatives address barriers to contraceptive entry in rural locations. Furthermore, participants discussed the advantages of telehealth, such as reduced travel distances and saving costs such as gas and transportation to access contraceptive services. These findings provide theoretical and practical opportunities to guide telehealth interventions and health communication campaigns to increase contraceptive uptake and decrease unintended pregnancies among women living in rural areas (Sundstrom et al., 2019).

To show that telehealth improves patient satisfaction, a study conducted by Wilkinson et al. (2016) proves high patient satisfaction with telehealth use in patients with Parkinson's disease. The authors stated that telehealth showed similar results to clinical outcomes. It was found in the research that greater satisfaction for the telehealth modality was found in assessments of convenience and accessibility/distance. Although certain aspects of the neurologic examination cannot be completed remotely (e.g., pull test and muscle tone assessment), most movement disorder–related exams are conducive to an audiovisual approach using the modified version of test models (Wilkinson et al., 2016). In conclusion, researchers stated that as the need for Parkinson's disease subspecialty care increases, innovative patient-centered solutions to overcoming barriers to access, such as video telehealth, will be invaluable to patients and provide high patient satisfaction.

A study by Cho et al. (2021) stated that cardiology patients reported overall satisfaction with telehealth during the COVID-19 pandemic. The research identified factors associated with patient convenience, gender, younger age, and non-white ethnicity correlated with greater satisfaction. The authors then stated that further research into telehealth's impact on patient satisfaction, safety, and clinical outcome is needed.

Waqar-Cowles et al. (2021) identified that there are encouraging signs that telehealth may be a viable method to deliver pediatric rheumatology care in the future. The research explained that most patients and caregivers reported positive experiences across all telehealth assessment sub-scales. Furthermore, patients and families familiar with telehealthcare were more likely to consider telehealth equal or preferable to in-person visits. Acceptability may increase with greater exposure to video visits and application in more targeted cases and when pediatric rheumatology providers have more familiarity with telehealth delivery and identify more optimal use cases (Waqar-Cowles et al., 2021). Research and innovation are needed to determine how evolving telehealth technology can help providers perform virtual exams with high fidelity and safety, thereby improving pediatric rheumatology telehealth delivery.

The study conducted by Ruelos et al. (2021) about the perception of orthopedic patients regarding telehealth use stated that the majority of patients expressed that the system was easy to use (90.0%), is convenient (86.7%), and saves them time (83.3%). Additionally, nearly all (95%) patients agreed that their surgeon could answer their questions using the technology. Patient perspectives on the widespread adoption of telehealth, such as ease of use, privacy protection, and convenience, showed that these anticipated barriers might be some of the most significant advantages of telehealth (Ruelos et al., 2021).

The COVID-19 pandemic may have provided the momentum for telehealth to become a mainstay of many healthcare services as a form of care delivery in the future. However, many aspects need to be addressed so that the benefits of this technology can be maximized.

Limitations

The articles included in this study were all peer-reviewed articles published from 2008 to 2022. Credible online resources and books were not included as they posed potential coding complications and data analysis issues. For these reasons, the review may not have examined other pertinent articles. The majority of the included research was conducted in the U.S., Canada, Australia, and Great Britain. Due to this, this study may not have captured the whole picture as results from other places may not have been accounted. Although, there is the certainty that the results may not have differed significantly if more articles had been included.

Conclusion

Telehealth and telemedicine play an essential part in widening access to care and improving patient satisfaction. COVID – 19 pandemic has launched the popularity and usefulness of this technology in many facets of healthcare. Telehealth has poised not only for convenience for patients, but it has the potential to provide so many further benefits, including improving public health, relieving pressure on the healthcare workforce, and helping to reduce financial stress to many. Some of the studies identified barriers that hinder the telehealth/telemedicine system; such barriers were human factors in using the technology, training, conflicting state policies, and privacy. These barriers are worth visiting for future studies to address and perhaps draw a bigger picture of telehealth and telemedicine as valuable assets to the healthcare system.

Recommendations for Further Study

In this study, many articles focused on the patient, yet patient care does not only include patients, but also consists of the system and providers. Future studies may include looking at the other side of patient care on how telehealth affects doctors, nurses, and other healthcare providers. It is also essential to study how a unified telehealth system in the United States can be achieved. This will assist lawmakers and advocates in pressing the approval of existing policy proposals waiting for debates and discussions in the senate and congress. Some examples of proposed telehealth acts are S. 1704/H.R. 5981 (Telehealth Expansion Act 2021), H.R. 5506 (Rural Telehealth Access Task Force Act), and H.R. 4480 (Telehealth Coverage and Payment Parity Act). Along with many other proposed laws, it is crucial to public health professionals and advocates to keep awareness of the benefits of the telehealth system in the open to address any gaps in health not just for people living in remote places but for all who want to avail these kinds of services.

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McMahon, K. D., & Duncan, J. (n.d.). Ironshore—telehealth care platform presents new insurance challenges. Ironshore. Retrieved August 29, 2020, from http://www.ironshore.com/blog/telehealth-care-platform-presents-new-insurance-challenges

MHS. (2020a, April 13). Military hospital dials in virtual healthcare to combat COVID-19. Military Health System. https://www.health.mil/News/Articles/2020/04/13/Military-hospital-dials-in-virtual-healthcare-to-combat-COVID-19

MHS. (2020b, May 19). DHA increases access to telehealth during COVID-19 pandemic. Military Health System. https://health.mil/News/Articles/2020/05/19/DHA-increases-access-to-telehealth-during-COVID-19-pandemic

Moffatt, J. J., & Eley, D. S. (2010). The reported benefits of telehealth for rural Australians. Australian Health Review, 34(3), 276–281.

Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health, 20(1), 1193. https://doi.org/10.1186/s12889-020-09301-4

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Nandra, K., Koenig, G., DelMastro, A., Mishler, E. A., Hollander, J. E., & Yeo, C. J. (2019). Telehealth provides a comprehensive approach to the surgical patient. The American Journal of Surgery, 218(3), 476–479. http://dx.doi.org/10.1016/j.amjsurg.2018.09.020

Nettesheim, N., Powell, D., Vasios, W., Mbuthia, J., Davis, K., Yourk, D., Waibel, K., Kral, D., McVeigh, F., & Pamplin, J. C. (2018). Telemedical support for military medicine. Military Medicine, 183(11–12), e462–e470. https://doi.org/10.1093/milmed/usy127

Nicosia, F. M., Kaul, B., Totten, A. M., Silvestrini, M. C., Williams, K., Whooley, M. A., & Sarmiento, K. F. (2021). Leveraging telehealth to improve access to Care: A qualitative evaluation of veterans’ experience with the VA TeleSleep program. BMC Health Services Research, 21(1), 77. https://doi.org/10.1186/s12913-021-06080-5

O’Connor, M., Asdornwised, U., Dempsey, M. L., Huffenberger, A., Jost, S., Flynn, D., & Norris, A. (2016). Using telehealth to reduce all-cause 30-day hospital readmissions among heart failure patients receiving skilled home health services. Applied Clinical Informatics, 07(02), 238–247. https://doi.org/10.4338/ACI-2015-11-SOA-0157

O’Donovan, M., Buckley, C., Benson, J., Roche, S., McGowan, M., Parkinson, L., Byrne, P., Rooney, G., Bergin, C., Walsh, D., Bird, R., McGroarty, F., Fogarty, H., Smyth, E., Ahmed, S., O’Donnell, J. S., Ryan, K., O’Mahony, B., Dougall, A., & O’Connell, N. M. (2020). Telehealth for delivery of haemophilia comprehensive care during the COVID‐19 pandemic. Haemophilia, 26(6), 984–990. https://doi.org/10.1111/hae.14156

Orlando, J. F., Beard, M., & Kumar, S. (2019). Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health. PLOS ONE, 14(8), e0221848. https://doi.org/10.1371/journal.pone.0221848

Pal, T., Hull, P. C., Koyama, T., Lammers, P., Martinez, D., McArthy, J., Schremp, E., Tezak,

A., Washburn, A., Whisenant, J. G., & Friedman, D. L. (2021). Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): Protocol to evaluate effectiveness of amulti-level telehealth-based intervention to improve rural cancer care delivery. BMC Cancer, 21(1), 1262. https://doi.org/10.1186/s12885-021-08949-4

Palen, T. E., Price, D., Shetterly, S., & Wallace, K. B. (2012). Comparing virtual consults to traditional consults using an electronic health record: An observational case–control study. BMC Medical Informatics and Decision Making, 12, 65. https://doi.org/10.1186/1472-6947-12-65

Paterson, C., Bacon, R., Dwyer, R., Morrison, K. S., Toohey, K., O’Dea, A., Slade, J.,

Mortazavi, R., Roberts, C., Pranavan, G., Cooney, C., Nahon, I., & Hayes, S. C.

(2020). The role of telehealth during the COVID-19 pandemic across the

interdisciplinary cancer team: Implications for practice. Seminars in Oncology

Nursing, 36(6), 151090. https://doi.org/10.1016/j.soncn.2020.151090

Perez, D. L. (2021). Expanding access to specialty care using video-telehealth: The

case for functional neurological disorder. Journal of the Academy of Consultation-Liaison Psychiatry, 62(6), 667–668. https://doi.org/10.1016/j.jaclp.2021.07.002

Polinski, J. M., Barker, T., Gagliano, N., Sussman, A., Brennan, T. A., & Shrank, W. H. (2016). Patients’ satisfaction with and preference for telehealth visits. Journal of General Internal Medicine; New York, 31(3), 269–275. http://dx.doi.org.nuls.idm.oclc.org/10.1007/s11606-015-3489-x

Price, L. E., Noulas, P., Wen, I., & Spray, A. (2019). A portal to healing: Treating military families and veterans through telehealth. Journal of Clinical Psychology, 75(2), 271–281. https://doi.org/10.1002/jclp.22720

Powell, R. E., Stone, D., & Hollander, J. E. (2018). Patient and Health System Experience With Implementation of an enterprise-wide telehealth scheduled video visit program: Mixed-methods study. JMIR Medical Informatics, 6(1), e10. https://doi.org/10.2196/medinform.8479

Ruelos, V. C. B., Puzzitiello, R. N., Menendez, M. E., Moverman, M. A., Pagani, N. R., Rogerson, A., Ryan, S. P., & Salzler, M. J. (2021). Patient perceptions of telehealth orthopedic services in the era of COVID-19 and beyond. Orthopedics (Online), 44(5), e668–e674. http://dx.doi.org/10.3928/01477447-20210817-07

Seto, E., Smith, D., Jacques, M., & Morita, P. P. (2019). Opportunities and challenges of

telehealth in remote communities: Case study of the Yukon telehealth system. JMIR Medical Informatics, 7(4), e11353. https://doi.org/10.2196/11353

Stingley, S., & Schultz, H. (2014). Helmsley Trust support for telehealth improves access to Care in rural and frontier areas. Health Affairs, 33(2), 336–341. https://doi.org/10.1377/hlthaff.2013.1278

Sundstrom, B., DeMaria, A. L., Ferrara, M., Meier, S., & Billings, D. (2019). “The closer, the better:” The role of telehealth in increasing contraceptive access among women in rural South Carolina. Maternal and Child Health Journal, 23(9), 1196–1205. http://dx.doi.org/10.1007/s10995-019-02750-3

Reisinger‐Kindle, K., Qasba, N., Cayton, C., Niakan, S., Knee, A., & Goff, S. L. (2021). Evaluation of rapid telehealth implementation for prenatal and postpartum Care visits during the COVID ‐19 pandemic in an academic clinic in Springfield, Massachusetts, United States of America. Health Science Reports, 4(4). https://doi.org/10.1002/hsr2.455

Rutherford, E., Noray, R., HEarráin, C. Ó., Quinlan, K., Hegarty, A., Ekpotu, L., Arize, C., Fabamwo, F., Alrubaiaan, A., Bhupalan, A., Alshehhi, A., Power, C., & Hill, A. D. K. (2020). Potential benefits and drawbacks of virtual clinics in general surgery: Pilot cross-sectional questionnaire study. JMIR Perioperative Medicine, 3(1), e12491. https://doi.org/10.2196/12491

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Waqar-Cowles, L. N., Chuo, J., Weiss, P. F., Gmuca, S., LaNoue, M., & Burnham, J. M. (2021). Evaluation of pediatric rheumatology telehealth satisfaction during the COVID-19 pandemic. Pediatric Rheumatology, 19(1), 170. https://doi.org/10.1186/s12969-021-00649-4

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APPENDIX A. ARTICLE SELECTION PROCESS

Figure 1. Study Selection Flow Diagram

APPENDIX B. SYSTEMATIC LITERATURE REVIEW

Table 1. List of Reviewed Articles

Author, Year	Article Title	Focus of study
Jones et al., 2012	Acceptability and cost-effectiveness of military telehealth mental health screening.	Access to Care
Weissman et al., 2020	Access to evidence-based Care for eating disorders during the COVID-19 crisis	Access to Care
Jester et al., 2020	Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions	Access to Care
Jong et al., 2019	Enhancing access to care in northern rural communities via telehealth	Access to Care
Pal et al., 2021	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery	Access to Care
Bate et al., 2021	Effect of the COVID‐19 induced phase of massive telehealth uptake on end‐user satisfaction	Access to care & Patient satisfaction
Reisinger-Kindle et al., 2021	Evaluation of rapid telehealth implementation for prenatal and postpartum Care visits during the COVID-19 pandemic in an academic clinic in Springfield, Massachusetts, United States of America	Access to care
Goncalves et al., 2017	Expanding Primary Care Access: A Telehealth Success Story	Access to Care
Young et al., 2011	Home Telehealth: Patient Satisfaction, Program Functions, and Challenges for the Care Coordinator	Patient satisfaction
Dean et al., 2019	Improving value and access to specialty medical care for families: a pediatric surgery telehealth program	Access to care & Patient satisfaction
Nicosia et al., 2021	Leveraging Telehealth to improve access to Care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program	Access to Care
Polinski et al., 2016	Patients’ Satisfaction with and Preference for Telehealth Visits	Access to Care
Chang et al., 2021	Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era	Access to Care
Jhaveri et al., 2020	"Soup cans, brooms, and Zoom:" Rapid conversion of a cancer survivorship program to telehealth during COVID-19	Access to care & Patient satisfaction
Imlach et al., 2020	Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences	Access to care & Patient satisfaction
O’Donovan et al., 2020	Telehealth for delivery of hemophilia comprehensive care during the COVID-19 pandemic	Access to care & Patient satisfaction
Aziz et al., 2020	Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic	Access to care
Gadenz et al., 2021	Telehealth to support referral management in a universal health system: a before-and- after study	Access to Care
Young et al., 2017	Telehealth: Increasing Access to High Quality Care by Expanding the Role of Technology in Correctional Medicine	Access to Care
Powell et. Al., 2018	Patient and Health System Experience with Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study	Access to care & Patient satisfaction
Garvin et at., 2021	Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness	Access to Care
Layfield et al., 2020	Telemedicine for head and neck ambulatory visits during COVID‐19: Evaluating usability and patient satisfaction	Patient satisfaction
White et al., 2022	The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy	Access to Care
Hobson et al., 2019	Using telehealth in motor neuron disease to increase access to specialist multidisciplinary Care: a UK-based pilot and feasibility study	Access to Care
Gilkey et al., 2021	Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals	Access to Care
Bradford et al., 2015	Awareness, experiences and perceptions of telehealth in a rural Queensland community	Patient satisfaction
Jeste et al., 2020	Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions	Patient satisfaction
Adams et al., 2021	Patient satisfaction and acceptability with telehealth at specialist medical outpatient clinics during the COVID-19 pandemic in Australia	Patient satisfaction
Steindal et al., 2020	Patients’ Experiences of Telehealth in Palliative Home Care: Scoping Review	Patient satisfaction
Rutherford et al., 2020	Potential Benefits and Drawbacks of Virtual Clinics in General Surgery: Pilot Cross-Sectional Questionnaire Study	Patient satisfaction
Sharma et al., 2021	Rapid telehealth implementation into an otolaryngology practice during the COVID-19 pandemic	Patient satisfaction
Paterson et al., 2020	The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice	Patient satisfaction
O’Connor et al., 2016	Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services	Patient satisfaction
Gordon et al., 2017	Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization	Patient satisfaction
Graziano et al., 2021	Psychological interventions during COVID pandemic: Telehealth for individuals with cystic fibrosis and caregivers	Patient satisfaction
Howren et al., 2020	Virtual rheumatology appointments during the COVID-19 pandemic: an international survey of perspectives of patients with rheumatic diseases	Patient satisfaction
Young et al., 2011	Home Telehealth: Patient Satisfaction, Program Functions, and Challenges for the Care Coordinator	Patient satisfaction
Bove et al., 2013	Managing hypertension in urban underserved subjects using telemedicine—A clinical trial	Patient satisfaction
Ly et al., 2017	The individual and contextual determinants of the use of telemedicine: A descriptive study of the perceptions of Senegal’s physicians and telemedicine projects managers	Patient satisfaction
Ashwood et al., 2017	Direct-To-Consumer Telehealth May Increase Access to Care but Does Not Decrease Spending	Access to Care
Watts et al., 2021	Can you hear me now? Improving palliative care access through telehealth	Access to Care
Stingley & Schultz, 2014	Helmsley Trust Support For Telehealth Improves Access to Care in Rural And Frontier Areas	Access to care
Nandra et al., 2019	Telehealth provides a comprehensive approach to the surgical patient	Access to Care
Sundstrom et al., 2019	“The Closer, the Better:” The Role of Telehealth in Increasing Contraceptive Access Among Women in Rural South Carolina	Access to Care
Perez, 2021	Expanding Access to Specialty Care Using Video-Telehealth: The Case for Functional Neurological Disorder	Access to Care
Maurice et al., 2020	Improving Access to Bariatric Surgery for Rural and Remote Patients: Experiences from a State-Wide Bariatric Telehealth Service in Australia	Access to Care
Moffat & Eley, 2010	The reported benefits of telehealth for rural Australians	Access to Care
Brenes et al., 2011	Benefits and Challenges of Conducting Psychotherapy by Telephone	Access to Care
Bhatia, 2021	Telehealth and COVID-19: Using technology to accelerate the curve on access and quality healthcare for citizens in India	Access to care
Seto et al., 2019	Opportunities and Challenges of Telehealth in Remote Communities: Case Study of the Yukon Telehealth System	Access to Care

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