Table 2

Identified barriers to telehealth and suggested interventions to overcome them

Factors	Identified barriers	Suggested interventions
Patient factors	Patient reluctance30 45 47 51 62 Varying digital and health literacy skills46 47 51 53 Lack of access to necessary equipment46 54	Integration of digital support into routine patient education Assessment of the patient’s health literacy before referral to telehealth care Assessment of the patient’s digital skills before referral to telehealth care Assessment of access to required equipment before referral to telehealth
Clinical factors	No possibility of face-to-face clinical and instrumental examination45 47 49 63 Disease burden, medical and psychological comorbidity45 62	Assessment before referral: Will telehealth provide all necessary information needed to make a clinical decision? Assessment before referral: Will telehealth be safe for this patient?
Healthcare provider factors	Lack of training48 49	Ensure necessary competencies by providing training on telehealth communication, interaction, legacy and clinical assessment
Organisational factors	Lack of data security51 54 Lack of approval for reimbursement from insurance companies44	Ensure that the telehealth interventions follow national and local obligations on legacy such as privacy and security requirements Involve payers and administration from the beginning in the development of telehealth interventions