Background: Given the risks involved with inequalities in health, non-adherence poses a major challenge to the health care system. Focus on adherence is therefore necessary in future health care as it can minimize inequality. Telemedicine is increasingly introduced to support disease management for patients with COPD. With the introduction of telemedicine, there has been a greater interest in investigating whether telemedicine has an impact on inequality in access or quality of healthcare. This study examines how inequalities in health are affected in the use of telemedicine interventions for patients with COPD. Two literature studies were separately prepared and the results were composed in a narrative synthesis. A systematic review contributes towards knowledge about the connection between both telemedicine interventions and the level of adherence. A narrative review contributes towards an understanding concerning how the use of telemedicine interventions affects both the access and treatment quality of healthcare services in patients with COPD.
Results: The systematic review performed resulted in ten articles, divided into three categories: adherence to physical activity, medicine adherence, and adherence with symptom management. The connection between telemedicine interventions and adherence resulted in three themes: expected number of workouts, personal feedback, and feedback time interval. The narrative review resulted in six articles that were themed into the following: decliners experience with telemedicine, the treatment quality using telemedicine, the use and access of telemedicine.
Discussion: There is no definitive answer concerning how the use of telemedicine interventions affects inequality in health. In this study, six ways have been found regarding how its application affects inequality: 1) an expectation to do exercises more than twice daily because it only supports a small part of being adherent; 2) by personal feedback because it improves contact, and it increases access to healthcare; 3) quick feedback on symptom registration because it provides an improvement in the quality of care, 4) in the case of false security in both use and inadequate use, processing quality is impaired; 5) telemedicine interventions tailored to the needs of the citizen improves the quality of treatment; and 6) patients declining telemedicine because they do not have the same access as those who use telemedicine and are at risk for the healthcare resources being used on the patients of telemedicine interventions.