Telemedicine Implementation for Safety Net Populations: A Systematic Review.

Background: Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. Methods: We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from N  = 45 articles. Results: Nine (20%) of 45 articles were randomized controlled trials. N  = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only n  = 19 (42%) included African American/Black patients in demographics descriptions, n  = 14 (31%) LatinX/Hispanic patients, n  = 4 (9%) Asian patients, n  = 4 (9%) patients aged 65+ years, and n  = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption ( n  = 9, 20%), broadband access/quality ( n  = 5, 11%), and patient preference for in-person care ( n  = 4, 9%). Facilitators included efficiency gains ( n  = 6, 13%), patient acceptance ( n  = 3, 7%), and enhanced access ( n  = 3, 7%). Conclusions: Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.