Evaluating the feasibility, adoption, cost-effectiveness, and sustainability of telemedicine interventions in managing COVID-19 within low-and-middle-income countries (LMICs): A systematic review

COVID-19 has tragically taken the lives of more than 6.5 million people globally, significantly challenging healthcare systems and service delivery, especially in low-and middle-income countries (LMICs). This systematic review aims to: (1) evaluate the feasibility of telemedicine interventions for COVID-19 management; (2) assess the adoption of telemedicine interventions during the COVID-19 pandemic; (3) examine the cost-effectiveness of telemedicine implementation efforts and (4) analyze the sustainability of telemedicine interventions for COVID-19 disease management within LMIC service settings. We reviewed studies from selected public health and health science databases, focusing on those conducted in countries classified as low and middle-income by the World Bank, using telemedicine for confirmed COVID-19 cases, and adhering to Proctor’s framework for implementation outcomes. Of the 766 articles identified and 642 screened, only 3 met all inclusion criteria. These studies showed reduced reliance on antibiotics, prescription drugs, and emergency department referrals among telemedicine patients. Statistical parity was observed in the length of stay, diagnostic test ordering rates, and International Classification of Diseases (ICD)-10 diagnoses between telemedicine and in-person visits. Telemedicine interventions designed for post-COVID physical rehabilitation demonstrated safety, sustainability, and enhanced quality of life for patients without requiring specialized equipment, proving adaptable across contexts with appropriate technology. These interventions were also economically sustainable and cost-effective for healthcare systems as a whole. Proposed strategies to bridge implementation gaps include community-level assessments, strategic planning, multisectoral partnerships of local hospital administration and lawmakers, legal consultations, and healthcare informatics improvements. Increased investment in telemedicine research focusing on infectious disease management is crucial for the continued development and refinement of effective strategies tailored to resource-constrained regions.Author summary: Our systematic review examines the feasibility, adoption, cost-effectiveness, and sustainability of telemedicine for managing COVID-19 in LMICs. Telemedicine has become an essential tool for expanding health management options while addressing healthcare delivery disruptions, physician shortages, and socio-economic barriers. In LMICs, limited healthcare access and resource constraints pose significant challenges. Key issues in implementing telemedicine include internet connectivity and device usage difficulties. However, telemedicine offers benefits such as technology applicability, financial savings, and improved health outcomes. Among the three studies reviewed, telemedicine’s effectiveness was comparable to face-to-face consultations, particularly in post-COVID rehabilitation, which proved cost-effective and enhanced patients’ quality of life. Telemedicine reduces healthcare access barriers and is adaptable across contexts with appropriate technology, but it can create challenges for diagnostics and medication access in rural areas, requiring a mix of in-person and telemedicine approaches. Despite these challenges, the benefits of telemedicine outweigh the drawbacks. We advocate for improving technological capabilities, creating community access points, and developing secure telemedicine platforms while prioritizing privacy and effective information sharing. There are opportunities for hospital teams, alongside regional and national lawmakers, to collaborate on research that enhances telemedicine strategies for managing COVID-19, emerging infectious diseases, and other health conditions in LMICs and globally.