title: The Empirical Foundations of Telemedicine Interventions in Primary Care.
abstract: This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world.
  
  
  
  The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost.
  
  
  
  The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective.
  
  
  
  Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
authors.affiliation: 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan.
authors.forename: Rashid L
authors.initials: RL
authors.lastname: Bashshur
authors.affiliation: 2 Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.|3 Department of History and Health Management and Policy, University of Michigan , Ann Arbor, Michigan.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Howell
authors.affiliation: 4 Department of Radiology & Imaging Sciences, Emory University , Atlanta, Georgia .
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krupinski
authors.affiliation: 5 Family Medicine, University of Michigan , Ann Arbor, Michigan.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Harms
authors.affiliation: 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan.
authors.forename: Noura
authors.initials: N
authors.lastname: Bashshur
authors.affiliation: 6 Department of Family and Community Medicine, University of Cincinnati , Cincinnati, Ohio.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Doarn
mesh_terms: D000367:Age Factors; D003362:Cost-Benefit Analysis; D019468:Disease Management; D014943:Global Health; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D020407:Internet; D008511:Medicine; D063731:Mobile Applications; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012737:Sex Factors; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*; D060145:Text Messaging; D016896:Treatment Outcome; D000078329:Workforce
keywords: cost; evidence; outcomes; primary care; telemedicine