gms | German Medical Science

Background and state of the art: Recent research suggests a number of shortcomings in telemedicine intervention development (Hastall et al. 2017) as well as implementation (Otto and Harst 2019). Therefore, a wide number of telemedicine interventions (Sood et al. 2007) are piloted every year (Lantzsch et al. 2018), yet seldom make it into regular care (Huang et al. 2017). In order to guide future planning, testing and scaling-up of successful telemedicine interventions, a consolidated research agenda is needed.

Aim: The objective of this study was to identify, categorize and prioritize current implications for future research in telemedicine for diabetes and hypertension in order to inform policy and practice decisions.

Methods: An iterative mixed methods design according to Creamer 2017 was followed, where both qualitative and quantitative methods were of equal priority. Three consecutive steps were taken: First, an updated (February 2020) umbrella review of telemedicine effectiveness (Timpel et al. 2019) was re-utilized to identify current research needs mentioned in the included systematic reviews and meta-analyses. Second, extracted data was categorized using inductive qualitative content analysis according to Mayring 2000. In a third step, the emerging categories and sub-categories informed the development of a quantitative survey intended to prioritize future research needs and to further distil them into topics for a future research agenda. For the latter, factor analysis was applied to reduce the number of items.

Results: After updating the umbrella review and applying the eligibility criteria 35 records were included, of which 32 reported on future research implications. Results yielded five categories as well as subcategories, covering a need for high quality studies, comprehensive technology assessments, in-depth considerations of patients’ characteristics, ethics & safety as well as implementation strategies.

Of the 188 participants of the survey, 86 prioritized the future research needs. The most pressing future research needs are data security, patient safety, patient satisfaction, implementation strategies and longer follow-ups. Chi² and t-test revealed significant differences in the priorities of participants with and without experience in telemedicine use, evaluation and development. A factor analysis revealed six over-arching factors: Evaluation of effectiveness, Relevant Outcomes, Research Planning, Implementation science, User-centered design and Data security.

Discussion: The results address a variety of barriers for telemedicine (Otto and Harst 2019). They acknowledge the variety and diversity of both patients (Ekeland et al. 2012) and telemedicine applications or components available (Sahin et al. 2019). As needs beyond evaluation, such as implementation strategies and patient satisfaction are more important to respondents with previous experience in telemedicine, these results may help learning from mistakes previously made (Huang et al. 2017).

Practical implications: Both the categories form the qualitative content analysis and the overarching factors gleaned from the survey results can serve as key topics of a future telemedicine research agenda.