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a b s t r a c t
Objectives: To conduct a review of reviews on the impacts and costs of telemedicine services.
Methods: A 代写留学生论文review of systematic reviews of telemedicine interventions was conducted. Inter- ventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treat- ments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review.
Results: In total 1593 titles/abstracts were identified. Following quality assessment, the
review included 80 heterogeneous systematic reviews. Twenty-one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problem-atic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes.
Conclusions: The emergence of new topic areas in this dynamic field is notable and review-ers are starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled inter-ventions, and more focus on patients’ perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest.

1. Introduction
Previous reviews of telemedicine have concluded thatirrefutable evidence regarding the positive impact oftelemedicine on clinical outcomes still eludes us. Onereview of more than 150 articles concluded that poten-tial effectiveness could only be attributed to teleradiology,telepsychiatry, transmission of echocardiographic imagesand consultations between primary and secondary healthproviders. Another systematic review that assessed morethan 1300 papers making claims about telemedicine out-comes found only 46 publications that actually studied atleast some clinical outcomes. A review that analyzed thesuitability of telemedicine as an alternative to face-to-facecare concluded that establishing systems for patient careusing telecommunications technologies is feasible; however,the studies provided inconclusive results regarding clinicalbenefits and outcomes. A report on peer-reviewed litera-ture for telemedicine services that substituted face-to-faceservices with ICT-based services at home and in offices orhospitals identified 97 articles that met the inclusioncriteria for analysis. The authors concluded that telemedicineis being used even if the use is not supported by high qualityevidence.https://www.51lunwen.org/liuxuelunwendx/ Reviews on cost outcomes have fared similarly. Astudy focused on cost-effectiveness interventions concludedthat there is no good evidence that telemedicine is or is not acost-effective means for delivering healthcare.
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