Satisfaction With Telehealth Services Compared With Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature
Authors: Kodjebacheva Gergana Damianova , Culinski Taylor , Kawser Bushra , Coffer Katelynn 
Published: March 2023

Background
Telehealth refers to the use of technology to deliver health care remotely. The COVID-19 pandemic has prompted an increase in telehealth services.

Objective
This study aimed to review satisfaction with pediatric care in studies that had at least one group of pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and at least one comparison group of those receiving nontelehealth services.

Methods
We searched for peer-reviewed studies published in the English language that compared the satisfaction with pediatric care between pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving nontelehealth services. Owing to stay-at-home orders, studies with comparison groups for nontelehealth services that took place either before or during the pandemic were eligible. We searched the PubMed, Embase, CINAHL, and PsycINFO databases on January 5, 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2 reviewers independently screened the titles and abstracts before reviewing the full text of the remaining articles. The following information was extracted from each eligible study: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group.

Results
All 14 eligible studies assessed satisfaction among caregivers and pediatric patients participating in video or telephone visits during the COVID-19 pandemic compared with those having in-person appointments either before or during the pandemic. In 5 of the 14 studies, a comparison of nontelehealth services took place before the pandemic, and in the remaining 9 investigations, nontelehealth services took place during the pandemic. A total of 13 studies were observational investigations with different designs, and 1 study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 of the 14 studies, satisfaction with telehealth services was higher than during in-person visits. Caregivers were satisfied with video visits for the ease of use and reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider, technological challenges, and a lack of physical examination. Those participating in nontelehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction where adolescent patients completed their own surveys; a higher percentage of adolescents using telehealth services reported effective communication with the provider compared with patients using in-person visits.

Conclusions
In most studies, telehealth services received more favorable or comparable satisfaction ratings than in-person visits. Needed improvements in telehealth services included strategies to address technological challenges and develop better rapport among the patient, caregiver, and medical provider. Interventions may investigate the influence of telehealth services on access to and quality of care.