Telemedicine in extreme conditions: Quality assurance, challenges, and directions for improvement: A systematic review
Abstract
Background: Telemedicine has become an important approach for delivering healthcare in settings where physical access to services is limited, disrupted, or impossible. Its relevance is particularly evident in extreme conditions, such as disasters, conflict-affected areas, remote locations, and other resource-constrained environments. However, the quality assurance of telemedicine services in such settings remains insufficiently clarified. This systematic review aimed to synthesize the current evidence on the quality assurance of telemedicine services in extreme conditions and to identify major challenges, quality-related considerations, and directions for improvement.
Method and Material: A systematic review was conducted in accordance with the PRISMA framework. Literature searches were performed in PubMed, Scopus, and Web of Science for studies published between January 2020 and July 2025, with a supplementary search of relevant open-access material. Eligible studies examined telemedicine applications in extreme, crisis-related, remote, or resource-constrained settings, or addressed quality-related dimensions of telemedicine relevant to such contexts. Fifteen studies met the inclusion criteria and were included in the final synthesis.
Results: The included studies suggest that telemedicine can improve access to specialist expertise, support continuity of care, and enhance responsiveness in unstable or disrupted environments. At the same time, recurrent challenges were identified, including limited connectivity, infrastructure constraints, insufficient institutional support, inadequate user training, and legal or regulatory uncertainty. Eleven studies were of moderate quality and four were of high quality.
Conclusions: Telemedicine appears to offer substantial value for healthcare delivery in extreme conditions, but its quality cannot be assumed on the basis of feasibility or technological availability alone. More robust quality frameworks, context-sensitive implementation models, and stronger evaluative evidence are needed.
Article Details
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Chandrinou, A., Exarchos, K., Gaitanou, K., & Mpogiatzidis, P. (2026). Telemedicine in extreme conditions: Quality assurance, challenges, and directions for improvement: A systematic review. Health & Research Journal, 12(2), 112–123. https://doi.org/10.12681/healthresj.45077
- Section
- Systematic Reviews
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