Objectives Post-pandemic telemedicine in Spain shows a divergence: use has fallen while patient satisfaction has risen. We examine this paradox and its implications for digital health policy. Methods Sequential mixed-methods design. Phase 1 analysed individual-level microdata from four waves (2022–2025) of the nationally representative Spanish Health Barometer using Cochran-Armitage tests and survey-weighted logistic regression, including covariate-adjusted models. Phase 2 comprised semi-structured interviews with ten purposively sampled physicians (eight hospital specialists, one primary care paediatrician and one out-of-hospital emergency physician), interviewed as key informants, analysed with constructivist grounded theory coding procedures in ATLAS.ti 23. Results Remote care use fell from 32.2% to 19.2%, while satisfaction among telephone users rose from 42.3% to 67.1%; both trends were virtually unchanged after adjustment for age, sex, chronic illness and education. Video consultation never exceeded 0.2% of most recent primary care consultations. Physicians described telemedicine as most valuable for monitoring stable, known patients, structurally limited by the absence of physical examination, and constrained by missing video infrastructure, shared records and legal rules. Conclusions The findings are consistent both with a shift from emergency-era mass use toward more clinically targeted use and with better-organised telephone consultations, which the data cannot distinguish. The interviewed physicians defined the clinical scope of remote care. Remote care in Spanish public primary care remains almost entirely telephone-based. The interviewed physicians identified video infrastructure, shared patient records, clear legal frameworks and digital health literacy as conditions for wider remote care, which warrant evaluation as policy priorities.
Background Older adults with mild cognitive impairment (MCI) may face specific challenges in vaccination counseling related to communication, memory retention, and health literacy. Voice-based artificial intelligence (AI) tools may offer a complementary approach to vaccination information in primary care. We developed AVA, a voice-based large language model (LLM) assistant designed to support vaccination counseling regarding seasonal influenza. Methods We used a three-stage co-design approach to develop a rapid prototype of AVA. An early stakeholder process evaluation was conducted with general practice teams and citizen representatives of the Bavarian Research Practice Network (BayFoNet). Semi-structured interviews and a focus group explored perceived implementation factors, guided by the Consolidated Framework for Implementation Research. A post-use survey explored stakeholders’ expectations regarding the potential impact of AVA on vaccination readiness among older adults with MCI. Results Stakeholders perceived AVA’s non-judgmental and empathetic communication style, provision of comprehensive information in simple language, and availability without time pressure as potential facilitators. Barriers included limitations in interacting with people with more severe cognitive impairment, the need for transparent communication about AVA’s identity and role, and organizational barriers to access vaccination. Survey responses indicated varying expectations regarding AVA’s potential impact on vaccination readiness. Conclusion The findings provide early stakeholder-based insights into the potential use and implementation requirements of a voice-based AI assistant for vaccination counseling. Field studies involving the target population are required before conclusions about its suitability, safety, or effectiveness can be drawn.
Neurological disorders are the leading cause of disability worldwide, yet access to advanced neurodiagnostic technologies remains highly uneven. Magnetoencephalography (MEG) provides non-invasive millisecond-resolved measurement of neuronal activity and complements electroencephalography and magnetic resonance imaging. However, MEG infrastructure remains concentrated in the Global North, reflecting the cost, maintenance, and facility requirements of conventional systems. Our source-audited census identified 155 publicly verifiable operational human-MEG facilities across 29 countries or economies, of which 28 (18.1%) were in the Global South; our search identified no publicly verifiable operational human-MEG facility in Africa. Population-normalised availability was approximately 0.40 facilities per 100 million people in the Global South compared with 9.41 per 100 million in the Global North. Recent advances in room-temperature MEG, including optically pumped magnetometers and emerging solid-state approaches, may reduce infrastructure barriers to deployment, broaden participation in MEG research, and expand clinical capacity. However, technological adoption alone does not ensure equitable access. We therefore propose a policy framework centred on global alignment, regional demonstration networks, and sustained local capacity building to help ensure that next-generation MEG contributes to more equitable neurological care and neuroscience participation.
Objectives To analyze surgical waiting times in Spanish public hospitals and assess the influence of healthcare resources, service activity, and regional organization on delays. Methods Administrative data on surgical waiting times across Spanish regions were analyzed using Generalized Additive Models for Location, Scale and Shape (GAMLSS), allowing flexible modeling of non-normal distributions. The econometric model includes explanatory variables such as region, waiting list size, average length stay, number of surgeries, study year, public hospital expenditure per capita, the number of doctors, nurses, hospitals, beds, and operating rooms. The analysis also examined the effect of Spain’s decentralized healthcare system on regional inequalities using the Coefficient of Variation and the Concentration Index. Results Traditional resource indicators are not significantly associated with surgical waiting times in the aggregated regional data analysed. By contrast, region, waiting list size, number of surgeries, and study year play an important role in determining surgical waiting times. In addition, the Concentration Index indicates that longer waiting times are concentrated in regions with lower hospital expenditure per capita. Conclusions Surgical waiting times in Spain are driven primarily by regional factors and demand pressures rather than basic resource availability. Furthermore, decentralization was not associated with increased regional inequalities over the study period, with evidence of a trend towards greater interregional equity. These findings suggest that increasing staffing or infrastructure alone may be insufficient to reduce delays, while organizational and governance factors appear to play a key role in the regional management of surgical waiting times.
Background In May 2022, during the Omicron surge, Taiwan implemented a strict "triage policy for mild and severe cases", directing severe cases to hospital care and mild cases to community-based telemedicine. Unlike permissive deregulation elsewhere, the policy combined mandatory, population-scale case separation with full National Health Insurance reimbursement and a defined activation date. Objective To evaluate implementation of Taiwan's community triage policy and telemedicine adoption, focusing on procedural challenges and enabling factors. Methods We conducted a convergent mixed-methods study. Cross-sectional citizen surveys were conducted before (January-March 2022) and after (October-December 2022) policy implementation and analyzed using multivariable logistic regression. Two physicians were interviewed retrospectively in May 2023, using a semi-structured guide prepared in advance, about discussions in three professional physician groups during April 2022-April 2023. Findings were integrated at the interpretation and reporting stages using MAST, TAM2, and Kingdon's policy-window theory. Results Among 797 survey respondents, telemedicine use was 8.8% before the policy and 34.5% after it (adjusted OR 5.90, 95% CI 3.70–9.41). In-person visits for administrative procedures remained common among users and unchanged across periods (30.0% vs. 31.2%, p = 0.889), while fewer users reported three or more consultations in Survey 2 (26.3% vs. 51.1%, p = 0.005). Interviewees described increased administrative burden and operating costs without proportional reimbursement. Conclusions Telemedicine use expanded rapidly during the policy period, but persistent administrative barriers indicate that rapid adoption did not amount to institutional integration. The design does not permit causal attribution. Sustainable implementation is likely to depend on end-to-end workflow digitization and adequate reimbursement. Public interest summary In May 2022, during a large COVID-19 outbreak, Taiwan asked people with mild illness to consult a doctor by video or telephone in their own community, so that hospitals could concentrate on severely ill patients. These consultations were fully paid for by the national health insurance system.We surveyed 797 members of the public before and after this policy, and interviewed two doctors about what colleagues had discussed in their professional groups.Telemedicine use was nearly four times higher after the policy than before. However, about one in three users still had to travel to a clinic afterward to pay, present an insurance card, or collect medicine, and this did not improve over time. Doctors reported more paperwork and higher running costs without extra payment.Moving the consultation online is not enough on its own. The steps around it must move online too.
