Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review
Date
2022-04-15
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Abstract
Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs).
Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence
on telemedicine use in surgical care in LMICs is lacking.
Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs.
Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs,
following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African
Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021.
Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published
articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization
Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine
platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%).
Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider
training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies
used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes.
Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic
platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required.
Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in
LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there
remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate
quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate
telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes