Background:This randomized controlled trial compared the patient-reported outcome measures (PROMs) of patients who attended virtual telehealth visits with those of patients who attended in-person visits at their postoperative sports medicine appointments in a safety-net population. This is a parallel group trial with a 1:1 allocation ratio with a superiority framework. Methods:This trial enrolled 90 patients who received operative sports intervention at one clinic. The intervention group (48 patients) attended telehealth visits. The control group (42 patients) attended standard in-person visits. Primary outcomes were Patient-Reported Outcomes Measurement Information System (PROMIS) Global-Physical (GH-P) and PROMIS Global-Mental (GH-M) scores obtained at the 6-month visit. Welch's t-test and Pearson chi-square test analyses were utilized. Post hoc inverse probability weighting (IPW) analysis accounted for covariate imbalance. Statistical significance was based on an α level of 0.05. Post hoc adjustment of the α level was 0.013. Results:Eighty patients were included in the primary analysis. The telehealth group (45 patients) had a mean GH-P score 50.46 (standard deviation [SD] 7.84; 95% confidence interval [CI] [48.11-52.81]), whereas the in-person group (35 patients) had a mean score of 50.26 (SD 7.76; 95% CI [47.60-52.92]), with Δ = 0.20, p = 0.91, IPW-adjusted p = 0.59, with negligible effect (d = 0.03, 95% CI [-0.42 to 0.47]). For the GH-M score, the telehealth group had a mean 56.51 (SD 10.02; 95% CI [53.50-59.52]), and the in-person group had 60.21 (SD 8.47; 95% CI [57.30-63.12]), with Δ = 3.70, p = 0.08, IPW-adjusted p = 0.17, with small effect (d = -0.4, 95% CI [-0.85 to 0.05]). None of the score differences between the two groups were statistically significant. Discussion:This study lacks statistical evidence to state that there is a difference in PROMIS scores between the telehealth and in-person groups. The difference of the means between the two groups is less than the minimal clinically important difference obtained from the literature. Due to participant attrition, the study was underpowered. Limitations include retrospective registration of this trial, an increased risk of making a type 2 error, having 23% of telehealth participants cross over to the in-person group, conducting 71% of telehealth visits by video and 29% by phone, and completing surveys using different methods. These limitations are potential systematic errors that weaken the study's internal validity. Level of Evidence:Level 1-prospective randomized controlled trial.
Background:5G-enabled telesurgery and robotic systems could improve access to specialist care, but acceptance remains limited by perceived risks. The relative importance of different risk dimensions is unclear. Objective:To examine how four risk perceptions (network latency, privacy leakage, treatment outcome difference, and postoperative rehabilitation outcome difference) affect acceptance intention among young and highly educated adults, and to derive implications for ethical risk communication and governance. Methods:A convenience sample survey was conducted among 345 university students. Descriptive statistics, Pearson's correlations, and multiple linear regression were used to test associations between risk perceptions and acceptance intention. Results:The four risk dimensions explained 26.3% of the variance in acceptance intention (adjusted R 2 = 0.263; F[4,340] = 31.639; p < 0.001). Acceptance intention was significantly and negatively associated with rehabilitation outcome risk (β = -0.318, p < 0.001) and treatment outcome risk (β = -0.160, p = 0.013). Network latency risk showed a marginal association (β = -0.126, p = 0.051), whereas privacy leakage risk was not significant (β = 0.005, p = 0.934). Conclusion:For young, highly educated respondents, perceived clinical effectiveness, particularly rehabilitation, was more predictive of acceptance intention than operational performance or privacy concerns. Risk communication and oversight should prioritize transparent evidence on treatment and rehabilitation outcomes and use differentiated messaging; privacy protection should be integrated into informed consent in a patient-relevant and decision-consistent manner.
Background:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic emergencies that require rapid diagnosis and specialized care, but access to inpatient dermatology consults is often limited. While store-and-forward inpatient teledermatology (SAFIT) has been used for triaging suspected cases, its role in ongoing disease management remains unclear. Objective:To characterize the clinical characteristics, treatment, and outcomes of patients with SJS/TEN managed by SAFIT, and to compare these measures according to whether the SAFIT consult occurred before or after burn unit admission. Methods:Retrospective case series of 15 consecutive patients with teledermatologist-confirmed SJS/TEN managed by SAFIT at a tertiary-care burn center. Clinical characteristics, treatment patterns, and patient outcomes were evaluated and compared based on the timing of teledermatology involvement relative to burn unit transfer. Time-to-biopsy after SAFIT consult was measured. Results:The cohort was 60.0% male with a mean age of 45.4 years. Mean SCORTEN was 1.6 ± 0.3, and mean body surface area involvement was 18.8 ± 5.9%. Biopsies were obtained in 93.3% of cases, with a mean time-to-biopsy of 2.5 ± 0.7 h after SAFIT consult. SAFIT initiated transfers to a burn center in 40.0% of cases, while 60.0% received their SAFIT consult after burn unit admission. There were no significant differences between groups in demographics, disease severity, treatment patterns, or clinical outcomes, including mortality, complications, and length of hospitalization. Mortality rates were consistent with expected ranges for SJS/TEN. Conclusion:When combined with burn unit care, SAFIT facilitates timely diagnosis and management of SJS/TEN, with comparable outcomes to prior literature regardless of consult timing. These findings suggest a role for SAFIT in standardizing and expanding access to dermatologic care. Future multicenter studies are warranted.
Introduction:Stroke is a leading cause of long-term disability worldwide. Low self-efficacy and high hospital readmission rates remain major barriers to successful post-stroke rehabilitation. Nurse-led tele-education has emerged as a potential strategy to support continuity of care after hospital discharge. Objective:To examine the impact of a structured nurse-led tele-education and follow-up program on self-efficacy and hospital readmission among stroke survivors. Methods:This quasi-experimental pretest-posttest study with a control group was conducted between April 2023 and August 2024 among stroke patients discharged from two tertiary hospitals in Hamadan, Iran. Eligible participants were allocated to intervention (n = 127) and control (n = 127) groups using a simple random number table. Eligible participants were allocated to intervention (n = 127) and control (n = 127) groups using a simple random number table. Because blinding was not feasible, the study was conducted using a quasi-experimental design. The intervention group received a 2-week tele-education program delivered via a mobile messaging application, complemented by weekly nurse-led follow-up calls, while the control group received usual discharge care with monthly follow-up contacts. Self-efficacy was assessed at baseline and 6 weeks after discharge using the Persian version of the Stroke Self-Efficacy Questionnaire. Hospital readmission was monitored over a 6-month follow-up period. Results:Participants (mean age: 65.32 ± 7.25 years) showed no baseline self-efficacy differences. Post-intervention, the intervention group had significantly higher self-efficacy scores (p < 0.001) and lower 6-month readmission rates (9.6% vs. 21.2%, OR = 2.51, p < 0.05). Conclusion:Early, structured tele-nursing was associated with higher self-efficacy and lower hospital readmission rates among stroke survivors. This model appears feasible, scalable, and potentially cost-effective for post-stroke care.
Background: Early initiation of intravenous thrombolytics for treatment of acute stroke leads to improved functional outcomes. Published guidelines aim to reduce door-to-needle (DTN) times in both prehospital and hospital settings without specific consideration of telestroke. Over the last decade, telestroke has become increasingly more common to provide emergency stroke care worldwide but published guidelines on specific practices have yet to be established. The implementation of EMS prearrival notifications, neurologic evaluation and thrombolytic administration in the CT imaging suite (CIS) are utilized as best practices by some programs. Methods: We utilized the Telecare by TeleSpecialistsTM database to investigate the impact of these practices on DTN times and thrombolytic treatment rates. Hospitals participating in all recommended Best Practices were considered the investigative group and those hospitals participating in all Best Practices except the variable of interest were considered the control group. Shapiro-Wilk, Mann-Whitney U, and Pearson's chi-squared tests were used when appropriate. Results: Pre-notification was associated with an 8-min reduction in DTN times (p = 0.0026) and 3.7% increase in thrombolytic treatment rates (p = 0.0016). Evaluation by the neurologist in the CIS was associated with a reduction in DTN times (6-min reduction, p = 0.0192) and increase in thrombolytic administration rates (1.46% increase, p = 0.0361). Implementing administration of IV thrombolytic in the CIS was associated with similar benefits (3-min reduced DTN times, p = 0.0176; 2.87% increase in thrombolytic treatment rate, p < 0.0001). Conclusion: Overall, these best practices reduced DTN times and improved treatment rates supporting their integration into telestroke practices globally.
Background:Telemedicine is now integral to health care delivery in Saudi Arabia. This study assessed patient characteristics, visit contexts, and patient-reported experiences at a capsule telemedicine clinic. Methods:We conducted a cross-sectional survey of 40 adult users of a capsule telemedicine clinic located within Masjid Al-Haram, Mecca, during a busy Ramadan Umrah period. Participants completed a questionnaire on demographics, visit context, satisfaction with services, clarity of results, and post-visit outcomes. Experience and outcome measures were summarized using descriptive statistics. Results:The median age was 50 years. Umrah pilgrims and other visitors comprised 75% and 25%, respectively. Visit reasons were evenly split between feeling unwell and routine checkups (40% each), with 20% for follow-up of an existing condition. Patient experience was highly positive: 95% (95% CI, 84-99) rated the location convenient, and 100% (95% CI, 91-100) rated staff helpfulness, service efficiency, and result clarity as "Good." After teleconsultation, 100% (95% confidence interval [CI], 91-100) felt more confident about their health and would recommend the service. Twenty percent (8/40; 95% CI, 11-35) were referred for hospital evaluation, and no adverse events occurred. Exploratory subgroup comparisons suggested possible differences in referral patterns, but the small sample size precluded definitive inference. Discussion:Patients reported high satisfaction with the capsule telemedicine service during a Ramadan Umrah period. Most participants were not referred for immediate hospital evaluation, suggesting potential feasibility and acceptability in high-density pilgrimage settings. Further studies with clinical follow-up and objective outcome measures are needed to assess effectiveness and safety.
Background:COVID-19 caused disruptions in access to oncology health care for patients with breast cancer. This study explored the time differences in days from the initial patient call to time-to-treatment initiation (TTI) and evaluated the relationship between initial in-person consult (IPC) and telehealth consult (THC). Methods:Retrospective data were collected for the years 2019, 2020, and 2021. Demographic characteristics were summarized for each year. Chi-square and nonparametric tests were used to examine demographic data, differences in the number of THCs versus IPCs each year, differences in TTI for patients who had THC versus IPC for each study year, and overall differences across each of the study years in TTI. Results:Records from 960 patients included 447 IPCs in 2019; 81 THCs and 47 IPCs in 2020; and 26 THCs and 359 IPCs in 2021. Significant differences were found for age (p = 0.013) between 2019, 2020, and 2021 (medians of 55, 51, and 55, respectively). Differences between the number of IPCs versus THCs from 2019 to 2021 combined were statistically significant (p < 0.001): 2019 (no THCs), 2020 (63% THCs vs. 37% IPCs), and 2021 (93% IPCs vs. 7% THCs). In 2019-2021, TTI was greater for patients who had an IPC versus those who had a THC; the median TTI was 28 days for THC versus 33 days for IPC, p = 0.045. Conclusions:Findings suggest that THCs did not delay and may accelerate TTI. Further studies examining the relationship of initial consult type to TTI are needed.
Objectives:This scoping review aimed to characterize the implementation of telehealth interventions in U.S. K-12 school settings, map how their performance and outcomes have been evaluated across a standardized evaluation taxonomy, and develop a conceptual framework to address gaps in evaluation practice. Methods:We conducted a scoping review following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, searching PubMed, CINAHL, Scopus, and Google Scholar for studies published between January 2019 and April 2026. Two reviewers independently screened records and extracted data on study characteristics, intervention types, and evaluation domains. Measures were classified into a standardized taxonomy and synthesized using descriptive mapping and frequency analysis. Framework development was iterative and informed by extracted findings, conceptual review, and integration of existing implementation and evaluation models, alongside policy guidance relevant to school-based telehealth (SBTH). Results:A total of 1,217 records were identified, with 22 studies meeting the inclusion criteria. Studies were heterogeneous across service lines and methodologies. Evaluation most frequently focused on access and utilization, satisfaction or acceptability, and implementation outcomes, while health outcomes, cost, academic outcomes, and sustainability were less consistently assessed. Evaluation approaches were fragmented, with limited use of standardized metrics and minimal integration across domains. These findings informed the development of a structured framework spanning Inputs, Implementation Processes, and Outcomes, capturing the relationships between contextual factors, service delivery, and multidimensional performance indicators. Conclusion:SBTH appears feasible, acceptable, and capable of improving access to care; however, fragmented evaluation practices limit comparability and policy translation. The proposed framework provides a structured approach to guide comprehensive, longitudinal evaluation and support scalable, integrated telehealth implementation in school settings.
Background: The rapid expansion of telehealth, which was accelerated by the COVID-19 pandemic, has outpaced standardized approaches to data capture, resulting in fragmented documentation and limited research infrastructure. A centralized telehealth taxonomy would be useful for improving documentation, evaluating utilization, and informing decision-making. However, no comprehensive telehealth taxonomy has been developed to date. Methods: A scoping literature review was conducted to identify the characteristics needed to build a comprehensive telehealth taxonomy that informs a data repository. Then, a hybrid hierarchical mind map taxonomy was built using the frameworks and concepts from the reviewed articles, along with insight and feedback from eight telehealth domain experts. The taxonomy was revised using an iterative process, and the final version was approved by the domain experts. Results: Ten articles were ultimately included in this scoping review. Based on the findings of those articles, the final taxonomy includes 14 core variables that span the full telehealth appointment, including previsit preparation, during-visit interactions, and postvisit follow-up. The variables are arranged across both patient and provider perspectives. The taxonomy includes four dimensions: synchronous and asynchronous modalities, user perspectives, functionality, and payment considerations. Furthermore, the taxonomy aligns with electronic health record data fields, thus promoting interoperability and structured data capture. Discussion: The unified framework developed herein aims to bridge gaps in telehealth research by providing a scalable, interoperable foundation for data repositories. Ultimately, this taxonomy lays the groundwork for improved telehealth data infrastructure and can enhance research, clinical care, and data-informed policy development.
Introduction: There is consensus that telehealth may be an effective and scalable solution to the nation's ongoing obesity crisis. However, there are concerns about the quality and safety of obesity care accessed via telehealth and particularly direct-to-consumer (DTC) telehealth. The current study sought to understand the perceptions of the efficacy, quality, and safety of care accessed via telehealth among individuals who accessed weight loss treatment via a national DTC telehealth platform. Methods: An online survey, originally intended for the purposes of quality improvement, was sent to individuals who had accessed weight loss treatment via a national telehealth platform. The survey, made available between June 30, 2025, and July 3, 2025, consisted of 22 questions that queried individuals about various aspects of their experience with the platform. Data were de-identified and retrospectively analyzed, with descriptive statistics used to report on the number and percentage of participants who indicated agreement with survey items. Results: 1381 participants who accessed weight loss treatment via the platform completed the survey. Overall, participants (>70%) reported a positive experience pertaining to the quality and safety of care accessed via the platform. The majority (>80%) of participants reported a positive experience with the online clinical intake and with providers on the platform. Participants consistently (>90%) rated their overall experience with the platform as equal to or better than prior in-person health care experiences. There was variability with regard to participants' awareness of specific safety practices implemented by the platform. Discussion: Our findings indicate that factors such as structured intake processes, ongoing communication with providers, and accessible educational resources may play important roles in fostering individuals' confidence and trust in telehealth-delivered obesity care.
Background: The world continues to expand our digital reliance. Populations are being left behind lacking the necessary knowledge or tools for succeeding in a technologically advanced space. This issue is apparent within both the digital health and telehealth space and has left health professionals wondering what can be done to bridge this gap. Objective: In late October 2024, Henry Ford Health (HFH), a health system located in Detroit, Michigan, held a summit titled "Advancing Health Equity-Bridging the Telehealth Divide" to attempt to find solutions for the problems facing patients in accessing their health care digitally. Community engagement sessions were held on the second day of the summit and involved discussions focused on three different age groups among six groups: three groups-older adults (age 55 and older); one group-general adults (ages 18-54); and two groups-children and family (ages 0-17). Methods: Initial open coding captured participant language and recurring concerns, while focused coding consolidated these into broader conceptual categories. This process was followed by affinity mapping to cluster-related codes into themes. Results: The resulting synthesis revealed seven thematic domains that reflect systemic and experiential factors shaping telehealth and digital health equity. The domains are as follows: Access and Infrastructure; Digital Literacy, Safety, and Confidence; Tech Support Quality and Delivery; Community Anchoring and Trusted Networks; Communication, Advocacy, and Educational Tools; System Design, Ease of Use, and Human-Centered Technology; and Equity, Inclusion, and Systemic Barriers. Conclusion: Patients and community members desire and need strong telehealth services that support the notion that health systems have opportunities and responsibilities to address these shortcomings by working with community members.
Introduction: Health care disparities are severe across Asia. To bridge gaps in professional knowledge and skills, Doctor-to-Doctor (DtoD) telemedicine shows promise. However, the specific technical skills required for effective DtoD conferences and consultations, particularly those involving advanced technologies, remain undefined. This study aimed to establish a consensus on these essential skills. Methods: We used the Delphi method, engaging 30 participants from Asia-Pacific Advanced Network Medical Working Group DtoD training programs. Investigators and an expert panel developed an initial list of technical skills for both synchronous and asynchronous DtoD teleconferences and consultations, which participants evaluated in Round 1. Following an in-depth workshop, a revised questionnaire incorporating new skills and feedback was assessed in Round 2, yielding the final list. Results: The study included 30 hospital IT staff, doctors, and nurses from 11 Asian countries, 57% of whom were affiliated with university hospitals. All participants completed both rounds. After integrating 46 written comments, 10 new skills were added, resulting in a final list of 43 technical skills. These encompassed conceptual understanding, technical execution, coordination, and security policy. Notably, “Extracting images from medical devices” and “Maintaining audio quality” were identified as key skills. Discussion: This study is the first to delineate the technical skills necessary for DtoD telemedicine conferences and consultations in Asia. The identified skills can guide future training, assessment, and development initiatives to strengthen the telemedicine workforce across the region.
Introduction: Activating Behavior for Lasting Engagement (ABLE) is a conversation-based intervention designed to reduce poststroke sedentary time. Remote delivery may overcome access barriers but requires adaptations to promote participant engagement and safety. We explored the feasibility of delivering ABLE remotely (teleABLE) using synchronous videoconferencing. Methods: Community-dwelling ambulatory stroke survivors (N= 11) were enrolled in this descriptive case series. Pre-and post-test measures of sedentary time (accelerometry), activity engagement (Activity Card Sort 3), and health-related quality of life (EuroQOL-5D-5L) were completed at weeks 0 and 8. Participants completed 12 sessions teleABLE sessions and two semi-structured interviews (mid-and postintervention). Feasibility metrics were documented and assessed against a priori benchmarks. Changes in clinical outcomes were reported descriptively. Framework analysis was applied to interview data to contextualize quantitative findings. Results: Most stroke survivors (median age = 56.5 years, median chronicity = 6.2 months poststroke) were retained through postintervention (90.9%). Feasibility benchmarks for safety (0 severe adverse events), participant satisfaction (Client Satisfaction Questionnaire-8 score = 3.7 vs. 3.0), and session frequency (1.7 sessions per week vs. 1.5) were met. Some participants experienced within-person change in sedentary time, activity engagement, and health-related quality of life. Participants characterized teleABLE as a useful planning process that contributed to re-engagement in activities and improved mental health. Conclusion: Intervention adaptations focused on structures to support participant engagement and safety during remotely delivered intervention. Clinical outcomes and qualitative data suggest that teleABLE may contribute to psychosocial outcomes such as disability adjustment and mental well-being. Future research is required to determine the efficacy of teleABLE.
Background:Rural regions of Kazakhstan face persistent barriers to specialist access. Arterial hypertension (AH) remains highly prevalent, while limited digital literacy may restrict the uptake of telemedicine solutions. Objective:To evaluate medical and digital literacy, patient satisfaction, and perceived barriers associated with cardiology teleconsultations for AH in rural Kazakhstan, and to explore changes in patient trust and demographic differences between survey phases. Methods:A two-phase service evaluation was conducted. Phase 1 (offline, February 2023) surveyed rural adults with AH (n = 134). Phase 2 implemented mobile-based cardiology teleconsultations (July 2023-January 2024) and included a post-consultation online survey (n = 51, September-December 2024). Descriptive data were summarized as n (%) or mean ± SD; inferential analyses included Welch's t-test (age), the Wilcoxon signed-rank test (trust before/after), Spearman correlation (digital literacy-trust), the chi-square test (gender-satisfaction), and Kruskal-Wallis (age group-satisfaction). Results:In Phase 1, awareness of hypertension and complications was high (96% and 76%), but knowledge of risk factors was lower (78%). Most participants owned a BP monitor (81%) and could measure blood pressure at home (78%); 40% did so daily. Digital engagement was limited-73% were unfamiliar with "digital medicine," and 75% did not use health apps. In Phase 2, 82% of patients found teleconsultations convenient, and 90% rated remote care as excellent or good; 73% rated physician performance as excellent. Reported barriers included poor internet connectivity (43%), and most consultations occurred via mobile phones (92%). The mean participant age declined from 59 ± 11 years (offline) to 48 ± 13 years (online) (Welch's t p < 0.0001). Trust in telemedicine significantly increased after the consultation (Wilcoxon p < 0.00001). Satisfaction did not differ by gender (p = 0.79) or age group (p = 0.349). A simplified cost analysis indicated ∼66.7% lower per-visit cost compared with in-person consultations. Conclusions:Mobile teleconsultations for hypertension management were feasible, well accepted, and associated with a significant improvement in patient trust among rural populations. Targeted efforts to improve digital literacy and connectivity could enhance equitable adoption. Early economic signals support integrating teleconsultations into routine rural health care services.
Background: Geriatrics specialists are scarce but needed to provide comprehensive, individualized care to older rural Veterans with complex needs. Tele-geriatrics and geriatric mental health (tele-GGMH) services, where clinicians provide specialized consultation and/or time-limited care to residents of a wide geographic area via telehealth, can help meet these needs. Clinicians referring Veterans patients to tele-GGMH services were surveyed to understand their reasons for requesting consultations and satisfaction with services provided.Methods: Veterans Health Administration clinicians from seven regions referring to tele-GGMH services between October 2021 and September 2023 completed the survey. Qualitative and quantitative analyses summarized referring clinicians' experience and satisfaction with tele-GGMH services. Differences between rural- and nonrural-serving clinicians and prescribing and nonprescribing clinicians were examined.Results: Sixty-nine clinicians responded. Most learned about the tele-GGMH services via word-of-mouth and believed the service increased access to geriatric mental health care. Follow-through with specialists' recommendations was associated with satisfaction, however nonprescribers and nonrural clinicians had decreased follow-through linked to lower satisfaction. Qualitative data indicated that the top reasons clinicians asked for consultation was to request specific services including subcategories of diagnostic clarification or evaluations, medication management or recommendations and nonpharmalogical interventions. The most frequent barrier reported was postservice barriers implementing the recommendations. Most additional feedback was of general satisfaction and appreciation.Conclusions: Tele-GGMH services are appreciated by referring clinicians and facilitate access to geriatrics expertise. Ability to follow through with the specialist's advice predicted satisfaction with the service. Receiving assistance with specific services was the most frequent reason for requesting services.
Background: The TeleWound Practice Program (TWP) is an evidence-based, coordinated national effort to deliver technology-enabled wound care services to Veterans with chronic wounds. To inform implementation across the Veterans Health Administration (VHA), we used the Practical, Robust Implementation and Sustainability Model (PRISM) to examine Veteran and TeleWound health care provider perspectives of the TWP to identify early lessons learned.Methods: We conducted semistructured interviews informed by the PRISM with Veterans who received TWP care and TWP providers, investigating experiences with and perceptions of TeleWound care and the perceived impact of the TWP on patient outcomes. We used PRISM constructs to organize emerging themes to describe patient- and provider-level factors relevant to implementation.Results: Fifteen Veterans and seven providers participated. Both Veterans and providers reported positive experiences, to date, with the TWP and saw many tangible benefits associated with its implementation, including improved Veteran access to high-quality wound care and more efficient, convenient care with fewer costs incurred by both Veterans and the VHA health care system. Both groups suggested that preparing Veterans for TWP encounters was critical. Despite many common themes between Veterans and providers, we learned of several unmet needs and suggestions unique to the Veteran or provider experience. Veterans noted that their unique clinical needs were not always met or easily accounted for through the TWP's remote modalities, highlighting a need for technical support. Providers reported that increased administrative burden and lack of buy-in among leadership and other providers impeded implementation.Conclusion: Findings suggest that it will be essential to (1) acknowledge and build on patients' and providers' positive experiences with TWP; (2) address Veteran-level needs and suggestions, and consider individual clinical needs and preferences when deciding if TWP is the best approach for their wound care; and (3) address unmet provider-level needs (e.g., securing leadership buy-in) to support implementation.
Introduction: Access to specialist care remains a major challenge in rural and remote areas of Canada. Virtual Hallway is a secure digital platform that enables timely, provider-to-provider telephone consultations between primary care providers (PCPs) and specialists. This study evaluates satisfaction and effectiveness of the platform in Prince Edward Island (PEI), a small, rural province, across two time points to assess its sustained impact and usage patterns.Methods: A cross-sectional survey was conducted during two periods in 2024. PCPs were invited to complete postconsultation surveys, which assessed user satisfaction, in-person referral avoidance, and motivations for specialist selection. Descriptive statistics and chi-square tests were used for analysis.Results: Survey data included 181 postconsultation responses. Referral avoidance remained high (85% and 75% at time points 1 and 2, respectively). User satisfaction was consistently high among both PCPs (98%-100%) and specialists (92%-98%). PCPs reported improved care quality even when referrals were not avoided. Over time, specialist selection shifted from local availability to unmet specialty access within PEI (p = 0.03), suggesting increased use for complex cases.Conclusion: The Virtual Hallway platform demonstrated sustained effectiveness in improving access to specialist care and reducing in-person referrals in a rural province. These findings support broader implementation of virtual peer-to-peer consultation platforms to address access disparities across Canada.
Background: There is a plethora of technologies used in the rapidly expanding field of telemedicine, with tele-intensive care units (TICUs) being a specialty with rather distinct needs and challenges. Technology is a crucial aspect of TICU collaboration to ensure high-quality telemedicine consultations in clinical routines.Methods: We conducted a feedback survey to assess the technical performance within our international TICU network. The survey, addressing medical staff that regularly participates in telemedicine rounds, was designed to specifically assess the technical performance of a TICU system. In detail, usability, perception of audio-visual quality, and user acceptance were evaluated.Results: The results show a positive evaluation by the vast majority of participants, with only minor differences between countries. Potential for improvement was identified in multiple domains closely linked to contextual factors.Discussion: The perception of telemedicine technology performance was promising and will guide further research to enhance technological acceptance and optimize TICU networks for widespread use.
Introduction: Telemedicine can be a vital tool for increasing health care access in dermatology. While dermatologists' perceptions about telemedicine are critical for adoption; unfortunately, there is scant research on perceived usefulness, ease of use, and intention to use telemedicine-and factors associated with these perceptions-among dermatologists. With comprehensive reimbursement for tele-dermatology through its National Health Insurance, Taiwan offers a unique environment to study these critical adoption factors among dermatologists. Methods: A cross-sectional survey of dermatologists, developed based on the Technology Acceptance Model, was conducted between March and June 2022. Descriptive statistics were used to describe current use and perceptions. Multivariate generalized linear regressions were used to identify factors associated with perceptions on and intention to use tele-dermatology. Results: Among the 88 dermatologists surveyed, 60% reported prior use of tele-dermatology, and 77% noted that COVID-19 increased their willingness to use. Compatibility with current work practices was associated with greater perceived usefulness (beta = 0.369; p = 0.015). Personal self-efficacy was associated with greater perceived ease of use (beta = 0.339; p = 0.003). Finally, greater behavioral intention to use was associated with organizational facilitating conditions (beta = 0.297; p = 0.005) and administrative policy and regulations (beta = 0.425; p < 0.001). Conclusions: The perceived usefulness of tele-dermatology was associated with compatibility with dermatologists' current work practices, while ease of use was associated with their self-efficacy. Despite the low perception on usefulness or ease of use, dermatologists' intention to use tele-dermatology was influenced by facilitating conditions and external policies. Policy makers should prioritize maintaining supportive regulatory environments and enhancing organizational facilitating conditions.
Rationale: Respiratory muscle dysfunction is a common sequela in long coronavirus disease (COVID). Inspiratory muscle training (IMT) can improve inspiratory muscle strength, endurance, functional capacity, and dyspnea. However, evidence supporting its effectiveness through telerehabilitation remains limited. Objective: To evaluate the effects of a supervised, home-based telerehabilitation IMT program on inspiratory muscle performance, dyspnea, and functional capacity in individuals with long COVID. Methods: This prospective quasi-randomized controlled study enrolled patients with long COVID, assigned to either an IMT group (12 weeks of supervised telerehabilitation) or a control group (usual care). Baseline and after 12-week assessments included dyspnea (baseline dyspnea index/transitional dyspnea index [TDI]), pulmonary function, sustained maximal inspiratory pressure, inspiratory muscle endurance test, and functional capacity (1-min sit-to-stand test). Results: A total of 53 individuals were enrolled. Baseline inspiratory muscle performance was comparable between the groups (p > 0.05). After 12 weeks, the IMT group showed significant improvements compared with controls in maximal inspiratory pressure (+31.6 cmH(2)O [95% confidence interval {CI}: 25.0-38.2] vs. +6.7 cmH(2)O [-6.1-19.5]; p < 0.01) and endurance time (+52.8 sec [17.3-88.2] vs. -9.5 sec [-90.3-70.1], p = 0.04). Dyspnea decreased significantly with clinically relevant improvements in all TDI domains (p < 0.001). No between-group differences were observed in lung function or functional capacity. Conclusion: A supervised, telerehabilitation IMT program is a safe, feasible, and low-cost intervention that improves inspiratory muscle strength, endurance, and dyspnea in patients with long COVID following severe infection. These findings support the use of supervised telehealth approaches to enhance respiratory muscle performance.
