Patients' Perspectives on Telemedicine for Type 2 Diabetes in Primary Care: Systematic Review and Thematic Synthesis

To identify and synthesize the factors influencing the delivery and uptake of telemedicine for managing type 2 diabetes mellitus (T2DM) in primary care based on patients' experiences and perspectives.

In this systematic review and thematic synthesis, we searched MEDLINE, EMBASE, PsycINFO, Google Scholar, SCOPUS, and CINAHL from inception to December 2023. The reference lists of eligible studies and other relevant systematic reviews were also searched. We included qualitative studies that explored patients' perspectives and experiences of using telemedicine to manage T2DM in primary care. Primary outcomes were the factors influencing the delivery and uptake of telemedicine interventions, identified through thematic synthesis following the approach by Thomas and Harden. Themes were presented in alignment with Karsh Health IT Implementation Framework to support theory-informed interpretation. The review was conducted in accordance with the ENTREQ guidelines and registered in PROSPERO (ID: CRD42024544785).

Of 3006 records retrieved, 25 studies met the inclusion criteria. Six key themes influenced patients' use of telemedicine for T2DM in primary care: access and navigation of services, communication and therapeutic relationship, patient engagement and self-management, quality and personalization of care, usability and technical support, and financial barriers. Patients valued timely support, flexible scheduling, continuity with providers, and personalized care. Telemedicine was seen as convenient and empowering, especially when digital literacy and system usability were supported. However, challenges such as internet access, lack of training, and affordability limited engagement with telemedicine.

This review identifies multilevel factors that influence patients' use of telemedicine and offers a theory-informed understanding of the obstacles to the successful implementation of telemedicine. Digital and health literacy, patient-provider relationships, and clear communication are essential for building trust and sustaining engagement. Usability is enhanced by user-friendly interfaces, timely access, and tailored training. These findings offer practical implications for healthcare providers, system designers, and policymakers. Future research should examine long-term engagement through theory-driven approaches.