Telehealth and patient satisfaction: a systematic review and narrative analysis

Telehealth use in the well-child health setting. A systematic review of acceptability and effectiveness for families and practitioners

Background

Universal well-child health nursing services in high-resource countries promote the health and well-being of children and families while preventing health inequities. The COVID-19 pandemic and technological advancements have led to the increased use of telehealth in this field. To enhance policies and practices, it's important to understand the acceptability and effectiveness of telehealth, as well as the barriers and enablers to its implementation, and to determine when its use is appropriate and safe.

Objective

To explore the global evidence on the use of telehealth in well-child health settings within high-income countries. Focussing on the effectiveness and acceptability of telehealth, along with the factors affecting its implementation and the considerations for safety from the perspectives of both providers and families.

Design

A mixed methods systematic review.

Methods

A systematic review was conducted following PRISMA guidelines. The inclusion criteria for the review included: primary research papers written in English, conducted in high-income countries, focused on telehealth in the well-child health setting, and involving children under six years of age. The search, which was completed in July 2023, systematically explored the CINAHL, ProQuest Central, PubMed, and Web of Science bibliographic databases. Studies were critically appraised for quality, and relevant data extracted. A convergent segregated approach was employed to synthesise both quantitative and qualitative data, which is presented in a narrative format.

Results

A total of 4,354 records were identified and screened, and 169 full-text papers were assessed for eligibility, resulting in 20 papers for inclusion. Telehealth acceptability among families was reported in 13 of the 20 studies reviewed, with participants expressing high satisfaction regarding its use as a complement to standard care. Only three studies examined practitioners' acceptance, revealing mixed responses. Effectiveness was observed in 15 studies, with no significant differences found between the control and telehealth groups, suggesting that telehealth may achieve outcomes like those of standard care. Four studies identified both enablers and barriers to the implementation of telehealth, though none addressed concerns regarding safety and appropriateness.

Conclusions

Telehealth shows promise for well-child health services, but there is limited evidence of its effectiveness and safety. The COVID-19 pandemic increased its use, yet risks need further exploration. To validate telehealth in this field, we must identify effective applications, tackle implementation barriers, and ensure client safety. Additional research is essential for developing evidence-based policies for future practices.

Demographic and socioeconomic disparities in the hybrid ophthalmology telemedicine model

ImportanceAs telemedicine use expands, it is important to evaluate demographic and socioeconomic disparities among patients receiving ophthalmic care through new hybrid telemedicine models.ObjectiveTo evaluate whether there are demographic and socioeconomic disparities in the delivery of the hybrid telemedicine model.DesignRetrospective, cross-sectional, case-control analysis of patient encounters from April to December 2020.SettingA single, academic, hospital-based eye clinic in Boston, Massachusetts.MethodsElectronic medical records of all patient encounters from April to December 2020 were reviewed and categorized into hybrid, virtual-only, and standard in-person visits. Patient-level data for all visits were extracted including age, sex, race/ethnicity, primary language, Area Deprivation Index (ADI), insurance type, and marital status. Visit-level data for all hybrid visits were also extracted from the medical record including the visit dates and patient adherence. Demographics for the cohort of patients with at least one no-show visit were compared with demographics for the cohort of patients who only had completed visits. The primary study outcomes were the differences in demographic characteristics between the hybrid visit show and no-show groups. The secondary outcomes included demographic characteristics of patients who did not complete their hybrid visit versus a time-matched cohort of patients who did not complete their standard in-person visit. Continuous variables for patient characteristics were compared with independent samples t-tests and categorical variables were compared using Pearson chi-square tests. Multivariate logistic regression was used to examine the differences between the cohorts. Variables with missing values other than suppressed ADI values were imputed using multiple imputations by chained equations.ResultsOf a total of 1025 patients who were scheduled for a hybrid visit, 145 (14.1%) patients failed to complete their visit. Primary language and insurance were found to be statistically different between patients who completed and did not complete their hybrid visits. More English speakers and fewer Haitian Creole speakers completed their hybrid visits (p = 0.007) while more patients with private insurance and fewer patients with Medicaid completed their hybrid telemedicine visits (p = 0.026). No associations were found between hybrid telemedicine visit adherence and age, sex, race/ethnicity, marital status, or ADI. When the 145 patients who failed to complete their hybrid visits were compared to a time-matched cohort of patients who failed to complete their standard in-person visit, we found that patients who missed hybrid visits were similar to those who missed standard in-person visits except for patients insured by Medicare. These patients were more likely to miss a hybrid visit than a standard in-person visit (Odds Ratio 2.199, 95% confidence interval 1.136-4.259, p = 0.019). No associations were found between patient nonadherence with hybrid telemedicine versus with standard in-person visits based on age, sex, primary language, race/ethnicity, marital status, or ADI.ConclusionThe hybrid telemedicine model was associated with insurance and language-based disparities. Patients with non-English primary language and Medicaid recipients were more likely to miss a hybrid visit than their counterparts. Our findings support developing deliberate interventions to ensure hybrid telemedicine care is delivered equitably to all patients.

The Association Between Patient Upsurge and Telemedicine Utilization During the COVID-19 Period in Japan: A Seasonal Autoregressive Integrated Moving Average Analysis with 9 Years Claims Data

Background: While the coronavirus disease 2019 (COVID-19) pandemic led many countries to relax telemedicine regulations resulting in increased usage, limited research exists on telemedicine utilization patterns throughout the entire pandemic period. Methods: We conducted a retrospective study using the claims data with National Health Insurance in Kanagawa Prefecture, Japan, from April 2014 to March 2023. Using seasonal autoregressive integrated moving average modeling, we compared observed telemedicine usage with predicted values based on pre-COVID-19 data (April 2014-March 2020) and analyzed utilization patterns across different infection waves. Results: Telemedicine usage increased during peak infection periods of each wave following the first wave (April 2020). From the sixth wave onward (January 2022), COVID-19-related consultations accounted for over 50% of telemedicine usage. Subgroup analysis by disease showed that while most conditions had high proportions of patients with COVID-19 comorbidities, mental disorders maintained relatively low proportions. The highest utilization was observed during the seventh wave, significantly exceeding predicted values. Conclusions: Telemedicine usage increased in parallel with infection surges throughout the pandemic period, not just during the initial outbreak. The findings suggest the necessity of improving telemedicine service quality and accessibility during nonpandemic periods in preparation for future emerging infectious disease outbreaks. This study reveals both the critical role of telemedicine during infectious disease outbreaks and the varying utilization patterns across different diseases.

Value-Based Experiences Related to Digital Follow-Up Services Among Critical Care Survivors: An International Qualitative Study

Intensive care units (ICUs) are increasingly striving to provide cost-effective and value-based support. To meet this trend, digital solutions might offer appropriate opportunities for delivering remote, personalized follow-up services. However, it remains unclear whether digital solutions align with survivors' preferences to improve post-ICU quality of life. The aim was to explore the value-based experiences related to digital follow-up services among critical care survivors. A qualitative design, with focus group interviews from May through October 2023, was conducted with critical care survivors recruited from four European countries. A thematic approach was used to analyze the data. Twenty-two participants were included, of whom half were women (n = 11). Three main themes were categorized: (1) powerless and uncontrolled, a search for regaining life; (2) adequate digital information; and (3) the role of technology and appropriate functionalities according to users' wishes. Overall findings across the four European countries highlighted value-based preferences such as personalized online information delivery, the possibility of e-consults with healthcare professionals, and digital access to peer support.

Telephone versus video consultations: A systematic review of consumer and provider preferences

IntroductionAs telehealth services are increasingly utilised and mature, it is important to continue to assess the preferences of both consumers and providers to ensure that these services are being used in the most acceptable and effective manner. This review aims to analyse both consumer and provider preferences for telephone and video consultations.MethodsA systematic search of MEDLINE, CINAHL and Embase databases was conducted in April 2023 to identify studies that investigated consumer or provider preferences for either telephone or video consultations. Data were extracted and synthesised narratively with the main reported findings from each article categorised in regard to modality preference (i.e. preference for either telephone or video; no preference between modality, equivalency, or mixed preference statements).ResultsA total of 78 articles were included in the analysis. Studies were published between 2003 and 2023, with the majority (86%) published after 2020. While most studies used quantitative survey methods (69.2%), five used qualitative (6.4%) and 19 used a mixed methods approach (24.4%). The majority of included studies (54% of consumer studies and 76% of provider studies) reported video as the preferred telehealth modality over telephone.DiscussionAlthough video is mostly preferred over telephone, a number of consumer studies reported equivalent preference for telephone and video consultations and highlighted the benefits of each modality for different purposes.

Medicaid Telehealth Policy in Marginalized Communities: Perspectives From Virginia Patients and Providers

We sought to understand stakeholder experience with telehealth services, through interviews with patients, providers, and health plans, to inform Medicaid policy after the COVID-19 public health emergency. Our primary aim was to examine whether and how such telehealth policies affect equitable care delivery and to uncover any remaining policy gaps. Applying the Framework for Digital Health Equity our study identified digital determinants that operate at the individual, interpersonal, community and societal levels. Across respondents, telehealth expansion was viewed as overwhelmingly positive and noted as a significant contributor to increased access among marginalized, minoritized, and rural Medicaid participants in this study. Despite these strengths, patients and health care providers identified several challenges and recommendations.

Level of Patient Satisfaction with Quality of Primary Healthcare in Almaty During COVID-19 Pandemic

BACKGROUND

This study aimed to assess patient satisfaction with the quality of healthcare services at selected public primary healthcare facilities in Almaty during the COVID-19 pandemic and to identify associated demographic and facility-related factors.

METHODS

A cross-sectional, quantitative study was conducted over a period of 6 months, from 30 June to 31 December 2021, through a web-based survey. An adapted questionnaire was employed to survey the respondents. In total, 1035 respondents participated in the study. To examine the relationship between demographic and facility characteristics and patient satisfaction, we utilized the proportional odds model for ordinal logistic regression.

RESULTS

A total of eight primary healthcare organizations from the public sector in Almaty participated in the survey. The analysis identified significant demographic predictors of patient satisfaction, such as marital status, social status, self-perceived health, and the use of online consultations. Among the facility-related factors, only the availability of a cross-ventilation system emerged as a significant predictor.

CONCLUSIONS

This study provides evidence for the factors influencing patient satisfaction with primary healthcare services in Almaty during the COVID-19 pandemic. Both demographic characteristics and facility-level attributes were found to significantly affect satisfaction levels. These findings underscore the need for targeted structural and organizational improvements in primary healthcare settings, especially during public health emergencies. Addressing these gaps through infrastructural upgrades, enhanced preparedness, and the integration of patient-centered care models can help to bolster trust and resilience within Kazakhstan's healthcare system.

Reliability and validity of in-home tele-neuropsychological testing in patients with Parkinson's disease: A randomized trial

OBJECTIVE

To assess the reliability and diagnostic validity of in-home tele-neuropsychological testing (in-home tele-npt) in individuals with Parkinson's disease (PD).

METHOD

We randomized 79 individuals with PD to in-person npt or in-home tele-npt at Baseline, and again to the same or crossover group for Week 4 testing. We assessed group differences in mean test scores using ANOVAs with Dunnett's t-tests. Test-retest reliability was assessed using intraclass correlation coefficients and Pearson correlations and compared across groups using 95% confidence intervals and z-tests with Fisher's z transformations. We compared the percentage of participants exceeding each test's standardized regression-based index across groups. We examined diagnostic validity by comparing group differences in cognitive classifications using Pearson's Chi-square test and Fisher's Exact test.

RESULTS

For most tests, the mean scores between in-home tele-npt and in-person npt were not significantly different. In-home tele-npt had weaker Baseline processing speed scores. The test-retest reliability was similar between the repeated tele-npt and repeated in-person npt groups in most tests. The crossover groups had weaker test-retest reliability in processing speed, verbal fluency, and memory tests. The percentage of significant change scores varied between groups and across tests. The percentage of participants classified as cognitively impaired, and the agreement of cognitive classification between testing sessions, were not significantly different between groups.

CONCLUSIONS

With few exceptions, in-home tele-npt and in-person tele-npt yield similar scores. Test-retest reliability is better when the testing paradigm is held constant. There are no significant differences in cognitive diagnostic classification rates between testing paradigms in individuals with PD.

Effectiveness of eHealth for Medication Adherence in Renal Transplant Recipients: Systematic Review and Meta-Analysis

BACKGROUND

As the optimal treatment for end-stage renal disease, kidney transplantation has proven instrumental in enhancing patient survival and quality of life. Suboptimal medication adherence is recognized as an independent risk factor for poor prognosis, graft rejection, and graft loss. In recent years, the advancement of IT has facilitated the integration of eHealth technologies into medical medication management, offering potential solutions to improve patient adherence. However, their efficacy in kidney transplant recipients remains inconclusive.

OBJECTIVE

This study aimed to evaluate the effectiveness of eHealth interventions in improving medication adherence among kidney transplant recipients and identify potential influencing factors.

METHODS

We systematically searched PubMed, Web of Science, Cochrane Library, Embase, CINAHL, Scopus, and Ovid databases for randomized controlled trials evaluating eHealth interventions targeting immunosuppressant medication adherence in kidney transplant recipients. The search time frame spanned from database inception to November 2024. Two investigators independently screened studies, extracted data, and assessed outcomes. Primary outcomes included adherence measured by self-reported questionnaires, electronic monitoring devices, tacrolimus trough levels, intrapatient variability of tacrolimus concentrations, and the proportion of patients achieving a tacrolimus coefficient of variation <40%. Meta-analyses were performed for dichotomous data and continuous data, while narrative synthesis was applied to single studies or data unsuitable for meta-analysis. Subgroup analyses were conducted to determine whether results differed based on adherence assessment methods, follow-up duration, eHealth functionalities, delivery modes, and intervention designs. Risk of bias and evidence quality were evaluated using the Cochrane Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively.

RESULTS

A total of 12 studies involving 1234 kidney transplant recipients were included. Significant between-group differences in adherence were observed only when assessed via electronic monitoring devices (risk ratio=1.46, P=.006; mean difference=0.37, P<.001). However, sensitivity analyses using the leave-one-out method demonstrated instability in these findings. Conflicting results or nonsignificant differences (P>.05) were identified across other outcome measures and subgroup analyses.

CONCLUSIONS

No definitive conclusions can be drawn regarding the efficacy of eHealth interventions in improving medication adherence among kidney transplant recipients, potentially due to heterogeneity in trial designs, intervention characteristics, user preferences, and variations in adherence definitions and measurement methodologies. These uncertainties are underscored by the low or very low quality of evidence, as assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. While eHealth holds promise, methodological refinements in study design and implementation remain critical. Future research should prioritize high-quality, large-scale evidence to validate its clinical efficacy.

TRIAL REGISTRATION

PROSPERO CRD42025640638; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025640638.

Moving from theory to practice: implementing a prehabilitation program before gastrointestinal cancer surgery (PREHAB-GI)

PURPOSE

Surgery remains the primary treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, it can lead to postoperative complications and reduced functionality. Prehabilitation aims to improve functional reserves before surgery. We aimed to evaluate the implementation of a multimodal prehabilitation program in "real-world" patients undergoing gastrointestinal cancer surgery.

METHODS

An implementation study evaluating prehabilitation in patients undergoing gastrointestinal (colorectal or UGI) cancer surgery at Concord Hospital. The prehabilitation program included supervised exercise, nutrition and nursing support delivered face-to-face or by telehealth (COVID-19 adaptations).

ASSESSMENTS

baseline, pre-surgery and 30 days after surgery.

PRIMARY OUTCOME

implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework.

SECONDARY OUTCOMES

functional, nutritional and surgical outcomes, with comparisons to historical controls.

RESULTS

Between January 2020 and December 2021, 181 patients were screened; 91 (50%) were eligible. Reach: 77/91 recruited (63 colorectal, 14 UGI). Median age, 70 years (IQR, 59-79); 60% were males. Median intervention duration, 16 days (IQR, 12.25-19.75).

EFFECTIVENESS

quality of life, anxiety and functional capacity improved from baseline to pre-surgery (6-min walk test (+16.1 m, p=0.038) and 2-min step test (+10.0 steps, p<0.001)). Compared to historical controls, hospital length of stay was reduced by 2.1 days (p=0.010), with no differences in complications. Adoption: 91% of referrals came directly from surgeons.

IMPLEMENTATION

94% completed the intervention, with high adherence and satisfaction levels. Maintenance: after study completion, the program was incorporated into standard care with some modifications.

CONCLUSIONS

Prehabilitation can be implemented in a real-world setting, with a trend towards improving functional and surgical outcomes, but dedicated resources are necessary to implement and maintain the program.

Awareness and attitudes of elderly Southeast Asian adults towards telehealth during the COVID-19 pandemic: a qualitative study

INTRODUCTION

We aimed to understand the awareness and attitudes of elderly Southeast Asians towards telehealth services during the coronavirus disease 2019 (COVID-19) pandemic in this study.

METHODS

In this qualitative study, 78 individuals from Singapore (51.3% female, mean age 73.0 ± 7.6 years) were interviewed via telephone between 13 May 2020 and 9 June 2020 during Singapore's first COVID-19 'circuit breaker'. Participants were asked to describe their understanding of telehealth, their experience of and willingness to utilise these services, and the barriers and facilitators underlying their decision. Transcripts were analysed using thematic analysis, guided by the United Theory of Acceptance Use of Technology framework.

RESULTS

Of the 78 participants, 24 (30.8%) were able to describe the range of telehealth services available and 15 (19.2%) had previously utilised these services. Conversely, 14 (17.9%) participants thought that telehealth comprised solely home medication delivery and 50 (51.3%) participants did not know about telehealth. Despite the advantages offered by telehealth services, participants preferred in-person consultations due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy and a lack of access to telehealth-capable devices.

CONCLUSION

Our results showed poor overall awareness of the range of telehealth services available among elderly Asian individuals, with many harbouring erroneous views regarding their use. These data suggest that public health education campaigns are needed to improve awareness of and correct negative perceptions towards telehealth services in elderly Asians.

Telephone Survey-Reported Perceptions of Telehealth Visits Among Black and Non-Black Patients Diagnosed With Cancer

PURPOSE

Empirical evidence underscores both benefits of telehealth visits and persistent disparities in use for Black adults. Guided by the Technology Acceptance Model, we evaluated perceptions regarding telehealth visits among Black and Non-Black adults receiving cancer care from two academic health systems.

METHODS

Between April 2022 and October 2023, a survey was conducted among adult patients treated for cancer in the past 3 years. Survey recruitment was stratified by visit type (telehealth or in-person) and race. Before a scheduled oncology visit, respondents completed a telephone survey to assess their perceptions of usefulness, ease of use, and attitudes toward telehealth visits. Frequency differences were estimated using chi-square tests, and prevalence differences using logistic regression.

RESULTS

The survey was completed by 773 respondents (42% Black) with a 15% response rate. Black respondents were younger and less likely to report male sex, being married, having a college education, comfortable income, or confidence in medical and e-literacy. Compared with Non-Black respondents, Black respondents perceived telehealth visits as less useful for determining health needs (37% v 48%) and asking questions (9% v 15%). They thought that telehealth visits were less easy with regard to understanding their health care provider (14% v 21%) and the ability to connect (23% v 30%). Black respondents expressed more concern about internet access (26% v 15%), access to electronic devices (17% v 9%), and finding assistance for connecting (24% v 12%). They also found telehealth visits to be less private (19% v 34%).

CONCLUSION

Racial differences in telehealth ease of use and usefulness perceptions highlight the need for oncology practices to couple connectivity support with effective communication strategies to avoid disparities in oncology telehealth services.

Knowledge comparison amongst telehealth service utilized and never-utilized adults in Bangladesh: a cross-sectional study

Background

Telehealth service is an approach to health care delivery that uses various telecommunication technologies, where the knowledge of the patient plays an important role in its acceptance, preference, and utilization. This study compared telehealth service knowledge among adults who utilized and never-utilized telehealth services and explored factors associated with telehealth knowledge.

Methods

This comparative cross-sectional study recruited 1252 adults from Bangladesh. The outcome variable of the study was the knowledge of telehealth services. We used convenience sampling approaches to recruit participants. The online questionnaire was distributed via Google Forms through Facebook, Messenger, and WhatsApp. The independent variables of the study were sociodemographic factors and the perceived health status of the participants. The bivariate logistic regression model was used to investigate the association between study variables and the level of knowledge among those who utilized and never-utilized the telehealth service. The data analysis was done using STATA version 16.

Results

In the never-utilized group, 54.41% of participants were male, with an average age of 28.89 years. In the utilized group, 55.77% of the participants were male, with an average age of 30 years. Age, marital status, educational level, student status, and perceived health status were significantly associated with good telehealth knowledge among those who never-utilized the telehealth service. Among the utilized groups, we found that age, marital status, and perceived health status were significantly associated with good knowledge of telehealth services.

Conclusions

This study emphasizes the importance of addressing the associated factors to improve telehealth knowledge, considering existing variations among adults who utilized and who never-utilize telehealth services.

Investigating Continuance Intention for Telehealth Visits in Children's Hospitals: Survey-Based Study

BACKGROUND

Telehealth visits are remote health care consultations conducted using digital technologies, such as video calls, phone calls, or web-based platforms. This type of service offers numerous benefits for both health care users and health care providers. Users save time and money by avoiding traveling to health care facilities. At the same time, health care providers can expand access to care for users in remote areas and enhance the continuity of care. These advantages are even more evident in pediatric settings, where attending in-person services must align with the commitments of the patient (eg, school activities) and the caregiver. Although the potential benefits of telehealth visits for users and health care providers were already known before the COVID-19 pandemic, its widespread adoption only occurred during it. Having experienced its benefits, hospitals are now, in the postpandemic phase, determined to maintain and strengthen their remote service offerings. It has, therefore, become crucial for them to understand the factors influencing users' intention to continue using telehealth visits (or "continuance intention"), even now after the access restrictions to health care facilities imposed during the COVID-19 pandemic have been lifted. However, the literature lacks comprehensive, valid, and reliable models explaining users' continuance intention toward telehealth visit services.

OBJECTIVE

This study aims to investigate the variables impacting users' continuance intention toward telehealth visits and identify suggestions for improvement.

METHODS

Two models of variables impacting users' continuance intention toward telehealth visits were developed. The first model applied to all users undergoing telehealth visits, while the second one applied only to patients who received a telehealth visit using videoconferencing tools. The models were created based on the literature and a qualitative study comprising interviews with physicians with extensive experience in telehealth visits. The models were then tested using partial least squares structural equation modeling on 477 responses obtained by administering a survey to guardians of patients who had received at least 1 telehealth visit in a major European children's hospital.

RESULTS

Both models showed that the variable information quality positively influenced the variables continuance intention and perceived usefulness and that perceived usefulness positively influenced continuance intention. The first model was robust to the medical specialty and the channel used to deliver the visit. The second model also showed that systems quality positively influenced information quality.

CONCLUSIONS

This study has identified and tested 2 comprehensive, valid, and reliable models on the variables influencing users' continuance intention toward telehealth visits. Moreover, the study's results provide insights for hospitals to improve telehealth visit services.

Telehealth satisfaction among patients with chronic diseases: a cross-sectional analysis

Background

The study aims to assess telehealth satisfaction among patients with chronic diseases focusing on key demographic and clinical factors that influence satisfaction.

Methods

A descriptive cross-sectional study was conducted using a self-reported online questionnaire between December 1, 2023, and January 30, 2024. The study targeted chronic patients who had been using telehealth for at least three months. After screening for eligibility and ensuring data completeness, responses from 1,070 patients from three non-governmental hospitals were included in the analysis. The questionnaire covered demographic, socio-economic, and technology-related data, as well as a telehealth satisfaction scale.

Results

A total of 62.9% of patients reported being satisfied with the telehealth services they received, while 37.1% expressed dissatisfaction. Logistic regression analysis identified several factors associated with patient satisfaction. The constant term was significantly positive (coefficient = 4.129, p < 0.001), indicating a baseline high level of satisfaction. Age negatively impacted satisfaction (coefficient = -0.191, p < 0.001), with older patients being less satisfied. Male patients showed a higher satisfaction rate (coefficient = 0.473, p = 0.047), while education level, particularly having a bachelor's degree, was strongly associated with increased satisfaction (coefficient = 1.977, p < 0.001). Marital status (married) was not a significant predictor (p = 0.403), whereas employment status (working) had a positive association with satisfaction (coefficient = 1.445, p < 0.001). Income level (sufficient and save) did not significantly affect satisfaction (p = 0.561). Having children was positively associated with satisfaction (coefficient = 1.189, p < 0.001).

Conclusion

Addressing demographic, socio-economic, and technological needs can enhance patient satisfaction with telehealth services. Tailoring services to specific patient preferences, especially for older patients and those needing continuous training, can improve telehealth effectiveness and acceptance.

Examination of Patient and Provider Satisfaction, Benefits, and Challenges with Psychiatric Outpatient and Hospital-Based Telehealth Treatment during the COVID-19 Pandemic

OBJECTIVE

During the COVID-19 pandemic, telemental health (TMH) use rapidly increased. Though patients report satisfaction with TMH, acceptability among different psychiatric providers (inpatient, outpatient, nurses) and for various diagnoses is less understood. This study aimed to expand understanding by examining TMH acceptability, benefits, and barriers for providers and patients during the early transition to TMH in the COVID-19 pandemic.

METHODS

Online anonymous surveys evaluated patient (n = 64) and provider (n = 39) satisfaction with and perceived benefits and challenges to TMH from October-December 2020 on 5-point Likert scales. Qualitative data was collected and themes identified.

RESULTS

Outpatient (3.97 ± 1.05) and inpatient (3.11 ± 1.6) providers, including nurses, reported high satisfaction with TMH, despite over 50% never having used TMH prior to the pandemic. TMH was viewed as acceptable across diagnoses, including serious mental illness and substance use. Provider-rated benefits of outpatient TMH versus in-person visits included COVID safety (mean difference[MD] = 3.05), travel (MD = 2.95), and reduced cancellations (MD = 1.81). Inpatient TMH similarly included COVID safety benefits (MD = 3.31), but also challenges related to team-based service provision (MD = 1.68) and working with trainees (MD = 1.19). Qualitative themes identified TMH challenges (e.g., technological: 56.7% patients, 66.7% providers) and benefits (e.g., convenience/flexibility: 80% patients, 81.5% providers).

CONCLUSIONS

TMH was associated with high satisfaction for patients and across provider types and patient diagnoses. This study provides further support that TMH across clinical settings allows for greater flexibility and accessibility to evidence-based care, and ongoing benefits even outside the context of the COVID-19 pandemic. It suggests the benefits of ongoing training of staff and trainees in TMH.

Monitoring oral health remotely: ethical considerations when using AI among vulnerable populations

Technological innovations in dentistry are revolutionizing the monitoring and management of oral health. This perspective article critically examines the rapid expansion of remote monitoring technologies-including artificial intelligence (AI)-driven diagnostics, electronic health records (EHR), wearable devices, mobile health applications, and chatbots-and discusses their ethical, legal, and social implications. The accelerated adoption of these digital tools, particularly in the wake of the COVID-19 pandemic, has enhanced accessibility to care while simultaneously raising significant concerns regarding patient consent, data privacy, and algorithmic biases. We review current applications ranging from AI-assisted detection of dental pathologies to blockchain-enabled data transfer within EHR systems, highlighting the potential for improved diagnostic accuracy and the risks associated with over-reliance on remote assessments. Furthermore, we underscore the challenges posed by the digital divide, where disparities in digital literacy and access may inadvertently exacerbate existing socio-economic and health inequalities. This article calls for the development and rigorous implementation of ethical frameworks and regulatory guidelines that ensure the reliability, transparency, and accountability of digital health innovations. By integrating multidisciplinary insights, our discussion aims to foster a balanced approach that maximizes the clinical benefits of emerging technologies while safeguarding patient autonomy and promoting equitable healthcare delivery.

The Role of Neuroinflammation in the Comorbidity of Psychiatric Disorders and Internal Diseases

Psychiatric disorders and internal diseases frequently co-occur, posing significant challenges due to overlapping symptoms, shared pathophysiological mechanisms, and increased healthcare burdens. Neuroinflammation has emerged as a central mechanism linking these conditions, driven by systemic inflammation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and autonomic nervous system (ANS) imbalance. This review synthesizes current evidence on the role of neuroinflammation in comorbid conditions such as depression, anxiety, cardiovascular disease, and diabetes mellitus, emphasizing bidirectional relationships and shared inflammatory pathways. This analysis identifies gaps in longitudinal studies, biomarker validation, and the integration of multidisciplinary care models. Emerging therapeutic approaches, including IL-6 inhibitors, vagus nerve stimulation, and behavioral interventions, show promise but remain underexplored in combined applications. Furthermore, disparities in research representation limit the generalizability of findings and highlight the need for inclusive clinical trials. Addressing these gaps through precision medicine, advanced biomarker monitoring technologies, and equitable healthcare strategies could transform the management of these complex comorbidities. By advancing our understanding of neuroinflammatory mechanisms and promoting integrated interventions, this review underscores the need for a collaborative, patient-centered approach to improve outcomes and reduce the global burden of psychiatric and internal disease comorbidities.

Improving uptake of telemedicine (phone/video consult): methods and lessons learnt

Telemedicine can improve care delivery through reducing clinic wait-time, improving accessibility to specialist care, minimising cross-infection risk at patient's convenience. Despite these benefits, telemedicine uptake remained low within our gastroenterology department, with only four teleconsultations conducted in 6 months prior to this project's conceptualisation. This quality improvement (QI) project aimed to improve telemedicine utilisation within our department by 20% over a 3-month period. Surveys conducted during the planning phase identified key barriers to telemedicine adoption, including high clinic load, concerns over medicolegal issues and unfamiliarity with data security protocols. To address these issues, a multistakeholder QI team introduced several key measures, including streamlining telemedicine workflow, providing clinician training and implementing patient educational posters. These interventions successfully increased the adoption of telemedicine (median 8 (IQR 2.5) vs 31 (IQR 13) teleconsultations per month, p<0.01) over the intervention period, with 84% of patients reporting positive experiences. Additionally, this project reduced carbon emissions, saving approximately 3446 kg of CO2, equivalent to 388 gallons of gasoline. This QI project highlights the potential for telemedicine to enhance healthcare delivery while promoting environmental sustainability. Key lessons include the importance of structured workflows and stakeholder engagement to overcome barriers. Future interventions should aim to refine telemedicine pricing models and expand the initiative to other departments within the hospital to ensure long-term sustainability.

Exploring participant satisfaction with an eHealth intervention for low back pain and knee osteoarthritis: Enhancing physiotherapy access in rural Australia

INTRODUCTION

Accessing health services in rural Australia is challenging and innovative solutions to meet residents' needs are required. Research into eHealth is crucial as it offers potential solutions to these challenges. The study aimed to assess participants' satisfaction and experience with an eHealth physiotherapy intervention at improving physical function for low back pain and knee osteoarthritis in rural Australia.

METHODS

Telephone surveys collected data on participant satisfaction and experiences. Satisfaction was rated on a scale of 0-10, and the data was presented descriptively and compared between groups (eHealth and usual care) using Mann-Whitney U tests. Participant experiences with the pilot trial were gathered using open-ended questions, categorised and presented descriptively.

RESULTS

75/156 (48%) participants responded to the satisfaction survey. Overall satisfaction was significantly higher for the eHealth group, median = 9 [IQR: 8-10] compared with the usual care group, median = 8 [IQR: 5-9] (p = 0.025). Satisfaction was also significantly higher in the eHealth group for all secondary measures in the study, including accessibility to healthcare practitioner (p = 0.001), time to contact physiotherapist (p = 0.011), cost of intervention (p < 0.001) and distance travelled (p < 0.001). For the pilot experiences, inconvenient aspects such as completing forms/administration and travel were significantly higher in the usual care group, while difficulties with exercises, were significantly higher in the eHealth group (p = 0.005).

CONCLUSIONS

An eHealth intervention for physiotherapy is acceptable to patients with knee osteoarthritis and low back pain in rural Australia. Future telehealth interventions should pay special attention to participant's exercise workload and motivation.

Patient Preferences for Telemental Health Care in a Federally Qualified Health Center

Objective: This cross-sectional study evaluated whether preferences for attending mental health visits virtually or in-person vary by demographics and identified factors influencing these preferences among federally qualified health center (FQHC) patients. Methods: FQHC patients (N = 350) completed a satisfaction survey of their mental health care experiences in 2022. Demographic data were obtained from the electronic health record. Fisher's Exact tests were used to determine whether modality preferences (phone, video, or in-person) varied across demographic factors. Open-ended comments were qualitatively evaluated using an inductive approach to identify themes related to modality preferences. Results: Modality preferences varied by age and language (p's <0.02) but not race and gender (p's >0.36). Reasons for modality preferences fell within six themes: (1) convenience, (2) connection, (3) transportation/accessibility, (4) health concerns, (5) caretaking responsibilities, and (6) technology. Conclusion: These findings clarify the reasons FQHC patients prefer telemental health care and identify gaps in its usage.

Disparities in Digital Health Care Use in 2022

Importance

Digital health care services expanded with the COVID-19 pandemic. Disparities in telehealth, telemedicine, and telemonitoring use remain understudied.

Objective

To examine associations between individual-level characteristics and digital health care use and if these associations differ by county-level social vulnerability.

Design, Setting, and Participants

This cross-sectional study was an online survey that included a nonprobability sample of US adults aged 18 years or older who resided in 871 counties in the least or most vulnerable quartiles of the Minority Health Social Vulnerability Index (MHSVI), an indicator of county-level social vulnerability. The study was conducted between February and August 2022, and data were analyzed from August 2023 to August 2024.

Exposures

Participant characteristics and MHSVI county-level social vulnerability.

Main Outcomes and Measures

Self-reported use of telehealth, telemedicine, and telemonitoring. Multivariable logistic regression models were fit to examine associations between sociodemographic, health, and technology factors and each service use, overall and stratified by MHSVI.

Results

Of the 5444 participants who were included in this study, 2927 were female (53.77%), 798 were non-Hispanic Black or African American (14.66%), 838 were Hispanic or Latino (15.39%), 3542 were non-Hispanic White (65.06%); the mean (SE) age was 45.4 (0.2) years. Overall, 2754 participants used telehealth (50.59%), 1609 used telemedicine (29.56%), and 854 used telemonitoring (15.69%). Being English nonproficient (adjusted odds ratio [aOR], 1.54; 95% CI, 1.23-1.92) and having had in-person health care visits (aOR, 4.71; 95% CI, 3.93-5.63) were associated with higher odds of using telehealth, whereas not having a primary care clinician was associated with lower odds (aOR, 0.68; 95% CI, 0.59-0.78). Similar findings were documented for telemedicine and telemonitoring use. Education was associated with higher odds of digital health care use in MHSVI most vulnerable counties (telehealth: aOR, 1.18; 95% CI, 1.06-1.32; telemedicine: aOR, 1.18; 95% CI, 1.05-1.33), whereas individuals who did not self-identify as heterosexual (telehealth: aOR, 1.47; 95% CI, 1.10-1.97; telemedicine: aOR, 1.57; 95% CI, 1.16-2.11; telemonitoring: aOR, 1.54; 95% CI, 1.02-2.31) and those who self-reported fair or poor mental health (telehealth: aOR, 1.29; 95% CI, 1.03-1.61) had higher odds of digital service use in the least vulnerable counties. Self-identifying as Black or African American or Hispanic was associated with high odds of telehealth (Black or African American: aOR, 1.41; 95% CI, 1.17-1.70; Hispanic or Latino: aOR, 1.41; 95% CI, 1.17-1.70), telemedicine (Black or African American: aOR, 1.44; 95% CI, 1.18-1.76; Hispanic or Latino: aOR, 1.27; 95% CI, 1.04-1.54), and telemonitoring (Black or African American: aOR, 1.40; 95% CI, 1.11-1.78; Hispanic or Latino: aOR, 1.46; 95%CI, 1.16-1.84) use overall, but these associations varied across MHSVI strata.

Conclusions and Relevance

In this cross-sectional study of US adults from MHSVI most and least vulnerable counties, digital health care use varied by participant characteristics. Some traditionally underserved groups self-reported higher use of digital health care. Differing associations between individual-level characteristics and digital health care use by county-level social vulnerability reflect the importance of place-based disadvantage indicators. Eliminating digital health care use disparities is important as it represents a complementary avenue to access health care for underserved populations.

Impacts of Lifestyle Intervention by a Nurse-Led Smartphone Application on Blood Pressure, Weight, and Pregnancy Outcomes in Pregnant Women With Gestational Hypertension: A Randomized Controlled Trial

High blood pressure and excess weight during pregnancy can have adverse outcomes. This randomized controlled trial evaluated the effects of a nurse-led smartphone application-based lifestyle intervention on blood pressure, body weight, and pregnancy outcomes in pregnant women with gestational hypertension between August and December 2023. Pregnant women, between 20 and 28 weeks of gestation, were allocated to the intervention or control group. Control group (n = 99) received standard high-risk pregnancy management, while intervention group (n = 96) also received lifestyle guidance via a nurse-led smartphone application. Intervention group experienced longer gestations (p = 0.007), higher neonatal weights (p = 0.028), and lower incidences of pre-eclampsia (p < 0.001), small for gestational age infants (p = 0.003), and preterm births (p = 0.023) compared to control group. The mixed-effect models for repeated measures showed that the nurse-led smartphone application intervention had no impact on body mass index, while significantly reducing systolic and diastolic blood pressure measurements (β = -1.666, 95% confidence interval, CI: -2.814 to -0.519, p = 0.005 and β = -2.247, 95% CI: -3.349 to -1.145, p < 0.001, respectively). Both systolic and diastolic blood pressures showed a downward trend from 28 weeks (p < 0.05). The nurse-led smartphone application-based lifestyle intervention significantly reduced adverse pregnancy outcomes and positively influenced blood pressure management in pregnant women with gestational hypertension.

Effectiveness of Telemedicine Interventions for Infection Prevention and Control: A Systematic Review

Infection prevention and control is a critical aspect of healthcare delivery, especially during the ongoing challenges posed by the coronavirus pandemic. Telemedicine has emerged as a valuable strategy for reducing the risk of infection transmission while maintaining the continuity of care. This systematic review evaluates the effectiveness, benefits, and challenges of telemedicine interventions aimed at improving infection prevention and control across various healthcare settings. A comprehensive literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using databases including PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and the Virtual Health Library, covering studies published up to November 2024. Studies eligible for inclusion comprised randomized trials, observational studies, and mixed-methods research assessing telemedicine applications for infection control. The methodological quality of studies was assessed using established tools for qualitative and quantitative research appraisal. Five studies met the inclusion criteria and highlighted several positive outcomes. Telemedicine interventions such as mobile applications, remote video assessments of infection control practices, and virtual infection control consultations were associated with reduced infection rates, improved compliance with preventive protocols, and timely identification of procedural gaps. In inpatient settings, telemedicine also helped conserve protective equipment and reduce staff exposure. High patient satisfaction and maintained quality of care were commonly reported. However, several challenges were identified, including technical barriers, increased workload for healthcare workers, and concerns regarding data security. These findings suggest that telemedicine is a promising and adaptable solution for enhancing infection prevention efforts, but successful implementation depends on addressing operational barriers, ensuring adequate training, and strengthening infrastructure. Further rigorous research is needed to evaluate the long-term impact and cost-effectiveness of telemedicine in infection control.

Evaluating the feasibility, acceptability, and preliminary effectiveness of tele-comprehensive behavior therapy for tics (teleCBIT) for Tourette syndrome in youth and adults

IntroductionComprehensive behavioral intervention for tics (CBIT) is an efficacious, first-line treatment for Tourette syndrome (TS) and other chronic or persistent tic disorders. However, CBIT's public health impact has been limited by suboptimal treatment access. Preliminary research has shown that providing CBIT over videoconference (teleCBIT) is a promising delivery method for patients who cannot access in-person care. However, extant studies have been small efficacy trials focused only on pediatric patients. Replication of these studies is needed in additional treatment settings and across a wider age range of patients, especially in light of advances in telehealth technology and increasing telehealth adoption among practitioners.MethodsWe conducted a single-arm trial to evaluate the feasibility, acceptability, and effectiveness of teleCBIT embedded in comprehensive, medical tic specialty clinics. From October 2016 to September 2018, patients were offered teleCBIT at their usual care appointments. Those who were interested and met inclusion/exclusion criteria received 8 sessions of CBIT guided by a manualized protocol. An independent evaluator, masked to treatment progress, administered assessments at baseline, post-treatment, and 3 and 6 months after treatment.ResultsTwenty-five percent of patients who were offered treatment initiated teleCBIT through the study, and all treatment initiators completed treatment. From pre- to post-treatment, decreases in Yale Global Tic Severity Scale (YGTSS) total tic severity scores showed a large effect size among pediatric patients (n = 19; t = 5.72, P < 0.001, d = 1.31) and a medium-to-large effect size for adult patients (n = 10, t = 1.41, P = 0.096, d = 0.664). Thirteen of 19 pediatric patients (68%) and 6 of 10 adult patients (60%) had a positive global treatment response at post-treatment. Patients rated the treatment as highly satisfactory. Ninety-three percent of sessions were free of substantial technical problems.DiscussionWithin the context of medical tic specialty clinics, teleCBIT demonstrated strong evidence of feasibility, acceptability, and preliminary effectiveness comparable to in-person treatment for both pediatric and adult patients. TeleCBIT warrants study in future research on enhancing care systems for patients with TS.Trial registryhttps://clinicaltrials.gov/ct2/keydates/NCT04007913.

Co-design of the Intelligent HOme-based Palliative care for End-of-life system: A development and feasibility study

ObjectiveThis study aimed to develop the Intelligent HOme-based Palliative care for End-of-life (I-HOPE) system, a WeChat mini-program designed to provide home-based palliative care (HBPC), including education, interaction, and social resource access for users.MethodsA mixed-method approach was employed to ensure a comprehensive exploration of user needs, system design, and evaluation. This approach integrated qualitative and quantitative methods, rapid prototyping, expert consultations, and co-design methodologies informed by social ecological theory. Four key stakeholder groups i.e. patients, caregivers, healthcare professionals, and the general public were included. Initially, field research and surveys were conducted to assess the palliative care needs of patients and caregivers. Based on these findings, the mini-program was developed in collaboration with a technical team specializing in healthcare technology. Usability, user experiences, and suggestions for improvement were then collected. This study was conducted in three tertiary hospitals and two community health service centers in Beijing, China.ResultsThe I-HOPE system achieved a System Usability Scale score of 71.89 ± 13.85. User feedback on version 1.0 led to improvements in interface design, features, information presentation, usability, and privacy protection.ConclusionThe development of the I-HOPE system represents an advancement in enhancing the accessibility and quality of HBPC. Future research should focus on identifying areas for further development and assessing its impact on palliative care outcomes.

Best Practice Guide for Reducing Barriers to Video Call-Based Telehealth: Modified Delphi Study Among Health Care Professionals

BACKGROUND

Telehealth has grown, especially during the COVID-19 pandemic, improving access for those in remote or underserved areas. However, its implementation faces technological, practical, and interpersonal barriers.

OBJECTIVE

The aim of this study was to identify and consolidate best practices for telehealth delivery, specifically for video call sessions, by synthesizing the insights of health care professionals across various disciplines.

METHODS

We first identified 15 common telehealth barriers from a preceding scoping review. Subsequently, a modified Delphi method was used, involving 9 health care professionals (physiotherapists, speech and language therapists, dietitians, and midwife) with telehealth experience in qualitative interviews and 2 iterative rounds of web-based surveys to form consensus.

RESULTS

This study addressed 15 telehealth barriers and identified 105 best practices. Among these, 20 are technology-related and 85 concern health care practices. Emphasis was placed on setting up telehealth environments, ensuring safety, building relationships and trust, using nonmanual methods, and enhancing observation and assessment skills. Best practice recommendations for dealing with patients or caregiver skepticism or lack of telehealth-specific knowledge were developed. Further, approaches for unstable networks and privacy and IT security issues were identified. Areas with fewer best practices were the lack of technology skills or technology access, unreliability of hardware and software, increased workload, and a lack of caregiver support.

CONCLUSIONS

This guide of best practices serves as an actionable resource for health care providers to navigate the complexities of telehealth. Despite a small participant sample and the potential for profession-specific biases, the findings provide a foundation for improving telehealth services and inform future research for its application and education.

Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study

BACKGROUND

The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively.

OBJECTIVE

We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs.

METHODS

A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable.

RESULTS

Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; P<.001) was the most significant factor, followed by attitude (β=0.242; P<.001), transition cost (β=-0.163; P<.001), and perceived usefulness (β=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (β=0.271; P<.001), availability (β=0.323; P<.001), subjective well-being (β=0.261; P<.001), and trust (β=0.156, P=.004) positively influenced perceived usefulness, while inertia (β=0.024, P=.22) did not. In addition, availability (β=0.420; P<.001) and subjective well-being (β=0.260; P<.001) were positively related to perceived ease of use, with inertia (β=-0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services.

CONCLUSIONS

This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic.

The AROMHA brain health test is a remote olfactory assessment to screen for cognitive impairment

Cost-effective, noninvasive screening methods for preclinical Alzheimer's disease (AD) and other neurocognitive disorders remain an unmet need. The olfactory neural circuits develop AD pathological changes prior to symptom onset. To probe these vulnerable circuits, we developed the digital remote AROMHA Brain Health Test (ABHT), an at-home odor identification, discrimination, memory, and intensity assessment. The ABHT was self-administered among cognitively normal (CN) English and Spanish speakers (n = 127), participants with subjective cognitive complaints (SCC; n = 34), and mild cognitive impairment (MCI; n = 19). Self-administered tests took place remotely at home under unobserved (among interested CN participants) and observed modalities (CN, SCC, and MCI), as well as in-person with a research assistant present (CN, SCC, and MCI). Olfactory performance was similar across observed and unobserved remote self-administration and between English and Spanish speakers. Odor memory, identification, and discrimination scores decreased with age, and olfactory identification and discrimination were lower in the MCI group compared to CN and SCC groups, independent of age, sex, and education. The ABHT revealed age-related olfactory decline, and discriminated CN older adults from those with cognitive impairment. Replication of our results in other populations would support the use of the ABHT to identify and monitor individuals at risk for developing dementia.

Willingness of healthcare professionals in China to continue participating in and recommend telemedicine post COVID-19 pandemic

Sustained engagement and promotion by healthcare professionals are essential for the advancement of telemedicine. Post coronavirus disease 2019 (COVID-19) pandemic, the preference for in-person care highlights the need for research on healthcare professionals' sustained telemedicine attitudes. This study assessed healthcare professionals' continued willingness to participate in and recommend telemedicine post-pandemic and identified factors influencing their decisions. From September to October 2023, a cross-sectional study was conducted among 560 healthcare professionals, with samples recruited from 230 hospitals across 11 provinces in China using a multi-stage sampling method. Overall, 518 (92.5%) of 560 respondents expressed their willingness to continue participating in telemedicine, and nearly all respondents (93.5%) displayed a willingness to recommend telemedicine to those in need. The results showed that perceived usefulness, subjective norms, patient coverage, and satisfaction were positively associated with healthcare professionals' willingness to continue participating in and recommend telemedicine. Satisfaction and subjective norms play a partial mediating role in the effect of usefulness on willingness to continue participating in and recommend telemedicine. Patient coverage partially mediates relationship between usefulness and willingness to recommend telemedicine. Chinese healthcare professionals exhibited a generally high level of willingness to continue participating in and to recommend telemedicine. To further enhance this willingness, it is essential to improve their perceptions of telemedicine's usefulness, increase their satisfaction with the technology, and emphasize the roles of subjective norms. Moreover, broadening patient access to telemedicine services will be crucial in promoting healthcare professionals' recommendations.

Adoption of tele health technology in mental and psychiatric services in Lebanon: a quantitative study

BACKGROUND

The rapid adoption of telemedicine during the COVID-19 pandemic showcased its capacity to revolutionize healthcare by augmenting accessibility, decreasing expenses, and improving patient outcomes. This study evaluated Lebanon's preparedness for the implementation of tele-mental health, concentrating on identifying critical factors affecting its adoption by mental health experts.

METHODS

A self-administered questionnaire was created and disseminated through email to mental health practitioners in Lebanon. The study employed the Extended Technology Acceptance Model (TAM2) and utilized the Partial Least Squares- Structural Equation Modeling (PLS-SEM) to provide a quantitative analysis of the determinants influencing the adoption of tele-mental health in psychiatric services.

RESULTS

Among the 138 respondents including psychiatrists, psychologists, and mental health nurses, 20% indicated they had never utilized telehealth for mental health services, whereas 54% had employed telehealth prior to the COVID-19 shutdown and expressed a desire to persist with its use. Furthermore, 19% utilized telehealth throughout the lockdown and continued its application, while 8% ceased its usage after the lockdown. The research revealed five primary factors affecting tele-mental health adoption: perceived usefulness, perceived ease of use, perceived risk, subjective norms, and job relevance.

CONCLUSION

This study highlights the significance of perceived usefulness, ease of use, perceived risk, subjective norm, and job relevance as essential factors influencing the uptake of tele-mental health services. Policymakers, healthcare administrators, and technology developers must concentrate on these criteria to optimize the introduction and sustainability of tele-mental health services in clinical practice, thereby ensuring enhanced mental health care delivery in Lebanon.

Strategies to improve telehealth access for culturally and linguistically diverse communities: a systematic review

AIMS

CaLD populations face considerable digital health inequities; strategies are needed to ensure telehealth models of care are available to all. We aimed to identify and describe interventions that enhance telehealth access for CaLD communities.

METHODS

We systematically searched four databases (PubMed, Scopus, Embase, and CINAHL). Included studies were published between 2011 and 2024 and reported on at least one of the outcomes described in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Two authors independently screened articles, solutions were synthesized qualitatively.

RESULTS

Twenty-seven articles were included in the review and primarily used videoconferencing as the predominant telehealth modality (n = 14, 52%). Five strategies were identified to promote telehealth use across CaLD communities including: (i) Provide bilingual options; (ii) Enhance staff cultural competence; (iii) Provide flexible adaptions to align with consumer needs; (iv) Supply technology and technological support; and (v) Involve digital health navigators and/or health educators.

CONCLUSIONS

Culturally competent professionals supported by language services and technological support are strategies which can help improve equity of access to telehealth services for people from CaLD communities. Such strategies can support the implementation of practical solutions to overcome health inequities and prevent access gaps.

Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals

Background

With the provision of home infusion therapy in children with acute or long-term illness on the rise, eHealth technologies have the potential to bridge the transition between hospital and home. However, eHealth interventions intended to support parents in managing home infusion therapy are sparse. Gaining insight into the needs and experiences of parents and health care professionals is crucial to developing feasible and sustainable eHealth interventions that target their needs. This study describes the first phase of a research study designed to develop and evaluate an eHealth intervention to support home infusion therapy.

Objective

This study aimed to identify the experiences and needs of parents and health care professionals during home infusion therapy and their preferences for digital features in a future eHealth intervention.

Methods

A qualitative study was conducted at 3 pediatric departments at a university hospital in Denmark. We individually interviewed 17 parents of 14 children who had received home infusion therapy with a portable pump. In addition, 5 focus groups were conducted with 15 health care professionals. We conducted a qualitative content analysis of the data, which we collected from February to July 2020.

Results

We identified 6 subthemes that we merged into 3 main themes: increasing safe self-management at home; adapting information and responsibility to individual changing needs; and requesting digital features to ensure skill level, safety, and quality of care. The analysis showed that parents and health care professionals had corresponding needs and preferences, for example, a need for a high sense of safety and easier ways to communicate during home infusion therapy. Both groups emphasized the need for digital features to improve problem-solving and communication as a supplement to existing care to promote a safe environment, self-management, and quality of care. A vital issue was that an eHealth intervention should be aligned with the workflow of health care professionals and comply with regulations regarding confidentiality in communication and data sharing.

Conclusions

Our study highlights the needs that parents and health care professionals have for increased safety and easier access to communication when receiving and providing home infusion therapy. The findings will be used to help develop an eHealth intervention supporting home infusion therapy tailored to individual needs.

Examining experiences and system impacts of publicly funded episodic virtual care: protocol for a cross-provincial mixed methods study

INTRODUCTION

Health systems are under pressure as one in five Canadians have no regular place for primary care, with many experiencing substantial travel times and delays in accessing care. In the context of these urgent needs, platforms for virtual care offer immediate access to care in 'walk-in' style format, with limited continuity for ongoing health needs or coordination with other health services. We refer to these services as episodic virtual care (EVC), to distinguish them from virtual services offered in longitudinal primary care. The governments of Nova Scotia (NS) and New Brunswick (NB) both offer publicly funded EVC and offer a unique opportunity for research.The overarching goal of this work is to learn from the implementation of EVC in NS and NB to understand experiences and system impacts, includingWhat are patient perceptions and experiences of EVC and how do these differ by patient characteristics?What are the characteristics of patients who use EVC and of clinicians who deliver it?What are the system impacts of EVC?

METHODS AND ANALYSIS

We will use a cross-sectional survey conducted through an online questionnaire to explore patient perceptions and experiences with EVC. We will also examine how these differ based on the type of care needed, age, gender, residence (urban or rural), immigration and language preference. We will use linked administrative data and quasi-experimental analysis to assess the impacts of EVC on visits to community-based primary care (including in-person walk-in clinics), emergency department visits, prescriptions and referrals for other health services like laboratory testing, imaging and consulting specialist physicians.

ETHICS AND DISSEMINATION

This proposal has been reviewed and received approval from the Nova Scotia Health Research Ethics Board. Findings will identify the impacts and trade-offs in the deployment of EVC, which will inform primary care planning. In addition to traditional academic publications and information provided to primary care patients/the public, this study will inform decision-makers across multiple jurisdictions as they contend with the challenge of meeting patients' immediate care needs for access to primary care, while seeking to improve coordination and integration of systems as a whole.

Investigation of the effectiveness of interactive telerehabilitation and transcutaneous electrical nerve stimulation on pain, functionality, disability and quality of life in patients with nonspecific chronic neck pain: a randomised controlled trial

OBJECTIVES

Despite the widespread use of TENS in the treatment of chronic nonspecific neck pain (CNNP), there are few studies on Telerehabilitation (TR), and no studies comparing their effectiveness compared to each other in this field. It was planned to investigate and compare the effectiveness of TENS and TR, which is an online rehabilitation tool.

METHODS

Forty-eight (female 45, male 3) patients with CNNP, aged 36.31 + 12.54 years, were randomized into TENS, TR or control groups. Pain severity was determined by Visual Analog Scale (VAS), Bournemouth Neck Questionnaire (NBQ), Neck Disability Index (NDI), Copenhagen Neck Functional Disability Scale (CNFDS), and World Health Organization Quality of Life Module (WHOQOL-BREF).

RESULTS

VAS, NBQ, NBI, CNFDS Time*Group interaction showed a significant positive change after treatment (p = 0.013, p = 0.007, p = 0.022, p = 0.005, respectively). The effect size of this difference over time was large (pη2 = 0.177, pη2 = 0.198, pη2 = 0.156, pη2 = 0.208, respectively). Post-treatment, the highest mean difference was found in VAS and NDI values in the TENS (MD:2.656, MD:7.000, p < 0.001), NBQ, CNFDS, WHOQOL-Bref in the TR (MD:13.187, MD:5.312, MD:-9.660, p < 0.001, respectively).

CONCLUSION

VAS and NBQ in the TENS and NDI, CNFS, WHOQOL-Bref in the TR group were more effective after treatment than before treatment in patients with CNNP.

TRIAL REGISTRATION

The clinical trial registration number for this study was: NCT06206343 (ClinicalTrials.gov).

The Rise, Fall, and Readjustment of Telehealth: Effect of Coronavirus Disease 2019 on Its Use in an Academic Health Clinic

BACKGROUND

 The coronavirus disease 2019 (COVID-19) pandemic accelerated the adoption of telehealth. Long-term implications for continued telehealth use on a large scale in primary care are still emerging, and the key to this understanding is how telehealth adoption impacts the delivery of health care.

OBJECTIVES

 Our objective was to quantify how telehealth adoption during the pandemic impacted patients' access to health care and the usage patterns of different access modalities (in-office, audio, and video).

METHODS

 This study analyzed 2 years of deidentified electronic health record data from the ambulatory clinics at a Midwest medical school from 2020 and 2021. We focused on patient demographics, primary diagnoses, and patient preferences for receiving health care throughout the COVID-19 pandemic.

RESULTS

 Of the 105,362 patient visits analyzed across in-office, audio, and video visits, demographic data varied by gender, age, and racial composition. During the early pandemic, telehealth usage peaked in April 2020, with audio and video visits accounting for 45.8 and 18.1% of the total visits, respectively. These rates declined to averages of 12.5 and 3.6%, respectively, over the following months. Primary diagnoses during telehealth visits are often related to COVID-19 exposure or mental health or behavioral issues. Lastly, statistically significant associations exist between the visit modality and primary diagnoses.

CONCLUSION

 The COVID-19 pandemic initially saw a surge in audio telehealth visits; however, as safety measures were established, the mix of visit modalities returned to prelockdown levels. Video and audio telehealth maintained increased usage relative to prepandemic levels, potentially owing to increased awareness of the technology as a means for accessing health care and a learning curve associated with adoption. Patients preferred remote care during high COVID-19 transmission. Video telehealth has shown significant associations with psychiatric, behavioral, and neurodevelopmental diagnoses. Disparities in video telehealth use among racial groups have highlighted potential access issues.

Usefulness of self-guided digital services among mental health patients: The role of health confidence and sociodemographic characteristics

BACKGROUND

Remote services provided via telephone or the internet have become an essential part of mental health provision. Alongside services involving healthcare personnel (HCP), self-guided digital services hold great promise for improved self-management and health outcomes without increasing the burden on HCP. Therefore, better understanding of patients' use and experienced benefits of these services are needed. This study investigated how health confidence and sociodemographic background are associated with mental health patients' experiences of self-guided digital services.

METHODS

This cross-sectional survey study was performed in 2022 at a Finnish Mental Health and Substance Abuse Services (MHSAS) unit of a regional public service provider that serves a population of about 163000 people. All patients who had visited the unit up to 6 months before the study were invited to respond to an online survey on their experiences with the remote MHSAS. We report the average subjective usefulness of telephone, guided digital and self-guided digital services. Regression models were fitted to study the associations of patient characteristics with use of any digital service, and with experienced usefulness of self-guided digital services.

FINDINGS

The respondents (n = 438) rated the usefulness of telephone, guided digital and self-guided digital services similarly (4.0/5.0, 3.9/5.0, and 3.9/5.0, respectively). Health confidence was associated with not using digital services at all as well as with high perceived usefulness of self-guided services. While elderly patients were more likely to avoid using digital services, age was not associated with experienced usefulness of self-guided digital services. No association between unemployment status and experiences of digital services was found.

CONCLUSIONS

Different types of remote services are perceived as beneficial by mental health patients. To ensure effectiveness and equity, patients' health confidence should be considered when directing them to self-guided services. Elderly mental health patients who use digital services are equally able as younger patients to benefit from self-guided services.

Design organization and clinical processes around patient characteristics: Evidence from a multiple case study of Hemophilia

Background: There is growing evidence of the relevance of designing organization of care around patient characteristics; this is especially true in the case of complex chronic diseases.Purpose: The goal of the paper - that focuses on the analysis of the clinical condition hemophilia in three different centers - is to address two different research questions:1. How can we define, within the same clinical condition, different patient profiles homogeneous in terms of intensity of service required (e.g. number of visits or diagnostics)? 2. What are the conditions to re-organize care around these patient profiles in a multidisciplinary and coordinated manner?Research design: The authors have used a multiple case study approach combining both qualitative and quantitative methodologies; in particularly the semi-structured interviews and the direct observation were aimed to map the process in order to come up with an estimate of the cost of the full cycle of care.Study sample: The research methodology has been applied consistently in three different centers. The selection of the structures has been based on two main different criteria: (i) high standards regarding both organizational and clinical aspects and (ii) willingness from management, nurses and physicians to provide data.Results: The study clearly shows that different patient profiles - within the same clinical condition - trigger a different set of diagnostic and therapeutic activities. It is, thus, important considering patient characteristics in the development and implementation of clinical pathways and this will imply relevant differences in terms of organizational and economic impact.Conclusions: These process-based analyses are very much critical especially if we want to move to a bundled and integrated payment system but, as shown by this study itself, require a lot of time and efforts since our healthcare information systems are still fragmented and vertically designed.

The Effects of Online Yoga Practice on Cancer Patients: A Systematic Review

Background: Cancer remains a leading cause of death, with 9.7 million deaths in 2022. Despite advancements in diagnosis and treatment, many cancer patients experience side effects that significantly impact their quality of life, including chronic pain, anxiety, depression, sleep disturbances, and cancer-related fatigue. Non-pharmacological interventions, such as yoga, have gained attention for their potential to reduce stress and improve overall well-being. However, barriers such as fatigue, pain, and transportation issues limit access to in-person yoga, leading to the growing adoption of online yoga as a viable alternative. Objective: This systematic review synthesizes research on the effectiveness of online yoga for cancer patients. A comprehensive search was conducted across Medline, PsycINFO, and Scopus databases on 24 October 2024. The methodological quality of the studies was assessed using the CASP Checklist. Of 6266 articles initially identified, 14 studies met the inclusion criteria, comprising qualitative (n = 4) and quantitative (n = 10) studies. Results: The results suggest that online yoga can improve stress and sleep quality, with moderate effects on anxiety, depression, and fatigue. However, variability in study designs and methodological limitations complicate the evaluation of its overall effectiveness. Conclusions: Online yoga offers a practical, accessible option for cancer patients unable to attend in-person sessions, showing the potential to enhance mental and physical health outcomes. Nevertheless, the variability in study methodologies highlights the need for more standardized research to establish its role as a supportive intervention in oncology care.

Digital Age Transformation in Patient-Physician Communication: 25-Year Narrative Review (1999-2023)

BACKGROUND

The evolution of patient-physician communication has changed since the emergence of the World Wide Web. Health information technology (health IT) has become an influential tool, providing patients with access to a breadth of health information electronically. While such information has greatly facilitated communication between patients and physicians, it has also led to information overload and the potential for spreading misinformation. This could potentially result in suboptimal health care outcomes for patients. In the digital age, effectively integrating health IT with patient empowerment, strong patient-physician relationships, and shared decision-making could be increasingly important for health communication and reduce these risks.

OBJECTIVE

This review aims to identify key factors in health communication and demonstrate how essential elements in the communication model, such as health IT, patient empowerment, and shared decision-making, can be utilized to optimize patient-physician communication and, ultimately, improve patient outcomes in the digital age.

METHODS

Databases including PubMed, Web of Science, Scopus, PsycINFO, and IEEE Xplore were searched using keywords related to patient empowerment, health IT, shared decision-making, patient-physician relationship, and health communication for studies published between 1999 and 2023. The data were constrained by a modified query using a multidatabase search strategy. The screening process was supported by the web-based software tool Rayyan. The review methodology involved carefully designed steps to provide a comprehensive summary of existing research. Topic modeling, trend analysis, and synthesis were applied to analyze and evaluate topics, trends, and gaps in health communication.

RESULTS

From a total of 389 selected studies, topic modeling analysis identified 3 primary topics: (1) Patient-Physician Relationship and Shared Decision-Making, (2) Patient Empowerment and Education Strategies, and (3) Health Care Systems and Health IT Implementations. Trend analysis further indicated their frequency and prominence in health communication from 1999 to 2023. Detailed examinations were conducted using secondary terms, including trust, health IT, patient-physician relationship, and patient empowerment, derived from the main topics. These terms clarified the collective impact on improving health communication dynamics. The synthesis of the role of health IT in health communication models underscores its critical role in shaping patient-centered health care frameworks.

CONCLUSIONS

This review highlights the significant contributions of key topics that should be thoroughly investigated and integrated into health communication models in the digital age. While health IT plays an essential role in promoting shared decision-making and patient empowerment, challenges such as usability, privacy concerns, and digital literacy remain significant barriers. Future research should prioritize evaluating these key themes and addressing the challenges associated with health IT in health communication models. Additionally, exploring how emerging technologies, such as artificial intelligence, can support these goals may provide valuable insights for enhancing health communication.

Prediction of outpatient rehabilitation patient preferences and optimization of graded diagnosis and treatment based on XGBoost machine learning algorithm

Background

The Department of Rehabilitation Medicine is key to improving patients' quality of life. Driven by chronic diseases and an aging population, there is a need to enhance the efficiency and resource allocation of outpatient facilities. This study aims to analyze the treatment preferences of outpatient rehabilitation patients by using data and a grading tool to establish predictive models. The goal is to improve patient visit efficiency and optimize resource allocation through these predictive models.

Methods

Data were collected from 38 Chinese institutions, including 4,244 patients visiting outpatient rehabilitation clinics. Data processing was conducted using Python software. The pandas library was used for data cleaning and preprocessing, involving 68 categorical and 12 continuous variables. The steps included handling missing values, data normalization, and encoding conversion. The data were divided into 80% training and 20% test sets using the Scikit-learn library to ensure model independence and prevent overfitting. Performance comparisons among XGBoost, random forest, and logistic regression were conducted using metrics, including accuracy and receiver operating characteristic (ROC) curves. The imbalanced learning library's SMOTE technique was used to address the sample imbalance during model training. The model was optimized using a confusion matrix and feature importance analysis, and partial dependence plots (PDP) were used to analyze the key influencing factors.

Results

XGBoost achieved the highest overall accuracy of 80.21% with high precision and recall in Category 1. random forest showed a similar overall accuracy. Logistic Regression had a significantly lower accuracy, indicating difficulties with nonlinear data. The key influencing factors identified include distance to medical institutions, arrival time, length of hospital stay, and specific diseases, such as cardiovascular, pulmonary, oncological, and orthopedic conditions. The tiered diagnosis and treatment tool effectively helped doctors assess patients' conditions and recommend suitable medical institutions based on rehabilitation grading.

Conclusion

This study confirmed that ensemble learning methods, particularly XGBoost, outperform single models in classification tasks involving complex datasets. Addressing class imbalance and enhancing feature engineering can further improve model performance. Understanding patient preferences and the factors influencing medical institution selection can guide healthcare policies to optimize resource allocation, improve service quality, and enhance patient satisfaction. Tiered diagnosis and treatment tools play a crucial role in helping doctors evaluate patient conditions and make informed recommendations for appropriate medical care.

Nurses' experiences of text-based digital triage at primary healthcare centres in Sweden: a qualitative interview study

BACKGROUND

Telehealth services are becoming increasingly popular at primary healthcare centres. Some examples include text-based digital triage and health guidance using chats, emails, images and pre-filled forms. Telephone-based communication has until recent years been the predominant means for triage and health guidance, but now includes written communication via computer or smartphone. Hence conditions to perform triage and health guidance have changed, which may affect the quality of nurses' work and patient safety. This motivates an in-depth exploration of the consequences of such changes for nurses working with telehealth. The study aimed to explore nurses' experiences of digital triage and health guidance at primary healthcare centres in Sweden.

METHODS

A qualitative inductive design was chosen for the current study. Four registered nurses and two public health nurses, working at primary healthcare centres in southern Sweden, contributed with information about text-based digital triage and health guidance. Semi-structured interviews were conducted to collect data. Data were analysed using qualitative content analysis.

FINDINGS

One main theme, "Adapting to a new professional toolbox to triage and give health guidance" was constructed based on three categories which describe the altered professional tools. They were: "Using one's senses differently to collect information", "Change of communication mode to convey messages" and "Change of timeframe and the use of time". Six subcategories describe how the new toolbox was experienced by the nurses. They were: "Loss of clinical ear", "Gain of viewing images", "Difficulties in written communication of care and emotions", "Seeing oneself as a writer or talker", "Tardy asynchronous communication" and "Available time".

CONCLUSION

The findings tell of a substantial change in nurses' professional toolbox that demanded other skills than they were used to working with. Due to limitations in communication and communication skills, digital triage alone may lead to an impaired workflow, quality of care, and patient safety as well as maintain the digital divide. However, digital triage may also enhance nurses' work with the addition of attached images, convenient communication for those who are comfortable with writing, and a gain of time for consultation and reflection. The current study contributes insights regarding new competencies that nurses and patients must have or gain to be able to benefit from the possibilities of digitisation of primary healthcare.

Satisfaction, user experiences, and initial efficacy of a technology-supported self-management intervention (iSMART) to improve post-stroke functioning: a remoted randomized controlled trial

BACKGROUND

Self-management interventions empower individuals to manage their chronic conditions and daily life after stroke. However, traditional in-person self-management interventions often face transportation and geographical barriers. Digital interventions may offer a solution to address this gap.

OBJECTIVES

This pilot randomized controlled trial (RCT) aimed to examine treatment satisfaction, user experiences, and the initial effect of the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention in stroke survivors to improve post-stroke functioning.

METHODS

Participants (N = 24) with mild-to-moderate chronic stroke completed a parallel, 2-arm, nonblinded, remote RCT. They were randomly assigned to either a 12-week iSMART or a control intervention (post-stroke information). iSMART was a technology-based self-management intervention involving skill-building education, human coaching, and text messaging. Participants completed a battery measuring treatment satisfaction, use experiences, and function and participation outcomes at baseline and post-intervention.

RESULTS

iSMART participants expressed greater satisfaction with their treatment (r = 0.387), healthcare environment (r = 0.454), relationships with providers (r = 0.374), and higher expectations for positive treatment outcomes (r = 0.328) than control participants, with medium effect sizes. The iSMART group rated the overall program and its coaching, skill-building, and text messaging components as helpful. iSMART participants showed a medium effect in improving overall post-stroke functioning, but control participants showed a small effect. Moreover, iSMART participants showed moderate-to-large effects in improving hand function (r = 0.699), mobility (r = 0.499), memory and thinking (r = 0.436), communication (r = 0.416), social participation (r = 0.307), community reintegration (r = 0.652), and perceived recovery (r = 0.545).

CONCLUSIONS

Our results provide initial evidence that iSMART supports stroke survivors in managing chronic conditions and enhancing post-stroke functioning.

Facilitators and barriers affecting the implementation of e-health for chronic respiratory diseases in remote settings: a qualitative evidence synthesis

BACKGROUND

Chronic respiratory diseases are important causes of disability and mortality globally. Their incidence may be higher in remote locations where healthcare is limited and risk factors, such as smoking and indoor air pollution, are more prevalent. E-health could overcome some healthcare access obstacles in remote locations, but its utilisation has been limited. An improved understanding of barriers and facilitators to the implementation of e-health in remote locations could aid enhanced application of these approaches.

METHODS

We performed a qualitative evidence synthesis to explore factors affecting the successful implementation of e-health interventions in remote locations for patients with chronic respiratory diseases. We searched PubMed, CINAHL, Embase, Web of Science and PsycINFO databases for qualitative and mixed-methods studies. Studies were assessed by two researchers, and 41 studies were included in the synthesis. Quality was assessed via the CASP-tool. Findings were coded with Atlas.ti software and categorised based on an adapted Digital Health Equity Framework.

RESULTS

Nineteen themes were identified across five levels (individual, interpersonal, community, society and technology), with associated facilitators and barriers for implementation. An important facilitator of e-health was its role as a tool to overcome obstacles of distance and to increase access to care and patients' self-efficacy. Potential barriers included the reduction of in-person interactions and an increased burden of work for healthcare providers. Good quality, usability, adaptability and efficacy of e-health interventions were important for implementation to be successful, as were adaptation to the local setting - including culture and language -and involvement of relevant stakeholders throughout the process.

CONCLUSIONS

Several factors affecting the implementation of e-health in remote and rural locations for patients with chronic respiratory disease were identified. Intervention objectives, target population, geographical location, local culture, and available resources should be carefully considered when designing an e-health intervention. These findings can be used to inform the successful design and implementation of future e-health interventions.

Effectiveness of physiotherapy modalities on persisting dyspnoea in long COVID: A systematic review and meta-analysis

BACKGROUND

Dyspnoea is often found months and years later in the "long-covid" syndrome, impairing quality of life and further perpetuating anxiety and post-traumatic stress disorders. Physiotherapy was recommended as a treatment in long-covid, but there is still insufficient evidence on its effectiveness.

METHODS

We conducted a systematic literature search on MEDLINE, PEDro, WOS, Scopus, VHL and the Cochrane Library until July 2023 (PROSPERO registration number: CRD42023427464). We selected comparative trials including adults with persistent breathlessness following COVID-19, regardless of the initial severity, for whom physiotherapy was implemented as a treatment for dyspnoea. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the PEDro Scale.

RESULTS

19 studies that included 1292 adults fulfilled the inclusion criteria, of which 15 were randomised controlled trials and 4 non-randomised controlled trials. As for the rehabilitation modalities, 6 studies used respiratory muscle training, 6 studies used low to moderate intensity rehabilitation, 6 used high intensity rehabilitation and one used passive rehabilitation. The methods used between and within each group differed greatly, leading to an expected high heterogeneity of results. Nethertheless the random-effects model found a significant difference favouring physiotherapy (SMD -0.63, 95 CI [-1.03; -0.24], p < 0.001, I2 = 88 %). Subgroup analysis showed a significant effect in the high intensity rehabilitation group alone, with null heterogeneity.

CONCLUSION

In people suffering from dyspnoea following a SARS-CoV-2 infection, physiotherapy and especially pulmonary rehabilitation may help alleviate respiratory symptoms. Future studies will need to provide more consistent rehabilitation methods and better descriptions of them so as to reveal clear effects and avoid the confusion caused by using too many rehabilitation modalities.

Acceptability of Teleconsultation Services for HIV Care in Nigeria: A Mixed Methods Study

Introduction: Access to HIV care remains challenging, especially for patients living in remote areas, despite advances in antiretroviral treatment. The acceptability of teleconsultations for routine HIV care post-COVID is not well-explored. We explored factors influencing teleconsultation acceptability among people living with HIV (PLWH) and attending a tertiary care center in Kano, Nigeria. Methods: We used a cross-sectional mixed methods study design. Structured questionnaires were administered to 415 PLWH, supplemented by in-depth interviews with a subsample (n = 20). Logistic regression models and thematic analysis were used for data analyses. Results: Of 415 respondents, 55.7% (n = 231) expressed willingness for teleconsultations. Primary motivations included convenience/efficiency (46.7%, n = 194), elimination of travel expenses (31.8%, n = 132), and remote access to specialist care (17.3%, n = 72). Reasons for reluctance included distrust of technology (61.9%, n = 260) and privacy concerns (37.1%, n = 156). Acceptance was higher among males (adjusted odds ratio (aOR) =1.58, 95% confidence interval (CI) = 1.12-3.72), participants with at least secondary education (aOR = 1.47, 95% CI = 1.27-4.97), monthly income ≥30,000 Naira (aOR = 2.16, 95% CI = 1.21-7.31), currently married (aOR = 3.26, 95% CI = 1.16-5.65), and participants without comorbidities (aOR = 2.03, 95% CI = 1.18-4.24). PLWH who self-assessed as being in good health (aOR = 3.77, 95% CI = 1.44-9.94), used the internet regularly (aOR = 3.12, 95% CI = 2.17-5.37), or were aware of telemedicine (aOR = 3.24, 95% CI = 2.45-7.68) were also more accepting of telehealth services. Themes highlighted the need to offer teleconsultation as an optional service. Conclusion: Teleconsultation acceptance among PLWH was influenced by sociodemographic, clinical, and technology-related factors. Successful integration of teleconsultation services for PLWH in similar settings necessitates targeted educational interventions and assessment of organizational readiness.

Savings Through Telemedicine: Initial Data From a Hospital-at-Home Program

OBJECTIVE

We aimed to estimate travel-related time and cost savings from the use of telemedicine for an inpatient hospital-at-home program.

METHODS

This was a retrospective study on the initial data obtained from a newly implemented hospital-at-home program from June 26, 2023, to March 31, 2024. Time cost savings were calculated based on difference between time spent on teleconsultation versus time needed to travel a round trip to patients' homes to conduct physical consultation via home visit. Travel distances were calculated based on the distance of patient's homes from the hospital.

RESULTS

There were 505 teleconsultations (497 scheduled, 8 unscheduled) delivered throughout 132 enrollments. Total travel distance saved was 4022 km. Total time savings was 18 707 minutes or 13.0 days. Total trip cost savings were Singapore dollars 4618.70.

CONCLUSIONS

Despite being a newly introduced program, utilization of telemedicine in delivery of hospital-at-home showed time savings for the clinicians, cost savings from the distance needed to travel otherwise. Incorporation of telemedicine in hospital-at-home delivery demonstrated time and distance savings even at the pilot phase of program.

Difference in medical student performance in a standardized patient encounter between telemedicine and in-person environments

INTRODUCTION

Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters.

MATERIALS & METHODS

The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups.

RESULTS

Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, p < 0.001). They had higher scores in physical exam (83.3 vs. 50, p < 0.001) and interpersonal communication domains (95 vs. 85, p < 0.001) and lower scores in obtaining a history (73.3 vs. 80, p = 0.0025). There was no significant difference in assessment and plan scores (50 vs. 50, p = 0.96) or likelihood of appropriately promoting antibiotic stewardship (41.3% vs. 45.8%, p = 0.48).

CONCLUSION

The authors identified significant differences in clinical performance between in-person and telemedicine SP encounters, indicating that educational needs may differ between clinical environments.