Incentives and Barriers to Remote Medical Systems for Alzheimer's Patients and Their Caregivers:A Systematic Review

Alzheimer's disease is currently the third most expensive chronic disease and in the near future will be the fourth leading cause of death in adults. As the disease progresses, these patients need constant care that can help these patients and their caregivers with the help of information technology. Telemedicine technology for Alzheimer's patients has a history of nearly 20 years. The purpose of this systematic review was to examine the goals, consequences, incentives, and barriers to remote medical care for Alzheimer's patients and their caregivers.Methods: In this review study, the original studies were conducted until January 2020 and searched for the keywords "telemedicine" and "Alzheimer's disease", etc. in the electronic databases of PubMed, Web of Science and Scopus. A total of 1045 related studies were found, after eliminating duplicates and applying inclusion and exclusion criteria, related articles were identified based on the research title. The required criteria for entering each article included telemedicine as an intervention tool, Alzheimer's patient and the original research article. Other articles were excluded. Finally, the goals and consequences of each study were extracted and then the incentives and barriers to the use of these systems for Alzheimer's patients and their caregivers were identified.Results: Finally, 56 articles published in 19 different countries were identified. More than half of the studies (30 articles (53.6%)) were related to the United States. In 30 articles (53.6%), patients or their caregivers received health care services in their home environment. The purpose of 14 articles on the use of telemedicine was to use it as an aid to improve the living conditions of patients and their caregivers. Outcomes of all articles were divided into three categories: cost effectiveness, patient satisfaction and clinical implications. Of all the articles submitted, 19 mentioned the cost-effectiveness and 18 articles referred to user satisfaction with the use of these systems. Finally, 43 effective interventions and 27 barriers were identified for these systems and a framework consisting of incentives and barriers was presented in order to implement and adapt Alzheimer's patients and their caregivers to these systems.Conclusion: The results of this study can be used by researchers in the implementation of telemedicine systems for a variety of purposes. Also, with financial support, treatment with home telemedicine systems can be much more effective and reliable than clinical telemedicine systems.