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Real-Time (Synchronous) Telehealth in Primary Care: Systematic Review of Systematic Reviews

Last updated: January 30, 2008
Issue: 100
Result type: Report


Real-time telehealth involves the use of information and communication technologies (e.g., a minimum set of video cameras, computer displays, and a secure high-speed Internet connection) to enable individuals to communicate live (or synchronously) over long and short distances.


Although real-time telehealth has been used for at least 50 years worldwide, a barrier to widespread adoption could be a lack of reliable evidence to provide the basis for policy, management, and clinical decisions.

Methods and Results

A systematic identification of studies on telehealth modalities published in English in peer-reviewed journals, assessing health outcomes, process of care, resource utilization, and user satisfaction in primary care, yielded 31 publications. Two independent teams of reviewers screened and extracted data and conducted quality assessments. While there was no formal economic analysis, any related economic outcomes were extracted from clinical reviews. The results from high quality reviews indicated that real-time telehealth could be as effective as in-person care among patients with psychiatric and neurological problems, and could reduce the number of hospital admissions and mortality rates among patients with chronic conditions such as congestive heart failure.

Implications for Decision Making

  • Evidence is compelling for some conditions. Real-time telehealth could be an effective way to improve communication between patients and providers, monitor chronic conditions such as congestive heart failure, and support patients with psychiatric and neurological conditions in remote and under-served communities.
  • Uncertainty remains. Information about cost-effectiveness, access to services, resource utilization, process of care, and user satisfaction is lacking. Theoretically, telehomecare could save money by eliminating travel costs and reducing the number of re-admissions to hospital.
  • Opportunities for further understanding exist. Canada has an aging population, a vast geographic area, and a limited health care workforce. As a result, telehealth programs could play a role in providing effective and efficient health services and equitable, fair, and sustainable health care delivery for all Canadians. The development of programs with limited collaborative work across provinces may prevent the expectations of the public from being met.