Journal of Modern Medical

Introduction
As fertility rate declines, population of older people and life expectancy increase. From 2000 to 2050, the proportion of people over 60 years will increase from about 11% to 22%. In other words, the number of people aged ≥60 is expected to increase from 605 million to 2 billion. Therefore, the ratio of the elderly population to the total population is increasing. Studies have shown that Iran’s elderly population will increase fivefold by 2050. Per capita health care costs for people over 65 years in the US and other developed countries are 3-5 times higher than those for people in other age groups, and 5-10% of the elderly in US account for more than two-thirds of the health care costs for people over 65 years. Also, elderly people account for 33% of hospital admissions and 44% of hospital bed days. In Iran, the study of the effect of age on health costs has indicated that the demand for healthcare services increases relatively from age 25 to 50. After this period, it shows a high upward trend and reaches its peak in the last years of life. To our knowledge, there are limited requirements for the provision of remote health services to the elderly, and it seems necessary to conduct a study that identifies all the managerial requirements for the provision of remote health services to the elderly. Therefore, the present study aims to identify managerial requirements in providing telemedicine to the elderly.

Methods
This study was conducted based on the 5-step approach of Arksey & O’Malley. Related studies published from 2010 to 2022 were identified by searching in Scopus, Web of Science, and PubMed databases, and also searching for gray literature in Google Scholar. The inclusion criteria were the study of any managerial requirements either during the preparation phase or during the implementation and evaluation of telemedicine services, written in English and Persian, existence of an English abstract with sufficient evidence in non-English articles, and the availability fulltexts. Those with unavailable fulltexts were excluded. 
Data extraction was done by two authors. In this step, all the data extracted from the articles were collected using a form. Two authors independently coded the data. Disagreements in coding were resolved in a meeting by discussion. Codes were grouped into primary themes. Finally, analytical themes were created and reviewed by two authors and discussed in a meeting to reach final agreement. 

Results
In the preparation stage of providing telemedicine (34 articles, 89%), 116 initial concepts, 28 unique concepts, 8 initial themes and 4 final themes were identified. In the implementation stage (32 articles, 84%), 64 initial concepts, 18 unique concepts, 8 initial themes and 2 final themes were identified. In the evaluation phase (13 articles, 34%), we identified 29 initial concepts, 9 unique concepts, 5 initial themes and one final theme.
The final themes in the preparation stage included planning and targeting, organizing resources and manpower, designing and developing technology infrastructure in collaboration with stakeholders, and deploying appropriate technology. The final themes in the implementation stage included developing and promoting technology, monitoring operations, maintaining. The final theme in the evaluation stage was the continuous improvement and assessment of long-term effectiveness and outcome. It indicates concepts such as creating criteria and evaluation indicators to measure the effectiveness of services, collecting and analyzing data on patient satisfaction and patient needs, creating a comprehensive regulatory framework, optimizing the telehealth workflow, and evaluating the long-term outcome and scalability of technology.

Conclusion
The present study reviewed the information of 38 studies related to managerial requirements for providing telemedicine to the elderly. Telehealth is an efficient and effective form of healthcare delivery, especially for the elderly. Evaluation of multiple parameters including patient satisfaction, cost, information security, as well as effectiveness and quality of services and reliability of telehealth technology are important parameters for long-term sustainability of telehealth. Creating a comprehensive regulatory framework and continuous monitoring of the program and positive feedback in the existing workflow were also among the important requirements. Evaluation is the final key to the success of any telemedicine program.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethic Committee of Shiraz University of Medical Sciences (Code: IR.SUMS.NUMIMG.REC.1401.066).

Funding
The present article was extracted from the master's thesis of Zahra Soharri, approved by Department of Healthcare Services Management, Health and Human Resources Management Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences (Grand No.: 26519).

Authors' contributions
Conceptualization and Methodology: All authors; Investigation: Erfan Kharazmi, Mahnaz Samadbeik, and Zahra Khorshidi; Writing–Original draft: All authors; Review & editing: Erfan Kharazmi, Mahnaz Samadbeik, and Zahra Khorshidi; Supervision: Erfan Kharazmi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors express their gratitude to the Shiraz University of Medical Sciences for making this research possible.




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