Abstract

Significant progress has been made in using information and communication technologies in medicine, by impacting the quality of health-care delivery system and patient care, and paving the way for ground-breaking tools for e-health and clinical decision-support systems. This study investigates the extent to which the evolution of telemedicine applications has been used to support patient care in Latin America (LATAM) amidst the pandemic. Theoretically, the study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify the impact of telemedicine in the region. Practically, the paper provides a systematic mapping study of the different domain areas and methodological progress in Telemedicine that occurred during the pandemic, and applied a text mining technique to understand the intensities of the terms expressed by the analyzed studies. The results show that while telemedicine has not been extensively used, a greater percentage of the studies report that telemedicine was effective. Approximately 70% positive emotional valence score was found. The paper also provides an empirical discussion and recommendations for the next steps in ample adoption of telemedicine.

Key words:
Telemedicine; LATAM; Patient care; Medical-service management; Consultation; COVID-19

Resumo

Foram feitos progressos significativos na utilização de tecnologias de informação e comunicação na medicina, com impacto no sistema de prestação de cuidados de saúde e nos cuidados aos doentes, e abrindo caminho a ferramentas inovadoras para sistemas eletrônicos de saúde e de apoio à decisão clínica. O presente estudo investiga até que ponto o crescimento das aplicações da telemedicina tem sido utilizado para apoiar os cuidados aos doentes na América Latina (LATAM) em meio da pandemia. Teoricamente, o estudo aplicou a metodologia Preferred Reporting Items for Systematic Reviews e Meta-Analyses (PRISMA) para identificar o impacto da telemedicina na região. Na prática, o artigo apresenta um estudo de mapeamento sistemático das diferentes áreas de domínio e progresso metodológico em telemedicina que ocorreram durante a pandemia, e aplicou uma técnica de text mining para compreender as intensidades dos termos expressos pelos pesquisas analisadss. Os resultados mostram que, embora a telemedicina não tenha sido amplamente utilizada, um maior percentual de estudos informa que a telemedicina foi eficaz. Foi encontrada uma pontuação de valência emocional positiva de aproximadamente 70%. O documento também traz uma discussão empírica para os próximos passos na adoção da telemedicina.

Palavras-chave:
Telemedicina; LATAM; Cuidados com o paciente; Gestão de serviços médicos; Consulta; COVID-19

Introduction

Pandemics poses important challenges to health care provision, especially in vulnerable countries, such as those in Latin America (LATAM)¹1 Sánchez-Duque JA, Arce-Villalobos LR, Rodríguez-Morales AJ. Coronavirus disease 2019 (COVID-19) in Latin America: role of primary care in preparedness and response. Aten Primaria 2020; 52(6):369-372.. On March 11, 2020, the World Health Organization (WHO)²2 World Health Organization (WHO). WHO Coronavirus (COVID-19). [cited 2021 maio 13]. Available from: https://covid19.who.int/?gclid=CjwKCAjwnPOEBhA0EiwA609Reci4oQxH9pdx_lQJ1Rlc5QyijmdgZB7jcae16Q11ni4ckzO4GWavWRoCL7IQAvD_BwE
https://covid19.who.int/?gclid=CjwKCAjwn... declared the novel coronavirus SARS-Cov-2, also known as COVID-19, a global pandemic outbreak³3 Garcia PJ, Alarcón A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun R. COVID-19 Response in Latin America. Am J Trop Med Hyg 2020; 103(5):1765-1772.. In the LATAM region, Brazil reported the first case by the end of February 2020, and by the end of March, every country in LATAM reported at least one death in the daily online tracker of the American Society/Council of America. After the first cases were reported, the first responses in LATAM involved the isolation of positive patients and evaluation of arriving travelers, continuing with the decrease in social contact, and implementation of telework; as a national health emergency state was declared in every country of the region³3 Garcia PJ, Alarcón A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun R. COVID-19 Response in Latin America. Am J Trop Med Hyg 2020; 103(5):1765-1772..

The high occupational risk generated by the saturation of health services and the shortage of protective equipment (PPI) for health personnel required the implementation of strategies to respond efficiently to increase in the demand for attending to COVID-19 positive patients, while decreasing social contact, since the main route of transmission is through respiratory secretions¹1 Sánchez-Duque JA, Arce-Villalobos LR, Rodríguez-Morales AJ. Coronavirus disease 2019 (COVID-19) in Latin America: role of primary care in preparedness and response. Aten Primaria 2020; 52(6):369-372.^,44 San-Juan D, Jiménez CR, Camilli CX, de la Cruz Reyes LA, Galindo EGA, Burbano GER, Penela MM, Perassolo MB, Valdéz AT, Godoy JG, Moreira AL, Kimaid PAT. Guidance for clinical neurophysiology examination throughout the COVID-19 pandemic. Latin American chapter of the IFCN task force - COVID-19. Clin Neurophysiol 2020; 131(7):1589-1598.. In this sense, telemedicine, defined as a “service that seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician at a distant site”⁵5 DHCS. Telehealth definitions. [cited 2021 maio 13]. Available from: https://www.dhcs.ca.gov/provgovpart /Pages/telehealthdefinitions.aspx
https://www.dhcs.ca.gov/provgovpart /Pag... ^,66 Medicaid. Telemedicine | Medicaid. 2021. [cited 2021 maio 13]. Available from: https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html
https://www.medicaid.gov/medicaid/benefi... , presented itself as an important tool during this health crisis. In comparison with developed countries where telemedicine is practiced side-by-side with more conventional health care, in developing countries, it is mostly used as an alternative to conventional health care⁷7 Combi C, Pozzani G, Pozzi G. Telemedicine for developing countries: a survey and some design issues. Appl Clin Inform 2016; 7(4):1025-1050..

The absence of technological resources, lack of training and/or provision of platforms for telemedicine consultations have been crucial obstacles in its use and development⁸8 Vasquez L, Sampor C, Villanueva G, Maradiegue E, Garcia-Lombardi M, Gomez-García W, Moreno F, Diaz R, Cappellano AM, Portilla CA, Salas B, Nava E, Brizuela S, Jimenez S, Espinoza X, Gassant PY, Quintero K, Fuentes-Alabi S, Velasquez T, Fu L, Gamboa Y, Quintana J, Castiglioni M, Nuñez C, Moreno A, Luna-Fineman S, Luciani S, Chantada G. Early impact of the COVID-19 pandemic on paediatric cancer care in Latin America. Lancet Oncol 2020; 21(6):753-755.^,99 Figueroa LM. Telehealth in Colombia, challenges associated with COVID-19. Biomedica 2020; 40(2):77-86.. Amidst the COVID-19 pandemic; evidence of increased access to telemedicine, to evaluation and follow up of patients among healthcare workers in LATAM¹⁰10 Delgado D, Wyss Quintana F, Perez G, Sosa Liprandi A, Ponte-Negretti C, Mendoza I, Baranchuk A. Personal safety during the covid-19 pandemic: realities and perspectives of healthcare workers in Latin America. Int J Environ Res Public Health 2020; 17(8):2798., and development in its practice in the several medical fields and specialties is addressed in this paper. This includes an empirical outlook on important advances in Telemedicine that could potentially extend its future use.

The rationale of this study

The aim of this study was to conduct a systematic review of the existing works of literature within the area of telemedicine to understand its impact and future directions amidst the COVID-19 pandemic in Latin American (LATAM) region. To this effect, the research objectives of this study were to uncover: (i) why telemedicine may have become a good option during the pandemic in LATAM, (ii) extent to which the practice (telemedicine) has been helpful during the COVID-19 pandemic, and (iii) its implication for future medical practice particularly in leu (aftermath) of the pandemic (post-COVID era).

Background information

In developed countries, it is evident that the telemedicine market had been growing even before the COVID-19 pandemic¹¹11 Al Shorbaji N. E-health in the Eastern Mediterranean Region: a decade of challenges and achievements. EMHJ - East Mediterr Heal Journal 2008; 14(Suppl.):S157-S173.

12 Jennett PA, Affleck Hall L, Hailey D, Ohinmaa A, Anderson C, Thomas R, Young B, Lorenzetti D, Scott RE. The socio-economic impact of telehealth: a systematic review. J Telemed Telecare 2003; 9(6):311-320.

13 Swinfen R, Swinfen P. Low-cost telemedicine in the developing world. J Telemed Telecare 2002; 8(Suppl. 3):63-65.^-1414 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153.. For example, the European telemedicine market grew from US$ 3.1 billion in 2010 to almost triple to US$ 12.6 billion in 2019 at a compound accelerated growth rate of 12.82%. Whereas, less effort has been invested in developing countries due to a limited budget to install technological infrastructure, and telemedicine was just an alternative to healthcare⁷7 Combi C, Pozzani G, Pozzi G. Telemedicine for developing countries: a survey and some design issues. Appl Clin Inform 2016; 7(4):1025-1050.. This scenario suddenly changed when COVID-19 pandemic forced every country to promote preventive measures such as physical isolation and no country was spared from those measures¹⁵15 Peres KG, Reher P, Castro RD, Vieira AR. COVID-19-related challenges in dental education: experiences from Brazil, the USA, and Australia. Pesqui Bras em Odontopediatria e Clínica Integr 2020; 20(Suppl. 1):e0131.

16 Wootton R. Telemedicine support for the developing world. J Telemed Telecare 2008; 14(3):109-114.^-1717 Wootton R. The development of telemedicine. In: Rigby M, Roberts R, Thick M, editors. Taking Health Telematics into the 21st Century. Oxon: Radcliffe Medical Press; 2000. p. 17-26..

In practice, we note that telemedicine has made a significant impact on the medical practice or profession by influencing the way patients receive care and/or interact with the care providers (doctors, consultants, etc)¹⁸18 Schinköthe T, Gabri MR, Mitterer M, Gouveia P, Heinemann V, Harbeck N, Subklewe M. A web- And app-based connected care solution for COVID-19 in- and outpatient care: qualitative study and application development. JMIR Public Heal Surveill 2020; 6(2):e19033.

19 Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF, Alseidi AA, Vreeland TJ. Using technology to maintain the education of residents during the COVID-19 pandemic. J Surg Educ 2020; 77(4):729-732.

20 Juan Ricardo Márquez V. Teleconsultation in a pandemic due to coronavirus: challenges for telemedicine in the post-COVID-19 era. Rev Colomb Gastroenterol 2020; 35(Supl. 1):5-16.

21 The American Telemedicine Association (ATA). Telemedicine, telehealth, and health information technology: an ATA Issue Paper Patient Care Health Provider [Internet]. 2006. [cited 2021 maio 11]. Available from: https://docplayer.net/1884808-Telemedicine-telehealth-and-health-information-technology.html
https://docplayer.net/1884808-Telemedici...

22 World Health Organization (WHO). WHO Global Observatory for e-Health. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Geneva: WHO; 2010.^-2323 FIFARMA. Telemedicine in Latin America during COVID-19 [Internet]. [cited 2021 mar 22]. Available from: https://fifarma.org/en/telemedicine-in-latin-america-during-covid-19/#/about/
https://fifarma.org/en/telemedicine-in-l... . This growth ranges from remote patient monitoring, to secure storage/management of patients’ medical data, real-time audio and video communication (consultation), and compliance, recommendations, or support, etc. For example, the American Health Information Community was a federal advisory body established by The American Telemedicine Association (ATA)²¹21 The American Telemedicine Association (ATA). Telemedicine, telehealth, and health information technology: an ATA Issue Paper Patient Care Health Provider [Internet]. 2006. [cited 2021 maio 11]. Available from: https://docplayer.net/1884808-Telemedicine-telehealth-and-health-information-technology.html
https://docplayer.net/1884808-Telemedici... to make recommendations to the Department of Health and Human Services (HHS) on how best to accelerate the adoption and development of e-health in the United States. The four main themes that emerged from the framework proposed by ATA²¹21 The American Telemedicine Association (ATA). Telemedicine, telehealth, and health information technology: an ATA Issue Paper Patient Care Health Provider [Internet]. 2006. [cited 2021 maio 11]. Available from: https://docplayer.net/1884808-Telemedicine-telehealth-and-health-information-technology.html
https://docplayer.net/1884808-Telemedici... were:

In LATAM context, The Latin American Federation of the Pharmaceutical Industry (FIFARMA)²³23 FIFARMA. Telemedicine in Latin America during COVID-19 [Internet]. [cited 2021 mar 22]. Available from: https://fifarma.org/en/telemedicine-in-latin-america-during-covid-19/#/about/
https://fifarma.org/en/telemedicine-in-l... ^,2424 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... in its response to the COVID-19 pandemic, is a research and development (R&D) biopharmatical organization dedicated to discovering and developing patient-centred innovative, quality and safe health products and services to facilitate a sustainable health system, regulatory standard, and ethical principles in the region. During the pandemic, FIFARMA²³23 FIFARMA. Telemedicine in Latin America during COVID-19 [Internet]. [cited 2021 mar 22]. Available from: https://fifarma.org/en/telemedicine-in-latin-america-during-covid-19/#/about/
https://fifarma.org/en/telemedicine-in-l... noted that while telemedicine may not solve all the challenges with patient care and management, they opined that the technology (telemedicine) has provided the stakeholders with the benefit of “accessibility”, “productivity” and “better results”. They stressed that the main implication of the outcomes will be to make “telemedicine” a central part of medicine especially in the aftermath of COVID-19 (post-COVID era) across the region. It is also noteworthy to mention that telemedicine was created to operate in complex scenarios, e.g., by allowing the medical practitioners access to hard-to-reach location such as the rural areas, and in turn, lowering the cost of healthcare for those patients in the region through increase in number of patients who are able to receive medical consultation, improvement of the healthcare workforce and productivity, and delivery of better clinical outcomes²³23 FIFARMA. Telemedicine in Latin America during COVID-19 [Internet]. [cited 2021 mar 22]. Available from: https://fifarma.org/en/telemedicine-in-latin-america-during-covid-19/#/about/
https://fifarma.org/en/telemedicine-in-l... .

Considering the reasons as to why telemedicine may have become a good option in the LATAM region; we note that the technology (telemedicine) has moved from being a form of caring for the health of “the next generation” of patients to “revolutionizing” the way in which the medical care is administered²⁴24 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... . Although this shift (traditional to telehealth) conceivably comes with some limitations such as scenarios whereby physical examination are necessary (e.g., taking heart rate, inserting contraceptive devices, or giving injections, etc.), lack of practitioners with the required skills and experience to implement virtual health projects, high cost of the IT infrastructures and electronic gadgets and devices, and lack of electricity and limited internet access²⁴24 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... . Nonetheless, FIFARMA²⁴24 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... following reports by The Inter-American Development Bank (IDB)²⁵25 Pagés C, Aclan C, Alfonso M, Alfonso M, Arroio R, Irigoyen J, Mejía Rivas I, Mendieta C, Moreno S, Muente A, Peñaherrera S, Pombo C, Regalia F, Savedoff WD, Stein EH, Tejerina L. From lockdown to reopening: strategic considerations for the resumption of activities in Latin America and the Caribbean within the framework of Covid-19. New York: Inter-American Development Bank; 2020. DOI: 10.18235/0002349
https://doi.org/10.18235/0002349... ^,2626 Blackman A, Ibáñez AM, Izquierdo A, Keefer P, Moreira MM, Schady N, Serebrisky T. Public policy to tackle Covid-19: recommendations for Latin America and the Caribbean. New York: Inter-American Development Bank; 2020. DOI: 10.18235/0002302
https://doi.org/10.18235/0002302... and The Organisation for Economic Co-operation and Development (OECD)²⁷27 Organisation for Economic Co-operation and Development (OECD). Regulatory quality and COVID-19: managing the risks and supporting the recovery (Note by the Secretariat in consultation with the Chairs and the Bureaus of the Regulatory Policy Committee and the Network of Economic Regulators) [Internet]. 2020. [cited 2021 maio 11]. Available from: https://www.oecd.org/coronavirus/policy-responses/regulatory-quality-and-covid-19-managing-the-risks-and-supporting-the-recovery-3f752e60/
https://www.oecd.org/coronavirus/policy-... has no doubt that “telemedicine” is here to stay in LATAM and across the world at large. Moreover, FINE²⁸28 FINE Research. COVID-19: evidence and Insights about the COVID-19 impact in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://www.fine-research.com/blog/news/covid-19-making-research-community-available/
https://www.fine-research.com/blog/news/... the go-to field agency for LATAM that was in the front-line in drawing evidence and insights about the impact of the COVID-19 pandemic in LATAM region confirmed in its report that despite the limitations of the hospital infrastructure, most countries in the LATAM region have improved in terms of e-health, perhaps, thanks to the practical implications of telemedicine and the resultant technologies.

Methodology

To uncover the objectives of this study as noted in the rationale of this study (see Introduction section); this work performed a systematic review of the relevant literature within the telemedicine, COVID-19, and LATAM context. The study criteria was grounded on a set of theoretic factors that we have chosen based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology²⁹29 Lu W, Wang Y, Gan M, Duan Q. Prognosis and predictive value of heat-shock proteins expression in oral cancer. Medicine (Baltimore) 2021; 100(3):e24274.

30 Wu C, Ge Y, Zhang X, Du Y, He S, Ji Z, Lang H. The combined effects of Lamaze breathing training and nursing intervention on the delivery in primipara: a PRISMA systematic review meta-analysis. Medicine (Baltimore) 2021; 100(4):e23920.

31 Chatziprodromidou I, Apostolou T, Vantarakis A. COVID-19 and environmental factors. A PRISMA-compliant systematic review. medRxiv 2020. DOI:10.1101/2020.05.10.20069732
https://doi.org/10.1101/2020.05.10.20069... ^-3232 Larrabee Sønderlund A, Hughes E, Smith J. The efficacy of learning analytics interventions in higher education: a systematic review. Br J Educ Technol 2019; 50(5):2594-2618.. The PRISMA approach for evaluation of the literature was chosen in order to allow the authors to determine the key factors and success rate reported across the LATAM region. This was done considering the impact and use of telemedicine during the pandemic, as well as, enables the study to point out the main implications and road map for future adoption of the associated technologies for medical practice.

Search process

The study conducted its search in different international databases that are related to the medical profession and academic publications. The search for articles was done in three main electronic databases within the medical field: PubMed, Scielo, and Redalyc. No unpublished information was obtained. The literature search was performed for the period between 2019 to 2021 to cover the COVID-19 era, including any pre-COVID or post-COVID insights that may have inadvertently been discovered.

Search terms

The study used a combination of keywords to extract the relevant studies from the academic databases. The selected keywords were as follows:

PubMed: ((((((((telemedicine) OR (teleconsulting)) OR (telehealth)) OR (e-health)) OR (virtual care)) OR (telemonitoring)) AND (coronavirus)) OR (COVID-19)) AND (Latin America)) OR (LATAM)

Scielo: (telemedicine) OR (teleconsulting) OR (e-health) OR (telemonitoring) OR (virtual care) AND (coronavirus) OR (COVID-19) AND (latin america) OR (LATAM)

Redalyc: included a search of the keywords (Telemedicine and Covid-19 or Latin America) in the “Knowledge base on epidemics and COVID-19” section that houses more than 13,000 research items on the topic, and filtered based on the countries in LATAM.

Inclusion and exclusion criteria of the literatures

The extracted papers from the databases were selected based on the following criteria²⁹29 Lu W, Wang Y, Gan M, Duan Q. Prognosis and predictive value of heat-shock proteins expression in oral cancer. Medicine (Baltimore) 2021; 100(3):e24274.

30 Wu C, Ge Y, Zhang X, Du Y, He S, Ji Z, Lang H. The combined effects of Lamaze breathing training and nursing intervention on the delivery in primipara: a PRISMA systematic review meta-analysis. Medicine (Baltimore) 2021; 100(4):e23920.

31 Chatziprodromidou I, Apostolou T, Vantarakis A. COVID-19 and environmental factors. A PRISMA-compliant systematic review. medRxiv 2020. DOI:10.1101/2020.05.10.20069732
https://doi.org/10.1101/2020.05.10.20069... ^-3232 Larrabee Sønderlund A, Hughes E, Smith J. The efficacy of learning analytics interventions in higher education: a systematic review. Br J Educ Technol 2019; 50(5):2594-2618. (see Figure 1): 1) Description or title of the paper is related to telemedicine, COVID-19, or LATAM? 2) If the full text is available? 3) Publication date between 2019 to 2021? 4) Was the method or approach clearly described in the paper? 5) Did the paper report the main contributions in terms of the study criteria or area of topic (telemedicine)? 6) Whether the study reported some kind of road map or implications for practice when/towards the adoption of telemedicine in healthcare and patient treatment with focus on COVID-19 effects? 7) How sizable is the scope and methodology of the paper applicable to this study? 8) Has the paper undergone the scientific peer review process with source/DOI?

Search outcome and results

The systematic search and review process focused on the impact and future of telemedicine amidst the COVID-19 pandemic in LATAM. It tries to uncover the state-of-the-art and/or gaps in the literature that are yet to be addressed. As shown in Figure 1, the first stage of retrieving the relevant studies based on the “search criteria” (see Search terms) resulted in a total of n = 342 papers. We then subsequently screened the retrieved papers based on their perceived suitability for this study criteria (e.g., title of paper, domain area of application, availability of full-text, peer-reviewed, research article). This resulted in n = 15 papers being excluded, of which the remainder (n = 327) papers were selected, read, and reviewed. Consequently, after examining the selected papers based on the suggested outcomes or whether the method/findings supports the scope of this study (i.e., telemedicine, COVID-19, and LATAM); a further n = 303 papers was excluded which were not related to the main three keywords. Thus, a total of 24 studies were identified and included in the systematic review and analysis of this study. The results are as reported in the following chart (Chart 1).

As gathered in Chart 1, the study notes that current studies representing the recent developments and use of telemedicine for patient care and management in LATAM during the COVID-19 pandemic were from six main countries (Mexico, Colombia, Peru, Brasil, Chile, Argentina) in the region (see Figure 2), with Brasil having reported the most number of sources with ten studies (~41.7%) out of the 24 analyzed papers (Figure 2). When considering the main domain areas in which telemedicine was applied amidst the COVID-19 in LATAM, we note that while the analyzed papers are all focused on the COVID-19, telemedicine, and LATAM; there was a variation in the areas in which the different studies were conducted. Ranging from patient management and healthcare, to cancer, radiology, and renal health. There was also nursing, pediatriac oncology, cardio-oncology, to neurogastroenterology, mental health, and psychology. palliative care, mobile app development, and education were also key areas of its (telemedicine) application. However, it is important to mention that while the analyzed studies have focused on the aforementioned areas, the main emphasis was on “telehealth” (~45.8%) (see Chart 1, Figure 3), another synonym for “telemedicine” that constituted the main scope of this study. It is also noteworthy to mention, as shown in Figure 3, that a majority of those studies (99%) have been carried out in 2020 at the peak of the Covid-19 era, with only one study conducted in 2021 at the time of conducting this review (Figure 3).

As gathered in Chart 1, figures 2 and 3, this review was an attempt to shed light on specific challenges and impact that Telemedicine and its underlying practices and technologies has on the patient care and management in LATAM amidst the COVID-19 pandemic. It is noteworthy to mention from the studies we analyzed that the concept (telemedicine) has not been extensively applied either in the source coverage or in their breadth of dimensions towards a comprehensive view of the entire domain of medical practice in the region. Also, noteworthy is the fact that the most pertinent studies were recently done amidst the period of the COVID-19 outbreak (Figure 3). Perhaps, this could be owing to the fact that the unprecedented COVID-19 outbreak is recent and currently a hot topic being addressed both by the researchers, medical professionals, and the governments in the diaspora. Therefore, whereas the current review explores telemedicine within the context of LATAM during the pandemic, there may also be studies that could have addressed and applied the concept (telemedicine) for patient care and medical practice pre-Covid and/or outside the context of LATAM which would perhaps form another direction for future studies.

Having said that, this study deemed it important to implement a text mining⁵³53 Kumakawa T. A text mining examination of university students' learning program posters. Open Access Libr J 2017; 4(6):e3639.

54 Tseng C, Chou J, Tsai Y. Text mining analysis of teaching evaluation questionnaires for the selection of outstanding teaching faculty members. IEEE Access 2018; 6:72870-72879.

55 Okoye K, Arrona-Palacios A, Camacho-Zuñiga C, et al. Impact of students evaluation of teaching: a text analysis of the teachers qualities by gender. Int J Educ Technol High Educ 2020; 17:49.^-5656 Litman DJ, Forbes-Riley K. Predicting student emotions in computer-human tutoring dialogues. In: Association for Computational Linguistics (ACL). 2004; p. 351-es. DOI:10.3115/1218955.1219000
https://doi.org/10.3115/1218955.1219000... analysis of the main findings and contribution of the analyzed (24 studies) papers. This was done in order to identify the most frequent and correlation (association) of the used words by the authors in describing the impact of telemedicine and its practice amidst the COVID-19 in LATAM. The method (emotional valence), a text analysis method, was consequently used to analyze and understand the level of impact (intensities of the words expressed by the studies) in their findings and/or main contribution.

To do this, first, we built a corpus⁵⁷57 Edara DC, Vanukuri LP, Sistla V, Kolli VKK. Sentiment analysis and text categorization of cancer medical records with LSTM. J Ambient Intell Humaniz Comput 2019:1-17. Doi:10.1007/s12652-019-01399-8
https://doi.org/10.1007/s12652-019-01399... (library of words) of the main findings (see Chart 1) in the studies using R statistics⁵⁸58 RStudio. RStudio. [cited 2020 abr 20]. Available from: https://rstudio.com/products/rstudio/
https://rstudio.com/products/rstudio... to determine the top most frequent terms (Figure 4) that the authors perceived as important or key in their different studies and findings. Second, we then determined the correlation of the top 5 most used words (terms) by measuring the probability (i.e., likelihood) of the authors using the associated terms in the analyzed data. The measurements of the correlation were between 0 and 1, representing 0% to 100%. The results of the different terms we found and their association (correlation) are reported in Table 1.As shown in Figure 4 and Table 1, the text mining analysis of the findings by the different studies allowed us to determine the top five words or terms that the authors referred to when presenting their main findings. In the wider spectrum and medical practice in LATAM, particularly as it concerns the use of telemedicine for patient care and management amidst the COVID-19 pandemic; the outcome of the analysis purportedly suggests that the main scope of the studies we analyzed was mainly to grasp the patients’ satisfaction and opinion regarding remote care which was implemented suddenly due to a mandatory physical isolation, but was not extensively focused on how telemedicine and its application have helped drive the medical practice and patient care and management forward¹⁴14 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153., which constitutes one of the main contributions of this present study.

Furthermore, we analyzed the impact (intensity or emotion levels) of the different reported studies in respect to the way they perceived the use of telemedicine amidst the COVID-19 pandemic in LATAM based on their main findings. To do this, we applied the emotional valence (text mining) analysis in R⁵⁸58 RStudio. RStudio. [cited 2020 abr 20]. Available from: https://rstudio.com/products/rstudio/
https://rstudio.com/products/rstudio... which fundamentally focuses on identifying (through polarization or quantification)⁵⁹59 Denecke K, Deng Y. Sentiment analysis in medical settings: new opportunities and challenges. Artif Intell Med 2015; 64(1):17-27. the intensities of the different emotions that are expressed in the reported findings (i.e., the 24 studies we analyzed) by extracting and assigning a score (valence) to each emotional term it finds. Practically, we made use of the get_nrc_sentiment method in R to extract the different scores (emotional valence). Typically, the method functions by extracting and quantifying the intensities (polarization) of the different terms or emotions using the positive (+), neutral (0) and negative (-) values⁵⁵55 Okoye K, Arrona-Palacios A, Camacho-Zuñiga C, et al. Impact of students evaluation of teaching: a text analysis of the teachers qualities by gender. Int J Educ Technol High Educ 2020; 17:49.^,5656 Litman DJ, Forbes-Riley K. Predicting student emotions in computer-human tutoring dialogues. In: Association for Computational Linguistics (ACL). 2004; p. 351-es. DOI:10.3115/1218955.1219000
https://doi.org/10.3115/1218955.1219000... ^,6060 Chintalapudi N, Battineni G, Canio M Di, Sagaro GG, Amenta F. Text mining with sentiment analysis on seafarers' medical documents. Int J Inf Manag Data Insights 2021; 1(1):100005. to represent each relevant term it finds in each run scenario. As represented in Figure 5, we report the results of the text mining method (emotional valence) considering the main findings of the analyzed studies.

As shown in Figure 5, the positive valence (+) scores represent an attractive emotion, whilst the negative (-) scores signify an aversive emotion. The zeros represent emotions that were classified as neutral (0) with no emotions or sentiment attached. Overall, we note that a larger margin of emotions expressed by the different studies in their main findings are classified or falls along the +1 (positive) score (see: Figure 5), which signifies attractive emotions, with the summary of the collective scores recorded in the studies presented as follows; min = -2, mean = 0.79, and max = 5.

The definition of emotional valence, otherwise allied to the text mining or sentiment analysis method, and its application within the medical domain has been illustrated in the literature⁵⁷57 Edara DC, Vanukuri LP, Sistla V, Kolli VKK. Sentiment analysis and text categorization of cancer medical records with LSTM. J Ambient Intell Humaniz Comput 2019:1-17. Doi:10.1007/s12652-019-01399-8
https://doi.org/10.1007/s12652-019-01399... ^,5959 Denecke K, Deng Y. Sentiment analysis in medical settings: new opportunities and challenges. Artif Intell Med 2015; 64(1):17-27.

60 Chintalapudi N, Battineni G, Canio M Di, Sagaro GG, Amenta F. Text mining with sentiment analysis on seafarers' medical documents. Int J Inf Manag Data Insights 2021; 1(1):100005.

61 Yadav S, Ekbal A, Saha S, Bhattacharyya P. Medical sentiment analysis using social media: towards building a patient assisted system [Internet]. [cited 2021 mar 22]. Available from: http://sideeffects.embl.de/
http://sideeffects.embl.de... ^-6262 Niu Y, Zhu X, Li J, Hirst G. Analysis of polarity information in medical text. AMIA Annu Symp Proc 2005; 2005:570-574.. As a matter of fact, as demonstrated in this study, such type of analysis is achieved by leveraging the underlying information (textual data) that are contained in the captured datasets to draw useful information in respect to the studied phenomenon. As reported in Figure 6, the study adopted the emotion (sentiment) polarization/classifications of medical datasets as described in Yadav et al.⁶¹61 Yadav S, Ekbal A, Saha S, Bhattacharyya P. Medical sentiment analysis using social media: towards building a patient assisted system [Internet]. [cited 2021 mar 22]. Available from: http://sideeffects.embl.de/
http://sideeffects.embl.de... and Niu et al.⁶²62 Niu Y, Zhu X, Li J, Hirst G. Analysis of polarity information in medical text. AMIA Annu Symp Proc 2005; 2005:570-574. to classify the different emotions types we have found based on the analyzed studies. This was done in order to determine the overall impact or implication of the reported emotions particularly in terms of the use of telemedicine and its associated practice/technologies in LATAM amidst the COVID-19 pandemic. Overall, we found that the large proportion or majority of the emotions expressed by the different studies in their findings in respect to the use of telemedicine in LATAM amidst the COVID-19 were classified as attractive with approximately ~70% positive emotional valence score reported. Besides, it is noteworthy to mention, as presented in Figure 6, when considering the individual emotion’ types or categories that a greater percentage of the studies believes that the impact of the telemedicine during this period was “effective” (approximately ~30%). Although, on the other hand, it can be said that while some of the studies felt that the use of the telemedicine, e.g., for patient care or management was “ineffective” (< 20%) (Figure 6), other studies were equally “uncertain” (< 20%) (Figure 6) about the impact or efficiency of the technology or practice (telemedicine) during this period (COVID-19).

Discussion

Researchers, medical practitioners, and the government have invested huge resources in the use of telemedicine³⁹39 Denadai R. COVID-19 pandemic as a driver for spreading virtual care globally: the future starts now. Clinics (Sao Paulo) 2020; 75:e1967. in fostering patient care and their management during the unprecedented time of the Covid-19 pandemic in LATAM⁴⁰40 Galindo Neto NM, Sá GGM, Barbosa LU, Pereira JCN, Henriques AHB, Barros LM. COVID-19 and digital technology: mobile applications available for download in smartphones. Texto Context - Enferm 2020; 29:e20200150.

41 Florêncio RS, Feitosa Cestari VR, Souza LC, Flor AC, Nogueira VP, Moreira TMM, Salvetti MG, Pessoa VLMP. Palliative care amidst the COVID-19 pandemic: Challenges and contributions. ACTA Paul Enferm 2020; 33:eAPE20200188.^-4242 Carlos DM, Wernet M, Okido ACC, Oliveira WA, Silveira AO, Costa LCR. The dialogical experience of being a mother of a child and a nurse in the COVID-19 Pandemic. Texto Context - Enferm. 2020;29:e20200329.. Telemedicine has become an inevitable means towards ensuring an effective patient care, monitoring, and medical service delivery particularly following the different contingency plans and lockdown strategies put in place by the different governing bodies and policy makers. To this end, the aim of this study was to establish the current state-of-the-art within the aforementioned area (telemedicine) to understand its impact and future directions amidst the Covid-19 pandemic in LATAM region. The main focus of our study was particularly to uncover (i) why telemedicine may have become a good option during the pandemic? (ii) the extent to which the practice (telemedicine) has been helpful during this period? and (iii) its implication for future medical practice particularly in anticipation (aftermath) to the post-COVID era.

Along these lines, we looked into the implication of telemedicine for medical practice by considering the reason why it may have become a good option during the pandemic in LATAM. We note based on the recent studies (24 papers) we analyzed, that the technology (telemedicine) has been “effective” (see: Figure 6) for healthcare and patient management during this period (COVID-19). Moreover, the pieces of evidence we drew from the literature shows that telemedicine has moved from being a form of caring for the health of “the next generation” of patients to “revolutionizing” the way in which medical care is delivered²³23 FIFARMA. Telemedicine in Latin America during COVID-19 [Internet]. [cited 2021 mar 22]. Available from: https://fifarma.org/en/telemedicine-in-latin-america-during-covid-19/#/about/
https://fifarma.org/en/telemedicine-in-l... ^,2424 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... . Although this aforenoted technological and professional shift, i.e., from the traditional to telehealth (e-health) medical practice, is perceived to come with some limitations as summarized in the Background Information section of this paper.

Unveiling the extent to which the practice (telemedicine) has been helpful during the COVID-19 pandemic; we note that while there is evidence of comprehensive review in Telemedicine across the globe in terms of its opportunities and developments according to the World Health Organization (WHO) which comprised of 59% of its member states (144 countries)¹⁴14 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153.. In theory, we note that in LATAM there has not been rigorous and up-to-date studies conducted that completely reveal the extent of its use to foster patient care and management in the region amidst the recent COVID-19 pandemic, which in turn, forms one of the main contributions of this paper. Although there is evidence, in practice, that the technology (telemedicine) has constituted one of the recent advancement to delivery of healthcare for patients in the region²³23 FIFARMA. Telemedicine in Latin America during COVID-19 [Internet]. [cited 2021 mar 22]. Available from: https://fifarma.org/en/telemedicine-in-latin-america-during-covid-19/#/about/
https://fifarma.org/en/telemedicine-in-l... ^,2424 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... ^,2626 Blackman A, Ibáñez AM, Izquierdo A, Keefer P, Moreira MM, Schady N, Serebrisky T. Public policy to tackle Covid-19: recommendations for Latin America and the Caribbean. New York: Inter-American Development Bank; 2020. DOI: 10.18235/0002302
https://doi.org/10.18235/0002302... ^,2727 Organisation for Economic Co-operation and Development (OECD). Regulatory quality and COVID-19: managing the risks and supporting the recovery (Note by the Secretariat in consultation with the Chairs and the Bureaus of the Regulatory Policy Committee and the Network of Economic Regulators) [Internet]. 2020. [cited 2021 maio 11]. Available from: https://www.oecd.org/coronavirus/policy-responses/regulatory-quality-and-covid-19-managing-the-risks-and-supporting-the-recovery-3f752e60/
https://www.oecd.org/coronavirus/policy-... .

Finally, when considering the implication of the technology (telemedicine) for future medical practice particularly in anticipation (aftermath) to post-COVID era in LATAM; the evidence we drew from the literature²⁷27 Organisation for Economic Co-operation and Development (OECD). Regulatory quality and COVID-19: managing the risks and supporting the recovery (Note by the Secretariat in consultation with the Chairs and the Bureaus of the Regulatory Policy Committee and the Network of Economic Regulators) [Internet]. 2020. [cited 2021 maio 11]. Available from: https://www.oecd.org/coronavirus/policy-responses/regulatory-quality-and-covid-19-managing-the-risks-and-supporting-the-recovery-3f752e60/
https://www.oecd.org/coronavirus/policy-... ^,2828 FINE Research. COVID-19: evidence and Insights about the COVID-19 impact in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://www.fine-research.com/blog/news/covid-19-making-research-community-available/
https://www.fine-research.com/blog/news/... and the systematic study conducted in this paper (see Chart 1, Table 1 and figures 5 and 6) shows that the anticipated post-COVID period, particularly for medical practice, implies an important impact on both the carnal and emotional health of the region. Practically, this includes an introspective and thoughtful transformation of the current health ecosystem, new protocols, modes or routines for delivering of medical care and patient management, that in the wider spectrum, calls for an increase in use and adoption of telemedicine²⁸28 FINE Research. COVID-19: evidence and Insights about the COVID-19 impact in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://www.fine-research.com/blog/news/covid-19-making-research-community-available/
https://www.fine-research.com/blog/news/... .

Therefore, from the wider spectrum of scientific research and medical practice; we note that telemedicin has been routinely offered in industrialized regions, otherwise referred to as high-tech countries, to remotely monitor and manage patients with chronic and severe diseases (hospital-to-clinic@home mode)¹⁴14 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153.. Low-income countries are faced with multiple barriers and use telemedicine in a limited manner to connect providers to referral centers or specialties. While telemedicine can be sustainable and scalable in such settings (low-tech), it has not been used for direct patient care⁶³63 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. J Telemed Telecare 2005; 11(8):384-390.. Globally, telemedicine has been shown to enhance the quality, access, efficiency, and cost-effectiveness of healthcare services¹⁴14 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153.^,6363 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. J Telemed Telecare 2005; 11(8):384-390.^,6464 Craig J, Petterson V. Introduction to the practice of telemedicine. J Telemed Telecare 2005; 11(1):3-9.. For instance, it has proved its effectiveness in overcoming the problem of distance and time barriers between the medical practitioners (care providers) and the patients²¹21 The American Telemedicine Association (ATA). Telemedicine, telehealth, and health information technology: an ATA Issue Paper Patient Care Health Provider [Internet]. 2006. [cited 2021 maio 11]. Available from: https://docplayer.net/1884808-Telemedicine-telehealth-and-health-information-technology.html
https://docplayer.net/1884808-Telemedici... ^,6363 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. J Telemed Telecare 2005; 11(8):384-390.. However, in spite of the promising benefits and capabilities of the technology which inadvertently varies in the several regions¹⁴14 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153., both the industrialized and developing countries are yet to consistently employ or fully adopt the technology in the different healthcare systems¹⁴14 Ryu S. Telemedicine: opportunities and developments in member states: report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthc Inform Res 2012; 18(2):153.. Ranging from the challenges of human and cultural factors (linguistic and cultural differences), to lack of digital literacy skills by the medical practitioners to effective use the telemedicine applications, limited studies that accounts for economic and cost-effectiveness (benefits) of the underlying telemedicines’ technology and applications, to lack of policy-makers to embrace and invest in telemedicine, technological and human-resource liability risks, and lack of international legal framework that allows the medical professionals to deliver e-services or e-consultations in different countries or jurisdictions¹¹11 Al Shorbaji N. E-health in the Eastern Mediterranean Region: a decade of challenges and achievements. EMHJ - East Mediterr Heal Journal 2008; 14(Suppl.):S157-S173.^,1313 Swinfen R, Swinfen P. Low-cost telemedicine in the developing world. J Telemed Telecare 2002; 8(Suppl. 3):63-65.^,2424 FIFARMA. A journey through telemedicine in Latin America [Internet]. 2020. [cited 2021 mar 22]. Available from: https://fifarma.org/en/a-journey-through-telemedicine-in-latin-america/
https://fifarma.org/en/a-journey-through... ^,2626 Blackman A, Ibáñez AM, Izquierdo A, Keefer P, Moreira MM, Schady N, Serebrisky T. Public policy to tackle Covid-19: recommendations for Latin America and the Caribbean. New York: Inter-American Development Bank; 2020. DOI: 10.18235/0002302
https://doi.org/10.18235/0002302... ^,2727 Organisation for Economic Co-operation and Development (OECD). Regulatory quality and COVID-19: managing the risks and supporting the recovery (Note by the Secretariat in consultation with the Chairs and the Bureaus of the Regulatory Policy Committee and the Network of Economic Regulators) [Internet]. 2020. [cited 2021 maio 11]. Available from: https://www.oecd.org/coronavirus/policy-responses/regulatory-quality-and-covid-19-managing-the-risks-and-supporting-the-recovery-3f752e60/
https://www.oecd.org/coronavirus/policy-... ^,6363 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. J Telemed Telecare 2005; 11(8):384-390.

64 Craig J, Petterson V. Introduction to the practice of telemedicine. J Telemed Telecare 2005; 11(1):3-9.

65 Qaddoumi I, Bouffet E. Supplementation of a successful pediatric neuro-oncology telemedicine-based twinning program by e-mails. Telemed e-Health 2009; 15(10):975-982.

66 IEEE. COVID-19 made internet access, broadband and hotspots an educational necessity [Internet]. [cited 2020 jun 10]. Available from: https://transmitter.ieee.org/covid-19-made-internet-access-broadband-and-hotspots-an-educational-necessity/
https://transmitter.ieee.org/covid-19-ma...

67 Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Nurs Times 2001; 97(35):35.

68 Kifle M, Mbarika VWA, Datta P. Telemedicine in sub-Saharan Africa: the case of teleophthalmology and eye care in Ethiopia. J Am Soc Inf Sci Technol 2006; 57(10):1383-1393.^-6969 Swanepoel W, Olusanya BO, Mars M. Hearing health-care delivery in sub-Saharan Africa - a role for tele-audiology. J Telemed Telecare 2010; 16(2):53-56..

It is noteworthy to mention that in developed countries, telemedicine is conducted side-by-side with more conventional health care, complementing it. While, in developing countries, telemedicine in most cases is an alternative, or even the only alternative, to conventional health care⁷7 Combi C, Pozzani G, Pozzi G. Telemedicine for developing countries: a survey and some design issues. Appl Clin Inform 2016; 7(4):1025-1050.. Despite the demonstrated benefits of those care strategies for patient’ access to health services, reduction of costs, and the rapprochement by institutions and specialists, to distant communities; obstacles such as the absence of technological resources and communications in the Different regions, and the lack of training in the operation of digital platforms, among others, have deterred the dissemination of telehealth⁹9 Figueroa LM. Telehealth in Colombia, challenges associated with COVID-19. Biomedica 2020; 40(2):77-86.. Moreover, a cross-sectional online survey which enrolled 936 healthcare workers in Latin America regarding access to telemedicine to evaluate and follow up patients, showed that 572 (61.1%) healthcare workers had access, and 364 (38.9%) did not have access¹⁰10 Delgado D, Wyss Quintana F, Perez G, Sosa Liprandi A, Ponte-Negretti C, Mendoza I, Baranchuk A. Personal safety during the covid-19 pandemic: realities and perspectives of healthcare workers in Latin America. Int J Environ Res Public Health 2020; 17(8):2798.. Nearly 60% of the respondents reported a decrease in their paediatric onco-haematology staff because of COVID-19 infection or quarantine. Half of the surveyed respondents reported that their centres did not provide a platform for telemedicine consultations, although non-professional social media channels were used⁸8 Vasquez L, Sampor C, Villanueva G, Maradiegue E, Garcia-Lombardi M, Gomez-García W, Moreno F, Diaz R, Cappellano AM, Portilla CA, Salas B, Nava E, Brizuela S, Jimenez S, Espinoza X, Gassant PY, Quintero K, Fuentes-Alabi S, Velasquez T, Fu L, Gamboa Y, Quintana J, Castiglioni M, Nuñez C, Moreno A, Luna-Fineman S, Luciani S, Chantada G. Early impact of the COVID-19 pandemic on paediatric cancer care in Latin America. Lancet Oncol 2020; 21(6):753-755.. The aforementioned affirmations, perhaps, calls for a broader and collective research and development plan or strategies that involves the several stakeholders (medical practitioners, health bodies and policy-makers, researchers and educational institutions, government, patients themselves and the care givers, etc.) in ensuring that the benefits of using the telemedicine for patients care and management does not dwindle but rather is embraced and promoted in the different settings of its use.

Conclusion

This study looked at the state-of-the-art in use of “telemedicine” to support patient care and management in Latin America (LATAM) during the COVID-19 pandemic, and empirically discussed its future implication for practice in the region. To do this, we applied the PRISMA methodology to identify the level of impact and opportunities of the technology (telemedicine), and why it may have become a good option in the region (LATAM). Twenty-four (24) relevant studies were identified and analyzed based on the different domain areas of their application and main findings/contribution. The outcome of our analysis shows that while telemedicine may have not been extensively applied in the source coverage or in their breadth of dimensions to cover the entire domain of medical research/field in the region (LATAM), a greater percentage of the (24 related) studies reported that the impact of telemedicine during the COVID-19 in LATAM was “effective” in addition to the approximately ~70% that expressed a positive feeling in use of the technology (telemedicine) for patients care and management in practice. Future studies can apply the method described in this paper to understand the extent and application of telemedicine in their different domain settings or demographic distribution, or yet, extend and/or remodification of the method to include further criteria or components that may have not already been introduced in this paper.

References

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