Virtual care in residential aged care and primary care settings: a systematic literature review using the SEIPS framework.

Abstract

The global need to improve access to primary care in residential aged care homes (RACHs) has driven interest in virtual care models. Despite rapid telehealth adoption, little is known about the sociotechnical factors influencing use in aged care settings, particularly from the perspectives of primary care providers, aged care staff, and residents. This review applied the Systems Engineering Initiative for Patient Safety (SEIPS) framework to synthesise evidence on barriers, enablers, processes, and outcomes of virtual care delivery in RACHs and primary care. We conducted a systematic review in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024562423). Databases searched included MEDLINE, Embase, CINAHL, and Scopus (January 2016-March 2025). Eligible studies reported qualitative, quantitative, or mixed-methods findings on virtual care involving RACHs and primary care. Data were extracted using a SEIPS-informed template and synthesised deductively across sociotechnical domains. Thirteen studies met the inclusion criteria. Common barriers included limited digital literacy, sensory and cognitive impairments, poor audio-visual quality, lack of staff training, and workflow disruption. System-level challenges included poor technology interoperability, inadequate digital infrastructure, and insufficient organisational and policy support. Enablers included strong clinician-resident relationships, access to remote monitoring tools, and peer support. Reported outcomes were mixed: improved access, communication, and reduced emergency transfers were noted, alongside concerns about increased workload, reduced relational care, and diagnostic limitations. Studies reporting resident perspectives are lacking. Virtual care has the potential to improve aged care access and outcomes, but effective implementation requires more than technology alone. Hybrid models integrating virtual with in-person care require supportive policies, funding models, and organisational workflows. Addressing interoperability gaps, infrastructure needs, and increasing co-design with residents are essential to create virtual care models that are sustainable, person-centred, and scalable in primary care and aged care contexts.