Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review

Background: There is a focus on increasing asynchronous telemedicine use, which allows medical data to be transmitted, stored, and interpreted later; however, limited evidence of the quality of care it allows in general practice hinders its use. Aim: To investigate uses and effectiveness of asynchronous telemedicine in general practice, according to the domains of healthcare quality, and describe how the COVID- 19 pandemic changed its use. Design & setting: Systematic review in general practice. Method: A systematic search was carried out across four databases using terms related to general practice, asynchronous telemedicine, uses, and effectiveness, and supported by citation searching. This was followed by screening according to pre- defined criteria, data extraction, and critical appraisal. Narrative synthesis was then undertaken guided by the six domains of healthcare quality and exploring differences in use before and following the COVID- 19 pandemic. Results: Searches yielded 6864 reports; 27 reports from 23 studies were included. Asynchronous telemedicine is used by a range of staff and patients across many countries. Safety and equity are poorly reported but there were no major safety concerns. Evidence from other domains of healthcare quality show effectiveness in making diagnoses, prescribing medications, replacing other consultations, providing timely care, and increased convenience for patients. Efficiency is impacted by negative effects on workflow, through poor implementation and patient non- adherence, limiting usability and requiring new administrative approaches from healthcare staff. Asynchronous telemedicine use increased rapidly from March 2020, following the COVID- 19 pandemic outbreak. Conclusion: Asynchronous telemedicine provides quality care for patients but is limited by reports of increased workload and inefficient workflow compared with face - toface consultations. Limits of evidence include heterogeneity and small - scale studies. Further research into cost- effectiveness, equity, safety, and sustained implementation will influence future policy and practice.