INTRODUCTION:This study examined factors influencing physical therapy patients' preference for virtual over in-person physical therapy. Key variables included physical therapy patients' technology comfort (TC), virtual treatment self-efficacy (VTSE), perceived provider expertise (PPE), and perceived provider integrity (PPI). METHODS:A cross-sectional survey of physical therapy patients was conducted in collaboration with a regional physical therapy provider. Data were collected from February to May 2025, resulting in 141 complete responses from patients aged 18-83 years. RESULTS:Patients' mean preference for virtual over in-person physical therapy was 2.97 (±1.27), as measured on a 5-point Likert scale. Multiple regression analysis indicated that patients' preference for virtual physical therapy (VPT) was positively associated with VTSE (β = 0.450, p < 0.001) and PPE (β = 0.484, p = 0.010). Additionally, TC had a significant positive interaction with PPI (β = 0.301, p = 0.035), and VTSE had a significant positive interaction with PPE (β = 0.358, p = 0.033). Demographic factors were not significantly associated with preference for VPT. CONCLUSIONS:The findings suggest that ]patients' confidence and provider-related perceptions have important associations with their preference for VPT. By fostering patients' confidence in applying virtual treatments and enhancing perceptions of provider expertise and integrity, physical therapy providers may influence patient preference for telerehabilitation. The findings highlight the need for further research on how patients' preference for virtual care is shaped by how they view their health care providers.
INTRODUCTION:Heart failure (HF) entails high morbidity, mortality, and health care costs. This scoping review maps and describes telehealth interventions for adult HF management, summarizing modalities, contexts, and reported outcomes (morbidity, mortality, and hospitalizations), and identifying evidence gaps, implementation challenges, and future trends. Our review question was: Which telemedicine interventions have been used in adult HF management, in which contexts, and what outcomes are reported for morbidity, mortality, and hospitalizations? METHODS:We searched four electronic databases (MEDLINE via PubMed, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, and Scopus) and gray literature (DataBase of Theses and Dissertations, Brazil) through December 2023, using a Population, Concept, Context framework. Two independent reviewers screened and extracted data; discrepancies were resolved by a third reviewer. RESULTS:Of 1,122 records, 81 studies were included. Evidence spans 12 thematic areas covering telemonitoring modalities, adherence, clinical indicators, early detection, symptom management, communication, satisfaction, cost considerations, comparative perspectives, public health contributions, and future trends. Reported outcomes were heterogeneous across study designs and settings. Evidence on effectiveness is mixed across modalities and settings. Signals of benefit appear in integrated, protocolized telemonitoring programs-particularly for reducing readmissions in selected contexts-while other modalities show neutral effects. Key gaps relate to standardization, data integration, and long-term sustainability. CONCLUSION:Telehealth is widely applied in HF care with diverse implementations; further rigorous and standardized evaluations are needed to clarify effectiveness across modalities and settings.
PURPOSE:The Veterans Health Administration (VHA) aims to provide same-day access from Primary Care to Integrated Mental Health (PCMHI) teams but faces challenges coordinating virtual services across traditional clinic workflows. This study examined whether modality concordance for primary care and PCMHI visits (i.e., both video, both phone, or both in-person) is associated with higher probability of receiving same-day PCMHI care. METHODS:This retrospective cohort study included 952,749 VHA primary care patients who newly initiated PCMHI services between FY2019 and FY2023 (October 1, 2018 and September 30, 2023). Same-day care was defined as receiving PCMHI services on the same day as a primary care visit. The exposure was the modality combination used for primary care visits and their resulting PCMHI visits. Multilevel regression models controlled for patient characteristics, clinic-level factors, year, VHA regional network, and clinic clustering. MAJOR FINDINGS:The highest probability for same-day PCMHI care was when both visits were conducted in-person (59%, p < 0.001). This probability dropped to 35% and below for all cases where phone or video was utilized for either visit. Further analysis demonstrated that modality concordance contributed minimally to same-day care after calculating the variance contributed by any telehealth (phone/video) use. CONCLUSIONS:The use of phone or video visits appeared to hinder the ability to provide same-day patient handoffs from primary care to PCMHI, even when the same modality was used for both visits. Interdisciplinary team workflows need to overcome barriers associated with telehealth (phone/video) use in general, which may not be easily rectified by matching on visit modality.
BACKGROUND:We evaluated the impact of a teleretinal screening program on increasing diabetic eye screening within urban community health clinics and factors associated with screening receipt. MATERIALS AND METHODS:A clinical teleophthalmology program providing teleretinal imaging for diabetic eye screening was introduced at two clinics (Clinics A and B) in an urban federally qualified health center in Madison, Wisconsin. We conducted a retrospective, cross-sectional study during the baseline (2020-2022) and teleophthalmology (2022-2024) periods and used logistic regression to identify factors associated with screening receipt. RESULTS:During the baseline period, patients (n = 1,094) had a mean age of 54 years, with 24.0% self-identifying as Black/African American and 44.8% as Hispanic/Latino, and 30.0% were uninsured. Screening increased from 14.4% to 40.3% (p < 0.001) in the teleophthalmology period, with the largest increases observed among Hispanic/Latinos (+32.1%) and the uninsured (+33.6%). In the multivariable analysis, men and uninsured patients became equally likely to receive screening in the teleophthalmology period as women and Medicare patients, respectively. However, those with Medicaid or commercial insurance remained less likely to obtain screening (OR: 0.63-0.69, 95% CI: 0.44-0.99) than those with Medicare. Those obtaining care at Clinic B were less likely to obtain screening than those at Clinic A in the baseline period but were more likely to obtain screening in the teleophthalmology period (OR: 1.75, 95% CI: 1.37-2.23). CONCLUSIONS:Teleophthalmology increased diabetic eye screening equity based on sex and insurance status. Clinic-level strategies to enhance patient outreach, clinical staff engagement, and clinic resource allocation may allow for further advances in telemedicine screening equity.
Objective: To describe the implementation, scale, and stakeholder experience of a statewide clinic-to-clinic pediatric subspecialty telemedicine program improving access to care for children in rural and underserved communities. Methods: A hub-and-spoke telemedicine network was developed linking pediatric subspecialists at an academic children’s hospital with advanced practice providers (APPs) at five regional spoke clinics. In this hybrid clinic-to-clinic model, APPs performed in-person assessments and facilitated synchronous telemedicine consultations for all new patients. Program utilization, travel burden reduction, and parent survey responses were analyzed descriptively; free-text parent comments and a provider panel discussion underwent qualitative content analysis. Results: From 2018 through 2024, the program completed 21,838 visits across 21 pediatric subspecialties, involving 98 clinicians. Families avoided an estimated 5.9 million travel miles, 99,000 travel hours, and approximately 2,400 metric tons of CO 2 emissions. Among 251 surveys returned, 90.0% of the 239 parents answering the rating item rated care as excellent and 8.8% as good. Providers attributed the model’s success to deliberate program infrastructure and standardization, strong trust and communication between subspecialists and site APPs, and improved access to timely subspecialty care closer to home. Full-time spoke sites achieved operational sustainability, whereas part-time sites were limited by staffing and workflow barriers. Conclusions: A clinic-to-clinic telemedicine model incorporating trained APPs at the point of care can sustainably expand pediatric subspecialty access while reducing travel burden and supporting provider satisfaction and retention. This scalable hybrid framework may help health systems address geographic barriers and pediatric subspecialty shortages.
INTRODUCTION:Telehealth is widely used by health professionals and students to deliver services in various settings. Health students need to acquire telehealth competencies prior to and during placement for safe delivery and competent practice. Therefore, understanding which student telehealth competencies have been assessed following a learning activity and what measures are used to do so in the literature is needed. METHODS:A scoping review was undertaken to identify (1) existing tools that measure telehealth competencies in students undertaking synchronous telehealth learning activities and (2) the telehealth competencies that these tools measure. Relevant electronic databases were searched. Titles and abstracts were independently reviewed by two researchers and included if published between 1995 and 2025, involved synchronous telehealth activities with real or simulated patients, and student telehealth competencies were assessed. Data were extracted and analyzed. RESULTS:Fifty-seven studies met inclusion criteria, with 82% conducted in the United States. Forty-nine studies (86%) used a case series research design. Students were from 10 health disciplines. Most studies (91%) used video-based telehealth activities. Almost three quarters of studies included simulation activities to facilitate telehealth learning. Outcome measures to evaluate student telehealth competencies were largely developed for individual studies, and most did not have established psychometric properties. Telehealth competencies assessed were in three areas: professional competencies, clinical competencies, and telehealth-specific competencies. CONCLUSION:Simulation is a commonly utilized learning activity to develop student telehealth competencies. There is a lack of specifically designed tools to assess student telehealth competencies. Further research is needed to develop robust assessment tools with established psychometric properties.
BACKGROUND:Mobile health (mHealth) technologies have the potential to transform health care delivery in low- and middle-income countries, particularly in ophthalmology. However, effective implementation depends on patients' readiness, access to mobile devices, and ability to use them. This study aimed to assess patients' readiness for mHealth by examining mobile phone ownership patterns, evaluating proficiency in phone use, and exploring attitudes toward adopting mHealth tools. METHODS:A cross-sectional questionnaire-based survey was conducted across three care settings at a tertiary eye hospital: the free section, paying section, and vision centers (VCs). Patients were randomly selected from clinic populations to reduce interviewer bias. Prior focus group discussions informed questionnaire refinement to capture diverse digital usage patterns. Sampling was structured according to average patient volume in each clinic. Data were collected from August to October 2023. RESULTS:Totally, 946 patients were interviewed: 41% were feature phone owners (FPOs), 37% smartphone owners (SPOs), and 21% had no phone (NPOs). Smartphone ownership was highest in the paying section (53%), feature phone ownership in the subsidized section (45%), and no-phone ownership in VCs (45%). Among NPOs, 80% were women. Patients aged over 60 were significantly less likely to own smartphones than feature phones (odds ratio [OR] = 0.10, p < 0.001) or have no phone (OR = 0.18, p < 0.001). Higher literacy levels were strongly associated with smartphone ownership. Nearly all SPOs and FPOs could receive calls, but far fewer FPOs could read (15-33%) or send short message service (2-8%). Only 22% of SPOs sought health information online, while most FPOs and NPOs did not use the internet. Electronic consent was acceptable to most SPOs and FPOs, but not among NPOs. CONCLUSIONS:Significant disparities in mobile phone ownership, digital proficiency, and attitudes toward mHealth exist among patients. mHealth interventions must therefore align with patient capabilities to ensure equitable and effective implementation.
BACKGROUND:High-acuity Medicare beneficiaries with annual expenditures exceeding $12,000 disproportionately drive the total cost of care (TCOC) through preventable acute utilization and are natural candidates for value-based and shared savings arrangements. Whether remote patient monitoring (RPM) produces near-term TCOC reductions in this cost-stratified population has been insufficiently evaluated in real-world practice. METHODS:A retrospective pre-post cohort analysis was conducted among 597 Medicare beneficiaries enrolled for at least 5 months in a technology-enabled RPM program, each with annualized preenrollment TCOC ≥$12,000. Patients received a cellular-enabled blood pressure monitor linked to a HIPAA-compliant platform staffed by licensed care navigators. The primary outcome was change in annualized TCOC over the 12 months before and after program initiation. Given right-skewed cost distribution (skewness = 4.47), the Wilcoxon signed-rank test was the primary inferential procedure. Secondary outcomes included per-1,000-patient rates of emergency department (ED) visits, inpatient hospitalizations, and 30-day readmissions. RESULTS:The mean age was 76.6 ± 8.2 years; 55.6% were female. The median annualized TCOC declined from $25,956 to $11,792, a reduction of $10,932 per patient (Wilcoxon p < 0.001; rank-biserial r = 0.47). The mean TCOC fell from $39,291 to $27,255 (p < 0.001). ED visits declined 19.9% (p < 0.001) and inpatient hospitalizations 40.9% (p < 0.001). Reductions were significant across all four baseline cost quartiles. Baseline TCOC was the dominant predictor of postenrollment costs (β = 0.50; p < 0.001; R2 = 0.23). At $100 per member per month, estimated net savings were $6.47 million (ROI: 9.0:1). CONCLUSION:Short-term RPM participation was associated with substantial reductions in TCOC and acute utilization among high-acuity Medicare beneficiaries, supporting RPM as a viable intervention to advance this population toward value-based care models. Prospective controlled evaluation is warranted to establish causal attribution.
BACKGROUND:Underserved populations experience structural barriers to health care access, including transportation limitations and socioeconomic constraints, which contribute to high no-show rates. Telehealth may mitigate these barriers; however, its impact on objective health care utilization metrics requires systematic evaluation. The objective of this article is to compare visit completion and no-show rates between telehealth and in-person care among underserved populations. METHODS:A systematic search of PubMed (January 2016-January 2026) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We included peer-reviewed studies focusing on rural, low-income, Medicaid-insured, and racial/ethnic minority populations that reported objective attendance data. This systematic review was prospectively registered in PROSPERO on February 18, 2026 (Registration No. CRD420261320752). RESULTS:Seventeen studies encompassing over 2.5 million encounters were included. Telehealth was consistently associated with reduced no-show rates across diverse settings. In a large safety-net system, no-show rates decreased from 25.1% to 14.6%. In primary care, telehealth narrowed the completion gap between Black and non-Black patients by 11.7 percentage points. Specialty applications, including postpartum monitoring and HIV care, demonstrated higher visit completion rates with telehealth. CONCLUSIONS:Telehealth is associated with improved appointment adherence and reduced disparities in health care access among underserved populations. Sustaining these benefits will require continued policy support, including reimbursement for audio-only modalities.
INTRODUCTION:Telemedicine plays a key role in Malaysia's National Digital Health agenda, but the population's readiness at the national level in public tertiary hospitals remains poorly understood. Identifying gaps in knowledge, attitudes, and practices is crucial to ensuring fair and successful telemedicine implementation, especially in semiurban areas where digital skills vary widely. METHODS:A cross-sectional study of 255 adult outpatients was conducted at a public tertiary hospital in North-East Malaysia, focusing on those who visited the family medicine, medical, orthopedic, and surgical outpatient clinics. Systematic random sampling was used to select participants. The study utilized a validated Bahasa Malaysia questionnaire to assess patients' knowledge, attitudes, and practices regarding telemedicine. Multivariable logistic regression analysis was conducted to identify sociodemographic factors predicting each readiness domain. RESULTS:While 60.4% of participants demonstrated good knowledge and 75.7% held favorable attitudes, understanding how these readiness levels can guide targeted interventions remains limited. Only 16.9% had prior telemedicine experience, and 52.2% showed adequate practice readiness based on the composite score. Younger age was independently associated with greater knowledge (adjusted odds ratio [AOR] 0.95; 95% confidence interval [CI] 0.93-0.98), more favorable attitudes (AOR 0.95; 95% CI 0.92-0.97), and greater practice readiness (AOR 0.97; 95% CI 0.95-0.99). The strongest predictor of practice readiness was prior telemedicine exposure (AOR 3.11; 95% CI 1.42-7.43). DISCUSSION:Our population faces a significant readiness-to-practice gap, mainly due to age-related digital barriers and limited experience. Addressing these challenges through structured onboarding can help ensure equitable access to health care for all, thereby encouraging collective action.
Objective: A prospective study to compare the mean blood pressure and mean weight of subjects with congestive heart failure (CHF) in the month before Ramadan, during the month of Ramadan, and in each of the two months following Ramadan to determine if fasting has any effect on health. Methods: Patients were given a blood pressure meter and weighing scale and instructed to take daily measurements. Data were transmitted wirelessly from the devices to a simple home gateway for automatic onward transmission to the data server without intervention from the subject. Subsets of data for blood pressure and weight were created for each of the months before Ramadan, during the month of Ramadan, and the two months following Ramadan for 2025 and 2026. The mean and standard deviation were determined for each patient, and comparison between successive months was performed for the cohort mean and standard deviation using t- test. Paired t -tests were performed for subgroups containing only patients participating in successive periods. Results: There was significant variation in the mean of an individual and in the mean of a cohort; however, the mean was consistent across the period with the value for the t- test between successive periods being greater than 0.25 (CI: 0.05). The value for the paired t- test was greater than 0.22 (CI: 0.05) for all periods except between post-Ramadan and 2 months post-Ramadan when the value was 0.10 (CI: 0.05), and some subjects were seen to exhibit significant changes. Conclusions: The t- test and paired t- test values show that there were no statistically significant differences between cohort means and paired comparisons for blood pressure and weight for all months, indicating there are no effects on health in patients with CHF due to fasting if appropriately clinically managed.
BACKGROUND:Telemedicine is conventionally modeled as a dyadic clinician-patient encounter, yet a third party-caregiver, community health worker, nurse, or increasingly an artificial intelligence (AI) conversational agent-frequently participates. No principled basis exists for determining when such a third party is a genuine facilitator versus an instrument of one party, rendering cross-study comparison incommensurable and deployment decisions poorly grounded. METHODS:We conducted a narrative synthesis of literature spanning triadic clinical communication, shared decision-making, and AI-mediated interaction to derive a technology-neutral conceptual framework and classification model. RESULTS:We propose conversational capacity, operationalized through four functions (interpret, translate, advocate, adapt), as the minimum criterion for triadic facilitation. The framework defines a structural boundary separating genuine triadic architectures (Modes A and B) from augmented dyadic models (Mode C); a five-level Conversational Capacity Spectrum classifying human and AI facilitators; and a Clinical Situation Matrix mapping architecture to morbidity complexity, patient vulnerability, and decision complexity. Advocacy emerges as the discriminating function AI is least able to perform, making it the current limiting dimension of AI facilitation. The framework generates three testable hypotheses and identifies an equity paradox whereby high-vulnerability populations most in need of human facilitation are those most likely to be assigned AI on resource grounds. CONCLUSIONS:Triadic telemedicine should be defined by conversational capacity rather than mere third-party presence. Replacing the binary triadic-versus-dyadic distinction with two gradable, measurable constructs is a prerequisite for cumulative research and responsible AI deployment in clinical consultations.
INTRODUCTION:Telehealth is a strategic component of primary health care and has advanced in Brazil through the National Telehealth Program. Its benefits can be enhanced by artificial intelligence (AI), which has emerged as a promising tool. This study aims to compare the performance of real human and AI-generated responses to queries submitted to the teleconsultation services of the Telehealth Center of the UFMG Faculty of Medicine (NUTEL FM-UFMG), a member of the Telehealth Brazil Program. METHODS:This is a comparative cross-sectional study of 180 real human and AI-generated responses, evaluated in a blinded manner according to quality criteria (medical adequacy, conciseness, coherence, and comprehensibility), risk potential, authorship identification accuracy, and inquiry resolution. Data from NUTEL FM-UFMG (January 2020 to May 2024) were utilized, covering cardiology, endocrinology, and obstetrics/gynecology (OB-GYN). Statistical analysis included the Shapiro-Wilk test, Kruskal-Wallis test, Nemenyi multiple comparison test, chi-square test, and Fisher's exact test. RESULTS:Across all specialties, a significant difference was observed in comprehensibility, with AI mean scores surpassing those of humans. For the remaining quality criteria, as well as for risk potential and inquiry resolution, no significant differences were found, despite AI scoring higher than humans. Within specific specialties, significant differences was observed in endocrinology (except conciseness) and cardiology (in conciseness); AI showed superior means. Across all specialties, as well as individually within endocrinology and OB-GYN, the accuracy of authorship identification (human vs. AI) was statistically significant. CONCLUSION:Despite existing limitations, AI demonstrates substantial potential as a support tool for teleconsultation services.
BACKGROUND:Telehealth technology can expand access to expert sexual assault nurse examiner (SANE) care in rural and underserved areas. Research previously demonstrated that telehealth-supported sexual assault nurse examiner (teleSANE) intervention led to changes in examination methods and evidence collection practices among a pediatric population; however, little is known about the impact of the intervention on changes among adolescent and adult victims of sexual assault (SA). The purpose of this study is to examine how SAFE-T SystemTM teleSANE consultations influence medical forensic examination (MFE) recommendations and changes for adolescent and adult survivors of SA in rural and suburban communities. METHODS:From June 2021 to September 2024, SAFE-T System teleSANEs provided 24/7 live telehealth consultations to local SANE-trained nurses at 11 hospitals in rural or suburban communities. A researcher-developed quality assurance tool was completed to assess the impact of the teleSANE consultation. RESULTS:Analysis of 178 teleSANE consultations conducted by 18 teleSANEs partnered with 64 local SANEs across 11 hospitals. TeleSANE consultations resulted in changes across 7 domains and 12 subcategories: The 8 domains include: Patient-centered Communication (67.4%); Initial History/Data Gathering (42.1%); Forensic Evidence Collection (78.7%); Use of Multimethod Techniques (65.7%); Use of Adjunct Techniques (60.1%); Photo Documentation (51.1%) and Quality (59.6%); Post-assault Clinical Recommendations (43.8%); and Strangulation Evaluation (17.5%). CONCLUSIONS:Telehealth technology partnering expert teleSANEs with local SANEs in forensic specialty limited-access areas resulted in substantive changes to MFEs. These changes may reflect improved quality of care and enhanced forensic evidence collection.
BACKGROUND:In Nigeria, women face significant barriers to accessing health care, including long distances to health care facilities, lack of autonomy, stigma surrounding health concerns, and the unavailability of primary and specialty care. Telehealth can facilitate access to care by eliminating physical distance barriers and enhancing ease and privacy. Yet, limited research has been conducted on its use and how it is perceived in Nigeria. METHODS:Guided by the theoretical framework of acceptability (TFA), this study explored Nigerian women's perceptions of telehealth and assessed for behavioral factors that influence willingness to use telehealth. Two hundred and eighty-eight adult women living in urban areas of Nigeria completed an online survey. RESULTS:Most respondents reported willingness to use telehealth (93.0%), with 69 (25.3%) very willing and 152 (55.7%) willing to use telehealth. Although 50.0% of the respondents reported having heard about telehealth, only 74 (27.2%) reported prior experience using telehealth, out of which 46 (69.7%) and 14 (21.2%), respectively, reported positive and very positive experiences using telehealth. Although all TFA constructs were correlated with willingness to use telehealth, only positive view of telehealth burden (β = 0.19, p = 0.03) and self-efficacy (β = 0.20, p = 0.015) were significant unique predictors of willingness. CONCLUSIONS:This study provides insight into how telehealth might be adopted by Nigerian women and suggests that although only a few have previously utilized telehealth and only half of the respondents had been aware of telehealth prior to taking the survey, most are willing to utilize it to meet their health care needs.
BACKGROUND:Telepsychiatry expanded rapidly during the COVID-19 pandemic to support continuity of psychiatric care, although its long-term durability following the expiration of pandemic-era policies remains uncertain. This study evaluated long-term utilization of telepsychiatry and patient and clinician acceptability within outpatient practice. METHODS:A repeated cross-sectional electronic health record analysis of outpatient psychiatric visits from 2020 to 2025 compared in-person and virtual visit completion and no-show rates across five annual intervals. Telepsychiatry acceptability was evaluated through a patient survey administered in 2021-2022 (n = 655) and clinician surveys conducted in 2020 (n = 50) and 2025 (n = 38). RESULTS:Among 219,007 visits, 44% were in-person and 56% were virtual. The overall no-show rate was 10.46%, with no significant difference between visit types (p = 0.178). Two intervals demonstrated significant differences: 2021-2022 (virtual = 9.6%, in-person = 11.0%, p < 0.001) and 2024-2025 (virtual = 11.9%, in-person = 10.9%, p < 0.001). The percentage of no-show visits increased as virtual visits decreased (Spearman's correlation = -0.90, p = 0.037). Most patients agreed that their telepsychiatry visit was as good as in-person (92.4%) and more convenient (97.1%). Provider belief that virtual visits were as effective as in-person decreased from 92.0% in 2020 to 74.3% in 2025 (p = 0.026). CONCLUSIONS:Telepsychiatry utilization remains a substantial component of outpatient care. Comparable no-show rates and high patient satisfaction support telepsychiatry as a viable and acceptable modality, although provider enthusiasm appears to have moderated over time.
BACKGROUND:Virtual critical care (VCC) programs provide remote specialist support to community hospitals caring for critically ill patients, yet Canadian evidence regarding their economic impact remains limited. This study aimed to estimate the cost savings associated with a newly implemented VCC program in Eastern Ontario. METHODS:A retrospective cost-benefit analysis of the first 19 months of a regional VCC program based at a tertiary academic center supporting 13 community hospitals was conducted. All adult patients with an initiated VCC consultation were included. Cost estimates focused on avoided interfacility transfers, transportation costs, and differences in inpatient costs between academic and community hospital settings. Descriptive statistics were used to compare estimated cost savings with program operating costs. RESULTS:Between April 2023 and October 2024, 473 VCC calls representing 312 unique patient encounters were recorded (298 patients included in analysis). Transfers to larger centers were avoided in 179 cases (60%). Avoided land ambulance transfers were estimated to save $61,101 CAD over the study period. Estimated inpatient cost savings associated with avoided transfers ranged from $687,643 CAD (mean length of stay [LOS]) to $2,681,420 CAD (median LOS), corresponding to monthly savings of $36,191-$141,127 CAD. These savings approached or exceeded the estimated VCC program monthly operating cost. CONCLUSION:The Eastern Ontario VCC program was associated with substantial estimated cost savings, primarily through avoided transfers and reduced use of high-cost academic intensive care beds. These findings support VCC as a potentially cost-effective health system intervention for supporting critically ill patients in community hospitals.
INTRODUCTION:As telemedicine becomes an integral component of health care delivery, understanding factors that influence medical students' acceptance of this technology is essential. This study explores medical students' perceptions of telemedicine adoption using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS:A cross-sectional survey of 98 medical students assessed telemedicine perceptions across UTAUT constructs: performance expectancy (PE), effort expectancy (EE), facilitating conditions (FC), social influence (SI), and behavioral intention (BI). Open-ended responses were thematically analyzed using a deductive approach to contextualize quantitative findings. RESULTS:PE was the strongest predictor of BI to use telemedicine among medical students (B = 0.771, p < 0.001), whereas EE, SI, and FC were not significant predictors. Qualitative responses reinforced telemedicine's perceived value, particularly for improving access to care and shaping future health care delivery, while highlighting limited formal training and a desire for more structured learning opportunities. CONCLUSIONS:These findings support integrating structured telemedicine training, experiential learning, and mentorship into medical curricula to enhance readiness for delivering technology-enabled care.
