Background: We evaluated whether structured teleoncology could support the safe and affordable delivery of systemic oncology treatment at a provincial Angolan hospital without such installed capacity previously. Methods: Retrospective cohort study at Lubango Central Hospital (HCL), Angola, as a proof of principle, September 2024–May 2025. The initial analysis covered 85 patients discussed at a multidisciplinary tumor board (MTB) by videoconference; a second analysis assessed safety, outcomes, and costs in 23 patients treated at HCL. Efficacy was judged against palliative-intent indicators. Results: In a cohort presenting overwhelmingly with advanced disease (87.0% stage III–IV), 93 cycles were delivered under remote supervision with no preparation errors, no contamination, no grade 4–5 adverse events (95% confidence interval 0–4.0%), no toxicity admissions, and no treatment-related deaths. Course completion reached 89.5%. The MTB processed 156 consultations and met all technical and operational targets; grade 1–3 events occurred in 16.1% of cycles, and partial remission reached 52.6%. Symptom onset to first presentation had a median of 6 months (range 1–11.7); the program-attributable interval was 1–2 weeks. Unit cost was 223,000 US dollars (USD); the drug cost was 251.93 USD per patient, against 643–794 USD averted per course in travel, lodging, and subsistence, and 533 USD per cycle in personnel costs (base salary). Conclusions: This program showed that systemic treatment under remote supervision was delivered safely and feasibly without a resident medical oncologist, with household savings of two and a half to three times the drug cost. This proof of principle suggests that the model may be workable elsewhere, though the small sample and absence of a control group limit firmer conclusions.
Introduction: Teledentistry expanded rapidly during COVID-19-related dental clinic closures, yet long-term utilization patterns, associated procedures, and patient characteristics remain insufficiently described. This study characterized teledentistry encounters by patient demographics and diagnoses and evaluated shifts in claim volumes and procedure patterns during and after clinic shutdown. Methods: A retrospective analysis evaluated 375 teledentistry claims from 288 patients at a university dental clinic (March 2020–April 2024). Change-point detection identified structural shifts in weekly claim volume. Independent t- tests and chi-squared tests compared demographics and procedure prevalence between periods. Encounters were linked to the most recent diagnoses within 90 days. Results: Most patients (83.7%) used teledentistry once. Claims peaked during shutdown (1.34/day) and declined thereafter (0.165/day). After the detected breakpoint in November 2020, average weekly claims decreased from 6.8 to 0.76. Limited oral evaluation was more common during shutdown than after (96.1% vs. 82.6%; p < 0.001). Post-shutdown patients were younger (mean age 37.8 vs. 42.7 years; p = 0.042), with no difference in sex ( p = 0.28). Teledentistry services were more often covered by insurance post-shutdown (91.6% vs. 77.0%; p < 0.001). Common diagnoses included benign oral lesions and temporomandibular disorders. Conclusion: Teledentistry utilization surged during clinic closures but stabilized at low volumes post-reopening. While these findings specifically reflect United States health care billing and clinic environments, the predominant reliance on teledentistry for limited evaluations and select diagnostic groups highlights targeted opportunities for virtual care. As noted in the broader literature, future efforts to support sustainable integration will rely on continued technological advancements and educational initiatives for patients and health professionals.
Background: The Personalized Implementation of Video Telehealth for Rural Veterans Team facilitated adoption of video telehealth for mental health care in rural facilities within the U.S. Department of Veteran Affairs (VA). It adapted several qualitative methods to support a multisited, multiyear telehealth implementation project. This paper details this work, providing guidance on how qualitative methods can be pragmatically used to support implementation of video telehealth. Methods: Three main qualitative activities were used to support implementation of video telehealth: interviews, integrated periodic reflections, and Rapid Reviews. The qualitative team consisted of two qualitative methodologists. From 2020 to 2023, needs-assessment interviews were conducted with site partners at 17 different VA medical centers. One-year post interviews were conducted with 15 site partners in 2020–2022. Integrated periodic reflections with the implementation team occurred twice a month from 2020 to 2024. From 2020 to 2024, the qualitative team created quarterly Rapid Reviews for active site partners. The number of periodic reflections created each quarter fluctuated from 5 to 12 during this time. Results: The qualitative activities and products presented here were used to support the implementation of video telehealth for mental health across multiple VA facilities. Methods were adapted to reduce burden for partners in rural areas. Qualitative activities supported practical use of information, helping all parties to understand how to continuously improve their activities for better mental health access. Conclusions: The implementation of other innovative technologies for mental health faces many of the same challenges as video telehealth. Qualitative methods can support communication and increase likelihood of successful implementation.
Background: Telehealth, remote monitoring, and other digital interventions may support chronic disease management, but evidence from Latin America and the Caribbean (LAC) remains fragmented. We evaluated clinical effectiveness and characterized human support, clinical integration, and implementation. Methods: PubMed, Scopus, SciELO, and LILACS were searched through July 2026 for studies of digital interventions in adults with type 2 diabetes or hypertension in LAC. Random-effects meta-analyses were restricted to randomized trials and used restricted maximum likelihood estimation, Hartung–Knapp adjustment, and 95% prediction intervals (PIs). Evidence certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Results: Thirty-six studies (41 reports) from 12 countries were included: 15 randomized and 21 nonrandomized. Six trials ( n = 689) showed lower HbA1c (mean difference [MD] −1.23 percentage points; 95% confidence interval [CI] −2.19 to −0.26; I 2 = 83.8%; PI: −3.64 to 1.18). Seven trials ( n = 2,280) showed lower systolic blood pressure (SBP; MD: −4.97 mmHg; 95% CI: −7.15 to −2.79; I 2 = 26.1%; PI: −8.85 to −1.09), and five ( n = 1,825) showed lower diastolic blood pressure (DBP; MD: −3.46 mmHg; 95% CI: −5.69 to −1.22; I 2 = 76.1%; PI: −9.24 to 2.33). Certainty was moderate for SBP and low for HbA1c and DBP. Professional support and clinical integration were common, whereas sustainability, scalability, interoperability, costs, and equity were inconsistently evaluated. Conclusions: Digitally enabled chronic care may improve glycemic and blood-pressure control in LAC, with the most consistent evidence for SBP. Heterogeneous intervention models and limited implementation evidence warrant comparative effectiveness–implementation studies.
