Impact of Telemedicine on Healthcare Accessibility and Patient Outcomes in Underserved Populations: A Systematic Literature Review

Abstract

Background: Telemedicine has moved from a peripheral innovation to a routine mode of care delivery. Its promise for underserved populations is that it replaces geographic distance with digital connection. Whether that promise is realised depends on more than technology, and the evidence on access and clinical outcomes in disadvantaged groups remains scattered across disciplines.

Objective: This review synthesises evidence on how telemedicine affects (i) the accessibility of healthcare and (ii) patient outcomes in underserved populations. It also examines the conditions under which telemedicine narrows or widens existing inequities.

Methods: The review followed PRISMA 2020 reporting principles and drew on scoping-review conventions. The pool comprised 148 records: an author-curated corpus of 117 and 31 supplementary landmark sources. Eligibility screening against pre-specified criteria retained 63 records. They comprised 14 review-level evidence syntheses, 17 conceptual, policy and methodological sources, and 32 contextual scholarly works. Findings were analysed through narrative synthesis and organised using a multidimensional access framework. Reviews were appraised against AMSTAR 2 principles.

Results: Review-level evidence consistently shows that telemedicine achieves clinical outcomes comparable to in-person care for many conditions. For heart failure, diabetes and common mental disorders it often achieves better outcomes than usual care. Patient satisfaction is generally high. Access gains are real but unevenly distributed. Older, poorer, rural, linguistically marginalised and digitally unconnected groups use video-based care less, so telemedicine can reproduce inequity even as it removes distance barriers. Outcomes depend on infrastructure, digital literacy, regulatory clarity, workforce readiness, and the design of the service pathway.

Conclusion: Telemedicine is best understood as an access-reconfiguring technology, not an access-guaranteeing one. This review proposes the access displacement principle: the technology moves barriers from the geographic domain to the digital, institutional and social domains. It argues that equity must be built into the design of telemedicine services from the start. Recommendations are given for policy, practice and research.