Mobile technologies to support healthcare provider to healthcare provider communication and management of care
Information
- DOI:
- https://doi.org/10.1002/14651858.CD012927.pub2Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 18 August 2020see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Effective Practice and Organisation of Care Group
- Copyright:
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- Copyright © 2020 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
- This is an open access article under the terms of the Creative Commons Attribution Licence , which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Authors
Contributions of authors
Conceiving and designing the review: MF, DGB, CG, SL, GM, SS, TT
Co‐ordinating the review: DGB
Searching, selecting studies and completing the data extraction and grading: ARM, BB, DGB, GV, IRC, MF, NH, TT
Writing the review: DGB, SS
Providing general advice and feedback: ARM, BB, CG, DGB, GM, GV, IRC, MF, NH, SL, SS, TT
Securing funding for the review: GM, TT
Sources of support
Internal sources
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National Institute of Medical Research, UK
External sources
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UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO), Switzerland
Provided funding for the review.
Declarations of interest
ARM: Consultancy from Infarmed ‐ national authority of medicines and health products. Health Technology Assessment Commission. Payment for development of education presentations from Portuguese Institute of Oncology ‐ Lisbon.
BB: none known.
CG: none known.
DGB: "I was commissioned by the WHO to conduct this review."
GM: owns stock in Apple Computer.
GV: "Since October 2017 I have been employed by Cochrane Response, an evidence services unit operated by the Cochrane Collaboration and contracted by the WHO to produce this review."
IRC: none known.
MF: none known.
NH: "Since June 2016 I have been employed by Cochrane Response, an evidence services unit operated by the Cochrane Collaboration and contracted by the WHO to produce this review".
SL: "I am the Joint Co‐ordinating Editor for the Cochrane Effective Practice and Organisation of Care Review Group. I am also a member of the WHO Executive Guideline Steering Group on maternal and perinatal health recommendations".
SS: "I am the Joint Co‐ordinating Editor for the Cochrane Effective Practice and Organisation of Care Review Group."
TT: none known.
Acknowledgements
We acknowledge the help and support of Cochrane Effective Practice and Organisation of Care (EPOC), through the editorial input of the following editors and peer referees, who provided comments to improve the review: Julia Worswick (EPOC former Managing Editor); Paul Miller (EPOC information specialist); Joshua Vogel (EPOC contact editor); Michael Kent Ransom (EPOC internal editor); Craig Ramsay (EPOC stats editor); Andrew Farmer (external referee), and Elizabeth Shaw and Euphrasia Ebai‐Atuh (consumer referees). The authors would also like to thank John Eyers for designing and running the search strategies; Hanna Bergman, Anna Georgeson, Jennifer Petkovic, Nicola Maayan, and Rachel Richardson, from Cochrane Response, for screening and extracting data; and Kate Cahill for copy‐editing the review.
National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the Effective Practice and Organisation of Care (EPOC) Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS) or the Department of Health.
We are grateful to the Guideline Development Group of the Digital Health Guidelines (World Health Organization) for their constructive feedback in formulating the guiding questions for this systematic review, and for the funding they provided to complete the review.
Cochrane Response, an evidence services unit operated by the Cochrane Collaboration, provided screening and data extraction services for part of this review.
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Aug 18 | Mobile technologies to support healthcare provider to healthcare provider communication and management of care | Review | Daniela C Gonçalves-Bradley, Ana Rita J Maria, Ignacio Ricci-Cabello, Gemma Villanueva, Marita S Fønhus, Claire Glenton, Simon Lewin, Nicholas Henschke, Brian S Buckley, Garrett L Mehl, Tigest Tamrat, Sasha Shepperd | |
| 2018 Jan 19 | Mobile‐based technologies to support healthcare provider to healthcare provider communication and management of care | Protocol | Daniela C Gonçalves‐Bradley, Brian S Buckley, Marita S Fønhus, Claire Glenton, Nicholas Henschke, Simon Lewin, Nicola Maayan, Garrett L Mehl, Tigest Tamrat, Sasha Shepperd | |
Differences between protocol and review
We stated in the protocol that there would be one 'Summary of findings' table per comparison, and that we would group the trials by health condition. We did not do this due to the low number of included trials and the large number of different health conditions. Following discussion among the authors we agreed that stratifying the included studies by setting (community, primary, secondary care) would provide relatively homogenous groups of studies and that reporting findings by setting would improve the usability of the evidence.
We changed the title from "Mobile‐based technologies to support healthcare provider to healthcare provider communication and management of care" to "Mobile technologies to support healthcare provider to healthcare provider communication and management of care".
For the outcome 'Healthcare provider and participant acceptability of and satisfaction with the intervention', the protocol stated that both objective and subjective measures would be included, the former being the number lost to follow‐up not explained by other reasons. We did not measure acceptability or satisfaction using loss to follow‐up data, due to insufficient information.
We split the outcome 'Resource use' into two outcomes ('Healthcare use' and 'Cost').
For the 'Summary of findings' tables, we included participant acceptability and satisfaction alongside healthcare provider acceptability and satisfaction. The former was already a prespecified outcome in the protocol, but not for the 'Summary of findings' table.
One of the authors left the team (Nicola Maayan); we added new authors (Ana Rita Maria, Ignacio Ricci‐Cabello, Gemma Villanueva).
Notes
This review is based on standard text and guidance provided by Cochrane Effective Practice and Organisation of Care (EPOC).
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Bias;
- Cell Phone [statistics & numerical data];
- Community Health Workers [statistics & numerical data];
- Computer Security;
- Dermatologists;
- Diabetic Retinopathy [diagnosis];
- Emergency Service, Hospital [statistics & numerical data];
- Guideline Adherence [statistics & numerical data];
- Health Care Costs;
- *Health Personnel [psychology, statistics & numerical data];
- Health Status;
- Patient Satisfaction;
- Personal Satisfaction;
- Primary Health Care [statistics & numerical data];
- Quality of Life;
- Randomized Controlled Trials as Topic;
- Referral and Consultation [statistics & numerical data];
- Renal Insufficiency, Chronic [therapy];
- Skin Diseases [therapy];
- Telemedicine [economics, *statistics & numerical data];
- Time Factors;
- *Time-to-Treatment;
- Ultrasonography;
Medical Subject Headings Check Words
Adult; Humans;
PICOs
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
| Providers' adherence to recommended guidelines | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Van Gelder 2017 | General practitioners consulting with nephrologists about adults with chronic kidney disease | Complete monitoring of disease progression Complete monitoring of metabolic parameters | OR 1.23 (0.89 to 1.70) OR 0.61 (0.22 to 1.72) | Follow‐up not specified OR: Odds ratio; IG: intervention group; CG: control group * Multilevel analysis for IG compared to CG; model with a random intercept keeping the independent variable (General Practice Information System) fixed |
Comparison 1: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Providers' adherence to recommended practice, guidelines or protocols, Outcome 1: Providers' adherence to recommended guidelines
| Time between presentation and management | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Azogil‐López 2019 | General practitioner consulting with hospital physicians about participants (aged ≥ 7 years) | Median time from referral request to appointment with hospital physician Median time from referral request to resolution of the process | IG: 17 days (IQR 8 to 32, N = 72) CG: 51 days, (IQR 35 to 57 days, N = 101) Median difference: −27 days (99% CI −20 to −33 days)* IG: 105 days (IQR 40 to 169); CG: 147 days (IQR 74 to 228) Median difference: −47 days (95% CI −74 to −17 days)* | IG: Intervention group; CG: Control group; IQR: Interquartile range 3‐month follow‐up * As reported by the authors |
| Piette 2017 | General practitioner consulting with dermatologists about adults with skin lesions | Median delay between | IG: 4 days (N = 53) CG: 40 days (N = 50) Adjusted HR 2.55 (P = 0.01)* | 3‐month follow‐up Reported in days Data also provided for number of participants not receiving an appointment (15 days, 1‐, 2‐ and 3‐month follow‐up) Adjusted hazard ratio (HR) as provided by the authors (adjusting for clustering of GPs and identities of dermatologists) |
| Sutherland 2009 | General practitioner consulting with radiologists about clients aged ≥ 13 years requiring a trans‐abdominal or trans‐vaginal ultrasound | Median time to participant follow‐up Median time to final diagnosis | IG: 67.1 hours (IQR: 45.9 to 113.7, N = 53) CG: 76.7 hours (IQR 65.8 to 144.7, N = 52) IG: 17.8 hours (IQR: 12.2 to 27.1, N = 53) CG: 23.9 (IQR 21.4 to 48.1, N = 52) | Duration not provided |
| Whited 2002 | General practitioner consulting with dermatologists about adults with skin condition | Mean time to intervention | IG: 73.8 days (SD 71.6, N = 135) CG: 114.3 days (SD 72.3, N = 140) MD: −40.5 days (95% CI −23.41 to −57.89) | Duration not provided SD: standard deviation; MD: mean difference |
Comparison 2: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Time between presentation and management of the health condition, Outcome 1: Time between presentation and management
| Healthcare use | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Healthcare use | ||||
| Byamba 2015 | General practitioner consulting with dermatologists about adults with skin lesions | Participant referred to tertiary‐care centres for consultation | IG: 7/221 CG: 28/229 RR: 0.28, 95% CI 0.13 to 0.63 | IG: Intervention group; CG: Control group RR: risk ratio; CI: confidence interval 5 months follow‐up Note: there was no evidence of clustering taken into account in the analysis, and we were not able to re‐analyse the data. It is possible there are potential unit of analysis errors. |
| Davis 2003 | Primary care provider at the rural primary practice consulting with ophthalmologist at the university setting about adults with diabetes | Participant received diabetic | IG: 23/30 CG: 4/29 RR 5.56 (95% CI 2.19 to 14.10) | Follow‐up not reported RR: risk ratio; CI: confidence interval |
| Liddy 2019a | Primary care provider consulting with specialists for a range of different conditions | Participants referred for face‐to‐face visits to all medical specialties available through eConsult service during the study period | Mean number of participants seen (SD, range) IG: 608 (258, 90 to 1134) CG: 724 (370, 11 to 1692) RR 0.93, 95% CI 0.85 to 1.03* | 12‐month follow‐up RR: risk ratio; CI: confidence interval * Adjusted for covariates |
| Mansberger 2015 | Primary care providers consulting with experienced investigators based at an eye institute about adults with diabetes | Participant received diabetic | IG: 157/296 CG: 90/271 RR 1.60 (95% CI 1.31 to 1.95) | 12‐month follow‐up (24, 36 and 48 months also reported; during these periods telemedicine was offered to all participants) |
| Piette 2017 | General practitioner consulting with dermatologists about adults with skin lesions | Participant referred for clinic follow‐up | IG: 14/39*; CG: 50/50 RR: 0.36 (95% CI 0.24 to 0.55) | 3‐month follow‐up * Only includes participants for whom dermatologists were able to elaborate a treatment plan based on transmitted photographs; for approx. 1/5 of participants allocated to IG the photographs were not usable |
| Sutherland 2009 | General practitioner consulting with radiologists regarding clients aged ≥ 13 years requiring a trans‐abdominal or trans‐vaginal ultrasound | Participant received ultrasound | IG: 36/53 CG: 9/52 RR 3.92 (95% CI 2.11 to 7.31) | Follow‐up not specified RR: risk ratio; CI: confidence interval |
| Van Gelder 2017 | General practitioners consulting with nephrologists about adults with chronic kidney disease | Participant referred for clinic follow‐up | IG: 29/1277 CG: 52/1727 OR 0.61 (95% CI 0.31 to 1.23)* | Follow‐up not specified OR: Odds ratio; CI: confidence interval * Multilevel analysis for IG compared to CG; model with a random intercept keeping the independent variable (General Practice Information System) fixed |
| Whited 2002 | General practitioners consulting with dermatologists about adults with skin condition | Participant referred for clinic follow‐up | IG: 110/135; CG: 140/140 RR: 0.82 (95% CI 0.75 to 0.88) | Follow‐up not specified RR: risk ratio; CI: confidence interval |
| Whited 2013 | General practitioner consulting with dermatologists about adults with skin condition | Client visited dermatology clinic | IG: 78/125 CG: 120/136 RR 0.71 (95% CI 0.61 to 0.82) | Proportion of participats who had at least 1 visit to the dermatology clinic during the 9‐month follow‐up |
Comparison 3: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Healthcare use, Outcome 1: Healthcare use
Comparison 3: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Healthcare use, Outcome 2: Referred for clinic follow‐up or clinical examination, 3 to 12 months follow‐up
Comparison 3: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Healthcare use, Outcome 3: Referred for clinic follow‐up or clinical examination, 3 to 12 months follow‐up
| Health‐related quality of life | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Armstrong 2018 | General practitioner consulting with dermatologists about adults with psoriasis | General health status: Description General health status: Evaluation | MD 0 (95% CI −0.003 to 0.003) MD −0.002 (95% CI −2.75 to 2.75) | General health status ‐ Description assessed with EuroQol‐5D‐5L. Scores converted into an index number, with values ranging from −0.109 (worst) to 1 (best). General health status ‐ Evaluation assessed with EuroQol‐Visual Analogue Scale. Higher scores represent better perceived health status Mean difference from baseline to 12 months follow‐up, 296 participants. MD: mean difference; CI: confidence interval |
| Whited 2013 | General practitioner consulting with dermatologists about adults with skin condition | Quality of life: Composite Health‐related quality of life | IG: MD −12.0 (SD 24.5, N = 160) CG: MD −13.2 (SD 21.6, N = 166) Similar scores between groups throughout the trial | Quality of life assessed with Skindex‐16, 0 ‐ 100 Higher scores represent worse quality of life Health‐related quality of life (HRQoL) assessed with Short‐Form Health Survey 12 (SF‐12) Higher scores represent better HRQoL Mean difference from baseline to 9‐month follow‐up IG: intervention group; CG: control group; MD: mean difference; SD: standard deviation |
Comparison 4: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Participant's healthcare status and well‐being, Outcome 1: Health‐related quality of life
| Clinical course | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Pak 2007 | Primary care professional consulting with dermatologist about adults with skin condition | Clinical course ratings | Improved IG: 173/272, CG: 154/236 No change IG: 89/272; CG: 76/236 Worse IG: 10/272; CG: 6/236 | Based on dermatologist's assessment, at four‐month follow‐up There was little or no difference between groups |
| Whited 2013 | General practitioner consulting with dermatologists about adults with skin condition | Clinical course ratings | Resolved IG: 31/125; CG: 35/136 Improved IG: 59/125; CG: 63/136 Unchanged (not clinically relevant) IG: 13/125; CG: 15/136 Unchanged (clinically relevant) IG: 13/125; CG: 17/136 Worse IG: 9/125; CG: 6/136 | Based on dermatologist's assessment, at nine‐month follow‐up There was little or no difference between groups |
Comparison 4: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Participant's healthcare status and well‐being, Outcome 2: Clinical course
| Healthcare provider satisfaction with the intervention | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Piette 2017 | General practitioners consulting with dermatologists about adults with a skin condition | Satisfaction | Global satisfaction Same proportion of GPs in both groups were satisfied or very satisfied (69%) Time to treatment satisfaction Similar proportion of GPs in both groups considered the time for resolution to be short or very short (IG: 77%; CG: 54%) | Response rate: 65% (N = 26) 2 questions with a Likert scale response (1 very satisfied to 4 very unsatisfied) Results provided narratively |
| Van Gelder 2017 | General practitioners consulting with nephrologists about adults with chronic kidney disease | Exprience with the intervention | Content of information sent was good Yes: 71%; No: 13%; Did not use: 16% Ease of use Good: 39%; Reasonable: 37%; Insufficient: 8%; Did not use: 16% Added to knowledge of kidney disease Yes: 68%; No: 16%; Did not use: 16% Pleased with feasibility of telenephrology Yes: 79%; No: 5%; Did not use: 16% | Intervention group only (general practitioners) Response rate: 66% (N = 36) |
| Whited 2002 | General practitioners consulting with dermatologists about adults with a skin condition | Satisfaction with the intervention | N = 275 participants Timely appointments (GPs) IG: 95% agreed, 5% neutral CG: 7% agreed, 70% disagreed Consultant sent back information (GPs) IG: 87% agreed, 13% neutral CG: 68% agreed, 17% neutral Educational benefit from the referral (GPs) IG: 55% agreed, 45% neutral CG: 34% agreed, 41% neutral Satisfied with the consult process (GPs) IG: 92% agreed, 3% disagreed CG: 23% agreed, 35% disagreed Less confident with TD than FtF (CD) 75% agree, 12.5% disagree TD consultation takes longer (CD) 100% disagree TD makes it easier to triage clients (CD) 100% agree Satisfied with using TD (CD) 75% agree, 25% neutral | IG: intervention group; CG: control group; TD: teledermatology; FtF: face‐to‐face; CD: consulting dermatologists GPs: 4 questions relating to timeliness, information transfer, education, and overall satisfaction; score agree, neutral, disagree Referring GPs (N = 60) Dermatologists: confidence in using TD for diagnostic and management, resource use, and overall satisfaction; score agree, neutral, disagree CD (N = 8) |
Comparison 5: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Acceptability or satisfaction, Outcome 1: Healthcare provider satisfaction with the intervention
| Participant satisfaction with care | ||||
| Study | Population | Outcomes | Results | Notes |
|---|---|---|---|---|
| Eminović 2009 | General practitioners consulting with dermatologists about adults with skin condition | General satisfaction Interpersonal aspects of care | IG: Mean 3.8 (SD 0.59, N = 191) CG: Mean 3.8 (SD 0.59, N = 159) MD: 0.0 (95% CI −0.12 to 0.12) IG: Mean 4.13 (SD 0.62, N = 191) CG: Mean 4.15 (SD 0.73, N = 159) MD: 0.2 (95% CI −0.12 to 0.16) | Shortened version of the Patient Satisfaction Questionnaire (PSQ III) 1 ‐ 5, higher scores indicate more satisfaction with the care received 1 month follow‐up IG: Intervention group; CG: Control group; SD: standard deviation; MD: mean difference; CI: confidence interval |
| Piette 2017 | General practitioner consulting with dermatologists regarding adults with skin lesions | Global satisfaction Time to treatment satisfaction | Similar proportion of participants in both groups were satisfied or very satisfied (IG: 85%; CG: 94%) Higher proportion of participants in the IG considered the time for resolution to be short or very short, compared to the CG (46%)* | Response rate: 100% (N = 103) 2 questions with a Likert scale response (1 very satisfied to 4 very unsatisfied) Results provided narratively P = 0.20, as provided by the authors |
| Whited 2002 | General practitioner consulting with dermatologists regarding adults with skin condition | Satisfaction | There was little or no difference between IG (N = 101) and CG (N = 93)* | Visit‐specific satisfaction questionnaire (VSQ), 1 ‐ 5, higher scores indicate more satisfaction 1 month follow‐up * As reported by study authors, no usable data |
| Whited 2013 | General practitioner consulting with dermatologists regarding adults with skin condition | Overall satisfied with the care received for skin problem | Agree/strongly agree: IG: 86.8%; CG: 92% Neutral: IG: 8.8%; CG: 6.7% Disagree/Strongly disagree: IG: 4.5%; CG: 1.2% | Single question assessing global satisfaction with the care received 9 months follow‐up N = 159 (IG) and 166 (CG) |
Comparison 5: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Acceptability or satisfaction, Outcome 2: Participant satisfaction with care
| Costs | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Byamba 2015 | General practitioners consulting with dermatologists about adults with skin lesions | Total mean costs | IG: USD 320 CG: USD 3174 Difference: USD 2854* | IG: intervention group; CG: control group Costs calculated in USD (2014) *Data as provided by the authors; no further information available 5 months follow‐up Note: there was no evidence of clustering taken into account in the analysis, and we were not able to re‐analyse the data. It is possible there are potential unit of analysis errors. |
| Eminović 2009 | General practitioners consulting with dermatologists about adults with a skin condition | Total mean costs | IG: EUR 387 (95% CI 281 to 502.5, N = 312) CG: EUR 354 (95% CI 228 to 484, N = 293) MD: EUR 32.5 (95% CI −29.0 to 74.7)* | Costs calculated in EUR (2003) 1‐month follow‐up MD: mean difference; CI: confidence interval * Data as provided by authors |
| Pak 2007 | Primary care professional consulting with dermatologist about adults with skin condition | Total mean costs | Total direct cost IG: USD 103,043 (SD:294, N = 351), CG: 98,365 (283, N = 347) MD: USD −4678 (95% CI −4720 to −4635) Lost productivity IG: USD 16,359 (SD:47, N = 351) CG: USD 30,768 (SD 89, N = 347) MD: USD 14,409 (95% CI 14,398 to 14,419) | Total direct costs include consultations, laboratory analyses and procedures and medications Costs calculated in USD (2006) 4‐month follow‐up |
| Van Gelder 2017 | General practitioners consulting with nephrologists about adults with chronic kidney disease | Mean cost per participant | IG: EUR 453.86 (95% CI 392.98 to 514.74; N = 1277) CG: EUR 433.74 (95% CI 387.64 to 479.84; N = 1727) (P = 0.60) | Main related medical costs, including number of contacts between healthcare providers and participant, as well as between healthcare providers; lab costs; prescriptions; referrals to secondary for renal care. Costs calculated in EUR (2017) Follow‐up not specified |
| Whited 2002 | General practitioners consulting with dermatologists about adults with skin condition | Mean expected cost per participant per visit | Using basic technology IG: USD 40.35; CG: USD 26.50 Using more advanced technology IG: USD 33.10; CG: USD 21.40 | Follow‐up not specified Costs calculated in USD (2002) N = 275 participants |
| Whited 2013 | General practitioners consulting with dermatologists about adults with skin condition | Mean total costs per participant | Healthcare system perspective* IG: USD 308 (SD 298; N = 195) CG: USD 338 (SD 291; N = 196) MD: USD 30 (95% CI USD −79 to 20) Societal perspective** IG: USD 460 (SD 428; N = 195) CG: USD 542 (SD 403; N = 196) MD USD −82 (95% CI USD −12 to −152) | * Includes intervention costs (healthcare providers input, dermatology visits, medication, travel reimbursement) ** Travel, loss of productivity, other dermatology care USD Follow‐up 9 months Costs calculated in USD (2011) |
Comparison 6: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Costs, Outcome 1: Costs
| Technical difficulties | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Quality of the data transmitted | ||||
| Pak 2007 | Primary care providers consulting with dermatologist about adults referred to the dermatology service from primary care clinics | Technical problems | 20/528 participants’ images were lost | 10 images in each group |
| Piette 2017 | General practitioner consulting with dermatologists about adults with skin lesions | Technical quality of the images received | 11/53 participants' images did not have enough quality as to allow diagnosis or treatment or both | Intervention group only The dermatologist was able to make a decision about the need of an in‐person appointment for 8 of the clients, based on the clinical notes sent along with the images |
| Sutherland 2009 | General practitioner consulting with radiologists about clients aged ≥ 13 years requiring a trans‐abdominal or trans‐vaginal ultrasound | Technical quality of the images received | Mean 4.6 (standard deviation 0.5) Procedural quality Mean 4.7 (standard deviation 0.6) | As rated by 6 radiologists based on 53 scans, delivered by email; 1 ‐ 5, higher scores represent better quality of the images and the procedure Intervention group only |
| Whited 2002 | General practitioner consulting with dermatologists about adults referred to the dermatology service from primary care clinics | Technical quality of the images received | Due to the bad quality of the images transmitted, 1/134 clients allocated to the IG required an in‐person consultation | Intervention group only |
Comparison 7: Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared to usual care: Technical difficulties, Outcome 1: Technical difficulties
| Time between presentation and management | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Gulacti 2017 | Emergency physicians consulting with specialists about adults attending the emergency department; duration not provided | Median consult time* | IG: 158 minutes (IQR:133 to 177.25, 95% CI:150 to169, N = 173) CG: 170 minutes (IQR:165 to 188.5, 95% CI: 170 to 171, N = 172) Median difference: −12 minutes (95% CI: −19 to −7), P < 0.0001** | * Time when consultation was requested minus time when a bed was requested (for admission to hospital) or discharge time IG: intervention group; CG: control group; CI: confidence interval ** Data as provided by the authors |
Comparison 8: Mobile technologies for use in the emergency department compared to usual care: Time between presentation and management of the health condition, Outcome 1: Time between presentation and management
| Healthcare use | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Gulacti 2017 | Emergency physicians consulting with specialists about adults attending the emergency department | Median emergency department length of stay | IG: 240 minutes (IQR: 230 to 270, 95% CI: 240 to 255.2, N = 173) CG: 277 minutes (IQR: 270 to 287.8, 95% CI:277 to 279, N = 172) Median difference −30 minutes, 95% CI −37 to −25* | IG: intervention group; CG: control group; IQR: interquartile range; CI: confidence interval Follow‐up not specified * Data provided by study authors |
Comparison 9: Mobile technologies for use in the emergency department compared to usual care: Healthcare use, Outcome 1: Healthcare use
| Technical difficulties | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Quality of the data transmitted | ||||
| Gulacti 2017 | Emergency physicians consulting with specialists about adults attending the emergency department | Technical problems | There were no problems reported | |
Comparison 10: Mobile technologies for use in the emergency department compared to usual care: Technical difficulties, Outcome 1: Technical difficulties
| Healthcare use | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Iversen 2018 | Community nurses consulting with diabetes specialist nurses and podiatrists about adults aged ≥ 20 years with new diabetes‐related foot ulcers | Outpatient clinic consultations Community nurse consultations | IG: Mean 2.8 (SD 1.9, N = 94), CG: Mean 2.5 (SD 3.0, N = 88) MD −0.48 (95% CI −1.46 to 0.49) IG: M 6.7 (SD 3.4, N = 94), CG: M 5.9 (SD 4.6, N = 88) MD 0.92 (95% CI −0.70 to 2.53) | 12‐month follow‐up SD: standard deviation; MD: mean difference; CI: confidence interval |
| Orlandoni 2016 | Home‐visiting nursing staff consulting with a hospital physician about older adults treated with home enteral nutrition | Outpatient visits Hospitalisations | Incidence rate ratio 95% CI: 0.65 to 1.30, P = 0.62 Incidence rate ratio 95% CI: 0.54 to 1.19, P = 0.26* | 12‐month follow‐up * Data as provided by the authors |
Comparison 11: Mobile technologies used by community health workers or home‐care workers compared to usual care: Healthcare use, Outcome 1: Healthcare use
| Participant healthcare status and well‐being | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Chang 2011 | Community‐based peer health workers consulting with clinic staff about adults who were receiving or started receiving antiretroviral therapy | Mortality | IG: 37/446; CG: 53/524 RR 0.82, 95% CI 0.55 to 1.22 | Average follow‐up: 103 weeks |
| Iversen 2018 | Community nurses consulting with diabetes specialist nurses and podiatrists about adults aged ≥ 20 years with new diabetes‐related foot ulcers | Mortality | IG: 5/99; CG 5/88 RR 0.94, 95% CI 0.28 to 3.12 | 12 months follow‐up |
| Taylor‐Gjevre 2018 | Rural‐based physical therapists consulting with urban‐based rheumatologists about adults with a clinical diagnosis of rheumatoid arthritis | Disease activity Health‐related quality of life | DAS28‐CRPa MD 0.9 (95% CI −1.2 to 3.1, P = 0.33) mHAQb MD 0.2 (95% CI −0.1 to 0.5, P = 0.14) RADAIc MD 0.9 (95% CI −0.5 to 2.4, P = 0.19) EQ5Dd MD −0.1 (95% CI −0.4 to 0.1, P = 0.29)* | aDisease activity score for rheumatoid arthritis, higher scores represent greater disease activity b Modified health assessment questionnaire, 0 ‐ 3, higher scores represent greater impairment cRheumatoid arthritis disease activity index, 0 ‐ 10, higher scores represent greater disease activity dEuroQol 5 dimensions questionnaire (EQ5D), 0 ‐ 1, higher scores represent better health‐related quality of life Mean difference (MD) between groups, (Control (N = 31), Intervention (N = 54)), from baseline to 9‐month follow‐up All data as provided by the study authors |
Comparison 12: Mobile technologies used by community health workers or home‐care workers compared to usual care: Participant's healthcare status and well‐being, Outcome 1: Participant healthcare status and well‐being
| Participant satisfaction with care | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Iversen 2018 | Community nurses consulting with diabetes specialist nurses and podiatrists about adults aged ≥ 20 years with new diabetes‐related foot ulcers | Experience with healthcare | IG: M 4.4 (SD 0.5, N = 67) CG: M 4.4 (SD 0.5, N = 57) MD: 0.0 (95% CI −0.18 to 0.18) | Generic Short Patient Experiences Questionnaire (GS‐PEQ), 1 ‐ 5, higher scores indicate more satisfaction 12‐month follow‐up |
| Taylor‐Gjevre 2018 | Rural‐based physical therapists consulting with urban‐based rheumatologists about adults with a clinical diagnosis of rheumatoid arthritis | Participant satisfaction | There was little or no difference between IG (N = 31) and CG (N = 23)* | Visit specific satisfaction questionnaire (VSQ9), 1 ‐ 5, higher scores indicate more satisfaction 9‐month follow‐up * As reported by study authors, no usable data |
Comparison 13: Mobile technologies used by community health workers or home‐care workers compared to usual care: Acceptability or satisfaction, Outcome 1: Participant satisfaction with care
| Costs | ||||
| Study | Population | Outcome | Results | Notes |
|---|---|---|---|---|
| Chang 2011 | Community‐based peer health workers consulting with clinic staff about adults who were receiving or started receiving antiretroviral therapy | Yearly total cost of running the mHealth intervention Cost per participant | N = 29 clusters, 970 participants. USD 1046 USD 2.35 | Intervention arm only, costs calculated in Ugandan shillings and converted to USD (2011). Does not include cost of a previously set‐up intervention to train peer health workers, to which the mHealth was an add‐on Average follow‐up: 103 weeks |
Comparison 14: Mobile technologies used by community health workers or home‐care workers compared to usual care: Costs, Outcome 1: Costs
| Technical difficulties | ||||
| Study | Population | Outcomes | Results | Notes |
|---|---|---|---|---|
| Quality of the data transmitted | ||||
| Taylor‐Gjevre 2018 | Community nurses consulting with diabetes specialist nurses and podiatrists about adults aged ≥ 20 years with new diabetes‐related foot ulcers | Technical problems | For 10 video‐conferencing visits images were not transmitted and only an audio‐link was available | Unclear how many visits were conducted in total Intervention group only |
| Technical difficulties reported by the healthcare professionals | ||||
| Chang 2011 | Community‐based peer health workers consulting with clinic staff about adults who were receiving or started receiving antiretroviral therapy | Problems with the equipment | Healthcare professionals were not always able to charge the mobile phone Some mobile phones were stolen | Qualitative outcomes based on a small number of interviews (4) Intervention group only |
Comparison 15: Mobile technologies used by community health workers or home‐care workers compared to usual care: Technical difficulties, Outcome 1: Technical difficulties
| Mobile technologies used by primary care providers to consult with a hospital‐based specialist compared with usual care | ||||
| Population: Primary care providers consulting with dermatologists (6 studies), ophthalmologists (2 studies), radiologists (1 study), nephrologists (1 study), or different specialists (1 study) | ||||
| Outcomes | Impact | № of participants | Certainty of the evidence | Plain language statement |
|---|---|---|---|---|
| Providers' adherence to recommended practice, guidelines or protocols: Adherence to the advised monitoring criteria Follow‐up not specified | 1 trial of telenephrology (Van Gelder 2017), using a web‐based platform with access to the electronic medical record reported OR of 1.23 (95% CI 0.89 to 1.70) for monitoring of disease and 0.61 (0.22 to 1.72) for monitoring of metabolic parameters | 3004 (1 cluster‐randomised trial, 47 general practices) | ⊕⊕⊕⊝ | Mobile technologies used by primary care providers to consult with a hospital‐based specialist probably make little or no difference to primary care providers’ adherence to the advised monitoring criteria for participants with chronic kidney disease (CKD), when compared with usual care |
| Time between presentation and management of the health condition Follow‐up: 3 to 6 months | 2 trials of teledermatology (Piette 2017; Whited 2002) reported that participants allocated to IG received the required treatment in less time than those allocated to CG (median delay 4 days for IG and 40 days for CG; MD −40.5 days, 95% CI −23 to −58) 1 trial of telemedicine using a portable ultrasound (Sutherland 2009) for people presenting with symptoms that required an ultrasound reported little or no difference between groups. 1 trial of eConsult for people attending primary care (Azogil‐López 2019) reported that participants allocated to IG had an appointment in less time than those allocated to CG (median difference −27 days, 99% CI −20 to −33) | 656 (4 randomised trials) | ⊕⊕⊕⊝ | The intervention probably reduces time between participants presenting and management among individuals with some skin conditions, symptoms requiring an ultrasound, or requiring an appointment with a specialist after attending primary care |
| Healthcare use Follow‐up: 3 to 12 months | 4 trials of teledermatology (Byamba 2015; Piette 2017; Whited 2002; Whited 2013; RRs ranged from to 0.28 (95% CI 0.13 to 0.63) to 0.82 (95% CI 0.75 to 0.88)) reported that those participants allocated to the intervention group were less likely to be referred for clinic follow‐up or attend an appointment at a clinic 2 trials of eConsults for nephrology (Van Gelder 2017) and different specialties (Liddy 2019a) reported little or no difference between groups (OR 0.61, 95% CI 0.31 to 1.23 and RR 0.93, 95% CI 0.85 to 1.03, respectively) 2 trials of telemedicine for retinopathy screening (Davis 2003; Mansberger 2015) and 1 trial for people presenting with symptoms that required an ultrasound (Sutherland 2009; RR 3.92, 95% CI 2.11 to 7.31) reported that those participants allocated to the intervention group were more likely to receive a clinical examination | 4810 (9 randomised trials) | ⊕⊕⊕⊝ Moderatec | Mobile technologies used by primary care providers to consult with hospital‐based specialists may reduce referrals and clinic visits among people with skin conditions, and increase the likelihood of receiving retinopathy screening among participants with diabetes, and an ultrasound in those referred with symptoms, when compared with usual care 1 trial did not specifically report the number of participants involved |
| Participants' health status and well‐being | Patient‐reported quality of life and health‐related quality of life (Follow‐up: 9 to 12 months) | |||
| 2 trials of teledermatology (Armstrong 2018; Whited 2013) found little or no difference between groups For health status (EQ‐5D‐5L): MD 0 (95% CI −0.003 to 0.003) For quality of life (Skindex‐16): IG: MD −12.0 (SD 24.5, 160 participants), CG: MD −13.2 (SD 21.6, 164 participants) For health‐related quality of life (SF‐12), results reported as little or no difference between groups | 622 (2 randomised trials) | ⊕⊕⊕⊝ | Mobile technologies used by primary care providers to consult with hospital‐based specialists probably make little or no difference to quality of life and health‐related quality of life among individuals with skin conditions | |
| Clinician‐assessed clinical course (follow‐up: 4 to 9 months) | ||||
| 2 trials of teledermatology (Pak 2007; Whited 2013) found little or no difference between groups | 769 (2 randomised trials) | ⊕⊕⊕⊝ | Mobile technologies used by primary care providers to consult with hospital‐based dermatologists probably make little or no difference to clinical improvement among individuals with skin conditions | |
| Acceptability and satisfaction | Healthcare provider acceptability and satisfaction (follow‐up immediately after the intervention) | |||
| 1 trial of teledermatology (Piette 2017) reported little or no difference between groups 1 trial of teledermatology (Whited 2002) reported that GPs allocated to the intervention were more likely to agree that participants received timely appointments and to be satisfied with the consult process than GPs allocated to the control group | 378 | ⊕⊕⊝⊝ | Mobile technologies used by primary care providers to consult with hospital‐based dermatologists may make little or no difference to healthcare provider acceptability and satisfaction with the intervention | |
| Participant acceptability and satisfaction (follow‐up: 1 to 9 months) | ||||
| 4 trials of teledermatology (Eminović 2009; Piette 2017; Whited 2002; Whited 2013) reported little or no difference between groups 1 trial reported MD 0.0 (95% CI −0.12 to 0.12; PSQ III), another trial reported that 87% of participants allocated to the intervention group were overall satisfied with treatment received, compared with 92% of those allocated to the control group* 2 trials reported the results as little or no difference only (VSQ9; *) | 972 (4 randomised trials) | ⊕⊕⊝⊝ Lowg | Mobile technologies used by primary care providers to consult with hospital‐based dermatologists may make little or no difference to acceptability and satisfaction of participants with skin conditions | |
| Costs Follow‐up: 1 to 9 months | 2 teledermatology trials (Eminović 2009; Whited 2013) and 1 telenephrology trial (Van Gelder 2017) reported little or no difference between groups 2 teledermatology trials (Pak 2007; Whited 2002) reported that when loss of productivity was considered, the cost per participant was higher for those allocated to the intervention 1 trial of teledermatology (Byamba 2015) reported that total costs were lower for those allocated to the intervention group. | 5423 (6 randomised trials) | ⊕⊕⊝⊝ Lowh | The intervention may make little or no difference to total or expected costs per participant for adults with skin conditions or chronic kidney disease |
| Technical problems | 1 trial recruiting GPs consulting with dermatologists about images they took (Pak 2007) reported that there was little or no difference between groups for technical problems | 698 (1 randomised trial) | ⊕⊕⊕⊝ Moderatei | The intervention probably results in few or no technical difficulties |
| CG: Control group; CI: Confidence interval; EQ5D: EuroQol five dimensions questionnaire; GPs: General practitioners; IG: Intervention group; MD: Median difference; OR: Odds ratio; PSQ III: Shortened version of the Patient Satisfaction Questionnaire; RR: Risk ratio; SD: Standard deviation; SF‐12: Short‐Form Health Survey 12; VSQ9: Visit‐specific satisfaction questionnaire (VSQ9) * Questions developed by the authors for the specific trial | ||||
| GRADE Working Group grades of evidence | ||||
| Rationale for downgrading the evidence aWe downgraded one point for risk of bias due to performance and detection bias, and lack of protection against contamination. | ||||
| Mobile technologies for use in the emergency department compared with usual care | |||||
| Patient or population: Emergency physicians consulting with hospital specialists about adults attending the emergency department | |||||
| Outcomes | Impact | № of participants | Certainty of the evidence | Plain language statement | |
|---|---|---|---|---|---|
| Providers' adherence to recommended practice, guidelines or protocols | ‐ | ‐ | ‐ | No studies were identified | |
| Time between presentation and management of the health condition Follow‐up not reported | 1 trial (Gulacti 2017) reported that those allocated with the intervention group were admitted to hospital or discharged more quickly from the emergency department (median difference −12 minutes, 95% CI −19 to −7 minutes) | 345 (1randomised trial) | ⊕⊕⊕⊝ | The intervention probably reduces time between participants presenting and management by a few minutes among individuals visiting the emergency department | |
| Healthcare use: length of stay in the emergency department Follow‐up not reported | 1 trial (Gulacti 2017) reported that participant allocated to the intervention group participants had a shorter stay in the emergency department (median difference −30 minutes, 95% CI: −37 to −25 minutes) | 345 (1 randomised trial) | ⊕⊕⊕⊝ | The intervention probably slightly reduces length of stay among individuals visiting the emergency department | |
| Participants' health status and well‐being | ‐ | ‐ | ‐ | No studies were identified | |
| Participant and provider acceptability or satisfaction | ‐ | ‐ | ‐ | No studies were identified | |
| Costs | ‐ | ‐ | ‐ | No studies were identified | |
| Technical problems | 1 trial (Gulacti 2017) reported that there were no technical problems during the course of the trial | 345 (1 randomised trial) | ⊕⊕⊕⊝ | The intervention probably results in few or no technical difficulties | |
| CI: Confidence interval | |||||
| GRADE Working Group grades of evidence | |||||
| Rationale for downgrading the evidence aWe downgraded one point for risk of bias due to high risk of performance and reporting bias. | |||||
| Mobile technologies used by community health or home‐care workers compared with usual care | ||||
| Patient or population: Community‐based peer health workers consulting with clinic staff about receiving antiretroviral therapy, community nurses consulting with diabetes specialist nurses or podiatrists about adults with Type 2 diabetes, home‐care nurses consulting with hospital specialists about home enteral nutrition, rural‐based physical therapists consulting with urban‐based rheumatologists | ||||
| Outcomes | Impact | № of participants | Certainty of the evidence | Plain language statement |
|---|---|---|---|---|
| Providers' adherence to recommended practice, guidelines or protocols | ‐ | ‐ | ‐ | No studies were identified |
| Time between presentation and management of the health condition | ‐ | ‐ | ‐ | No studies were identified |
| Healthcare use | Outpatient clinic and community nurse consultations (follow‐up: 12 months) | |||
| 2 trials (Iversen 2018; Orlandoni 2016) reported little or no difference between groups for outpatient visits (MD −0.48, 95% CI −1.46 to 0.49) or community nurse consultations (MD 0.92, 95% CI −0.70 to 2.53) | 370 (2 randomised trials) | ⊕⊕⊕⊝ Moderatea | Mobile technologies used by community health or home‐care workers probably make little or no difference for outpatient clinic and community nurse consultations of participants with new diabetes‐related foot ulcer and older individuals treated with home enteral nutrition | |
| Hospitalisation (Follow‐up: 12 months) | ||||
| 1 study (Orlandoni 2016) reported that the incidence rate ratio for hospitalisations was similar between groups among older individuals treated with home enteral nutrition (95% CI 0.54 to 1.19, P = 0.26) | 188 (1 randomised trial) | ⊕⊕⊝⊝ | Mobile technologies for communication between home‐visiting nursing staff consulting with a hospital physician may have little or no effect on hospitalisations among older individuals treated with home enteral nutrition | |
| Participants' health status and well‐being | Mortality among individuals living with HIV or diabetes (Follow‐up: 11 to 12 months) | |||
| 2 trials reported little or no differences between groups. 1 study (Chang 2011) recruited peer health workers who consulted with clinic staff (RR: 0.82, 95% CI 0.55 to 1.22), and another study (Iversen 2018) recruited community nurses who consulted with diabetes specialist nurses (RR: 0.94, 95% CI 0.28 to 3.12). | 1157 | ⊕⊕⊝⊝ | The intervention may make little or no difference in mortality among people living with HIV or diabetes | |
| Disease activity or health‐related quality of life (Follow‐up: 9 months) | ||||
| 1 trial of rural‐based physical therapists consulting with urban‐based rheumatologists about adults with a clinical diagnosis of rheumatoid arthritis (Taylor‐Gjevre 2018) reported little or no difference between groups for disease activity (DAS28‐CRP MD 0.9, 95% CI −1.2 to 3.1; mHAQ MD 0.2, 95% CI −0.1 to 0.5; RADAI MD 0.9, 95% CI −0.5 to 2.4) or health‐related quality of life (EQ5D MD −0.1, 95% CI −0.4 to 0.1) | 85 (1 randomised trial) | ⊕⊕⊝⊝ | Mobile technologies used by community health or home‐care workers may make little or no difference for disease activity and health‐related quality of life in participants with rheumatoid arthritis | |
| Participant and provider acceptability or satisfaction | Healthcare provider acceptability and satisfaction | |||
| ‐ | ‐ | ‐ | No studies were identified | |
| Participant acceptability and satisfaction (Follow‐up: 9 to 12 months) | ||||
| 2 trials on diabetes (Iversen 2018) and arthritis (Taylor‐Gjevre 2018) reported little or no difference between groups for participants' experience with healthcare (GS‐PEQ MD 0.0, 95% CI −0.18 to 0.18) and satisfaction (VSQ9 results reported narratively) with the intervention. | 178 (2 randomised trials) | ⊕⊕⊕⊝ | Mobile technologies used by community health or home‐care workers probably make little or no difference for participant acceptability and satisfaction for participants with new diabetes‐related foot ulcer and participants with rheumatoid arthritis | |
| Costs | ‐ | ‐ | ‐ | No studies were identified |
| Technical difficulties | ‐ | ‐ | ‐ | No studies were identified |
| CI: Confidence interval; DAS28‐CRP: Disease activity score for Rheumatoid Arthritis; EQ5D: EuroQol five dimensions questionnaire; GS‐PEQ: Generic Short Patient Experiences Questionnaire; MD: Mean difference; mHAQ: Modified health assessment questionnaire; RADAI: Rheumatoid arthritis disease activity index; RR: Risk ratio; VSQ9: Visit‐specific satisfaction questionnaire | ||||
| GRADE Working Group grades of evidence | ||||
| Rationale for downgrading the evidence aWe downgraded one point for risk of bias due to high risk of performance (2 studies), detection (2 studies), attrition (1 study) and reporting (1 study) bias. bWe downgraded one point for imprecision because the 95% CI shows potential effect on both sides of “no effect” line and that there were few events. cWe downgraded one point for risk of bias due to high risk of performance, detection, and attrition bias. dWe downgraded one point for imprecision because the 95% CI shows potential effect on both sides of “no effect” line . eWe downgraded one point for risk of bias due to high risk of performance (2 studies), detection (1 study), attrition (1 study) and reporting (2 studies) bias. fWe downgraded one point for risk of bias due to high risk of performance, detection, attrition, and reporting bias. gWe downgraded one point for risk of bias due to high risk of performance (2 studies), detection (2 studies), attrition (1 study), and reporting (2 studies) bias. | ||||
| Study | Incentives | Specific training |
|---|---|---|
| Participants were paid for participating in the study, through gift cards (main paper, p.3, end 1st paragraph) | Participants and their carers were taught how to take standardised images of skin lesions, as well as how to communicate with the dermatologist using a secure web‐based system. PCPs also had access to the training materials. (Protocol, p.19, 2nd paragraph) | |
| ‐ | GPs attended a 2‐day training session to learn how to take images and use the medical record system and software on mobile phones (p.1, top 2nd column) | |
| PHWs were given a bicycle, t‐shirts, basic supplies, and an initial monthly allowance (parent trial) | PHWs allocated to the intervention group were given a mobile phone, and attended a 1‐day residential training and a brief field‐based practical training on the intervention (main paper, p.3, 2nd paragraph) | |
| ‐ | GPs allocated to the intervention group received detailed instructions on how to take digital images and use the web‐based form (main paper, p.559, bottom 1st column) | |
| ‐ | All staff received training in the use of the web‐based system, as well as in‐person access to hospital clinics to improve their practical skills (main paper, pp.97‐8) | |
| Specialists received financial incentives for each eConsult they undertook (support paper, under 8. Payment) | ‐ | |
| Participants received monetary incentive to complete follow‐up questionnaire (associated paper, p.524, bottom 1st column) | Technicians performing imaging attended a 3‐day training session to learn how to take images and ongoing feedback as needed (main paper, p.943, bottom 1st column) | |
| ‐ | GPs received training and a workbook on how to take photographs (p.2, top 2nd column) | |
| ‐ | The on‐site investigator received sonographic training over a 2‐month period, as well as practice guidelines for trans‐abdominal ultrasound scanning (P. 192, mid 1st column and top 2nd column) | |
| ‐ | Physical therapists and rheumatologists received an orientation and education session about rheumatoid arthritis and the study protocol and methods (main paper, p.2, top 2nd column) | |
| GP: general practitioner; PCP: primary care provider; PHW: peer health workers | ||
| Study ID | Population | Disadvantaged populations included/excluded? | Notes |
|---|---|---|---|
| General practitioner consulting with dermatologists about adults with psoriasis | Participants without access to the Internet and a digital camera or smartphone with camera features were excluded | ‐ | |
| GP consulting with hospital physicians about participants (aged ≥ 7 years) | Participants deemed as complex were not eligible for receiving the intervention | Complex participants defined as those lacking a specific diagnosis or requiring further clinical assessment | |
| GP consulting with dermatologists about adults with skin lesions | Intervention was set in rural health clinics in Mongolia | ‐ | |
| Community‐based peer health workers consulting with clinic staff about adults who were receiving or started receiving antiretroviral therapy | Specifically targeted HIV‐positive participants in rural Uganda. However, many participants had limited access to mobile phones*, which might have limited the benefits of the intervention. For the healthcare providers, the costs of the intervention were also a factor, as although they were given a monthly stipend it was not always enough Charging the mobile phone was often challenging, as access to electricity was limited | * Current mobile phone penetration in Uganda at the time the trial was conducted was 39% | |
| PCPs at the rural primary practice consulting with ophthalmologist in the university setting about adults with Type 2 diabetes | Specifically targeted rural‐based ethnic minorities, 35% of whom did not have health insurance | ‐ | |
| Emergency physicians consulting with specialists about adults attending the emergency department | Only consultants who owned a smartphone and were familiarised with the secure messaging service were included | ‐ | |
| PCPs consulting with experienced investigators based at an eye institute about adults with Type 2 diabetes | Primary clinics that served a large number of ethnic minorities, including a high percentage of participants with transient housing | ‐ | |
| General practitioners consulting with dermatologists about adults with skin lesions | Participants who were not able to attend in‐person appointments at the dermatologist office were excluded, i.e. participants unable to travel or those residing in nursing homes. | ‐ | |
| GP consulting with radiologists about participants aged ≥ 13 years requiring a trans‐abdominal or trans‐vaginal ultrasound | Sample was composed mainly of low‐skilled workers relying on government‐supported primary clinics for their health care | ‐ | |
| Community nurses consulting with diabetes specialist nurses and podiatrists about adults aged ≥ 20 years with new diabetes‐related foot ulcers | Specifically targeted rural‐based adults | ‐ | |
| GP consulting with dermatologists about adults with skin condition | Participants who could not speak or read English or who failed a single‐question literacy assessment* were excluded | *Single‐Item Literacy Screener (SILS), which identifies limited reading ability (Morris 2006) | |
| GP: General practitioner; PCP: primary care provider; PHW: Peer health workers | |||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Providers' adherence to recommended guidelines Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Time between presentation and management Show forest plot | 4 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Healthcare use Show forest plot | 9 | Other data | No numeric data | |
| 3.1.1 Healthcare use | 9 | Other data | No numeric data | |
| 3.2 Referred for clinic follow‐up or clinical examination, 3 to 12 months follow‐up Show forest plot | 3 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 3.2.1 Referred to a dermatology clinic | 3 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 3.3 Referred for clinic follow‐up or clinical examination, 3 to 12 months follow‐up Show forest plot | 2 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Health‐related quality of life Show forest plot | 2 | Other data | No numeric data | |
| 4.2 Clinical course Show forest plot | 2 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Healthcare provider satisfaction with the intervention Show forest plot | 3 | Other data | No numeric data | |
| 5.2 Participant satisfaction with care Show forest plot | 4 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Costs Show forest plot | 6 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Technical difficulties Show forest plot | 4 | Other data | No numeric data | |
| 7.1.1 Quality of the data transmitted | 4 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Time between presentation and management Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 9.1 Healthcare use Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 10.1 Technical difficulties Show forest plot | 1 | Other data | No numeric data | |
| 10.1.1 Quality of the data transmitted | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 11.1 Healthcare use Show forest plot | 2 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 12.1 Participant healthcare status and well‐being Show forest plot | 3 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 13.1 Participant satisfaction with care Show forest plot | 2 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 14.1 Costs Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 15.1 Technical difficulties Show forest plot | 2 | Other data | No numeric data | |
| 15.1.1 Quality of the data transmitted | 1 | Other data | No numeric data | |
| 15.1.2 Technical difficulties reported by the healthcare professionals | 1 | Other data | No numeric data | |
