Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionTelemedicine, propelled by recent technological advancements, has transformed healthcare delivery, notably benefiting patients with chronic non-communicable diseases (NCDs) such as systemic arterial hypertension and diabetes mellitus. This meta-analysis of randomized clinical trials aimed to assess the efficacy of telehealth-based interventions on disease control rates and clinical parameters among NCD patients, including systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) levels.MethodsWe conducted searches in PubMed, Scopus, Web of Science, and the Cochrane Database for interventional studies that compared tele-monitoring with usual care in patients with hypertension and type 2 diabetes mellitus. Odds ratios with 95% confidence intervals (CIs) were computed.ResultsOur meta-analysis included 75 studies, encompassing a total of 106,261 patients, with 50,074 (47.12%) receiving usual care and 56,187 (52.88%) receiving tele-monitoring care. The telemedicine group was associated with a statistically significant reduction in SBP (mean difference (MD) −4.927 mmHg; 95% CI −6.193 to −3.660; p < 0.001; I² = 90%), DBP (MD −2.019 mmHg; 95% CI −2.679 to −1.359; p < 0.001; I² = 54%), FBG (MD −0.405 mmol/L; 95% CI −0.597 to −0.213; p < 0.001; I² = 32%), and HbA1c (MD −0.418%; 95% CI −0.525 to −0.312; p < 0.001; I² = 76%).ConclusionsOur meta-analysis shows that telehealth technologies notably enhance blood pressure and blood glucose control. This supports integrating telemedicine into clinical protocols as a valuable complementary tool for managing hypertension and diabetes mellitus comprehensively.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundThe COVID-19 pandemic led to widespread adoption of telemedicine, which has persisted in healthcare delivery.ObjectiveWe aimed to characterize telemedicine use in ambulatory cardiology clinics over two years following the onset of the COVID-19 pandemic.MethodsRetrospective cross-sectional study from 16 March 2020 to 27 June 2022 in a single-center ambulatory cardiology clinic and telemedicine visits. Mixed effects logistic regression was used to model the association of diagnosis class (based on International Classification of Disease 10th Revision codes) with whether an encounter was scheduled as telemedicine, adjusting for age, sex, race, ethnicity, date, and zip code. This was performed for telemedicine and in-office encounters across 15 University of California Los Angeles (UCLA) Health System ambulatory cardiology clinics.ResultsThe analysis included 76,127 patients (49.60% women, age 61.5 ± 17.30 years, 57.27% white, 12.25% Hispanic, 81.79% with zip code in a UCLA Health service area) over 255,674 encounters. Each patient had a median of two encounters (range 1–81). Of all encounters, 29,154 (11.40%) were scheduled as telemedicine. Telemedicine was more likely used in the management of chronic conditions, especially metabolic disorders (adjusted OR [aOR] 2.36, 95% CI 2.19–2.54) and cardiomyopathies (aOR 2.16, 95% CI 1.99–2.34), than for evaluation of undifferentiated signs/symptoms. Telemedicine was less likely used for general exam/screening (aOR 0.49, 95% CI 0.44–0.56) and heart transplant (aOR 0.51, 95% CI 0.40–0.64).ConclusionAmong the outpatient encounters in this study, the most established use case for telemedicine in cardiology was for care of chronic cardiovascular conditions among nontransplant patients, suggesting that future telemedicine expansion should be targeted toward the most appropriate clinical scenarios.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>AimsTo assess whether telemonitoring improves outcomes in patients with chronic heart failure.Methods and resultsA literature search was conducted on studies of randomized controlled trials involving non-invasive telemonitoring and heart failure using Medline, Embase, and Cochrane Library. The primary outcomes were all-cause mortality, all-cause hospitalization, and hospitalization for heart failure. Secondary outcomes were length of stay, health-related quality of life as assessed by validated questionnaires, healthcare costs and cost-effectiveness, and self-care behaviors. We performed a meta-analysis using a random effects model for the primary outcomes. The effect measure was odds ratio with corresponding 95% confidence interval, and heterogeneity among studies was assessed using the Higgins I2 value. We screened 212 references, and 34 randomized controlled trials were included in this review. A total of 16179 participants with heart failure were included. Non-invasive telemonitoring reduced all-cause mortality by 18% (OR 0.82, 95% CI 0.71 to 0.95; participants = 15,211; studies = 28; I2 = 34%; GRADE: moderate-quality evidence) and heart failure hospitalization by 20% (OR 0.80, 95% CI 0.69 to 0.94; participants = 7491; studies = 18; I2 = 31%; GRADE: moderate-quality evidence). Non-invasive telemonitoring didn’t demonstrate significant benefit on all-cause hospitalization (OR 0.93, 95% CI 0.82 to 1.05; participants = 11,565; studies = 25; I2 = 49%).ConclusionTelemonitoring programs in patients with heart failure were associated with a reduction in all-cause mortality and heart failure hospitalization without harmful events.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionIn obstetrics, telehealth is widely used in the provision of prenatal and postpartum care. The objective was to compare the utilization of commonly recommended services after delivery among individuals receiving telehealth versus in-person postpartum care.Study DesignWe performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 1 July 2020 and 30 June 2023. The primary exposure was the exclusive use of telehealth versus an in-person visit for postpartum care. Two primary outcomes were assessed between 0 and 365 days after the delivery: 1) long-acting reversible contraceptive (LARC) method use and 2) pap smear screening. Secondary outcomes occurring between 0 and 365 days after delivery included: clinic-based weight assessment, clinic-based blood pressure assessment, any prescription contraception use, primary care visit, and pregnancy within 1 year.ResultsAmong the 9953 individuals, 9058 (91.0%) had a postpartum visit. 1811 (19.9%) utilized telehealth exclusively, which peaked during the COVID-19 pandemic. Exclusive telehealth users were less likely to have a pap smear (21.6 vs. 40.1%, p < 0.001) or use LARCs (8.6 vs. 19.4%, p < 0.001) than those receiving in-person care. In the adjusted analysis, the odds ratio for receiving a pap smear was 0.38 (95% confidence interval [CI] 0.32–0.47) and for using a LARC was 0.38 (95% CI 0.31–0.47) when comparing telehealth to in-person care. Reduced odds of all secondary outcomes were seen in the exclusive telehealth use compared to the in-person cohort, with the exception of subsequent pregnancy within 1 year, which was not significantly different.DiscussionAcknowledging that telehealth now has become an important means for patients to access medical care, these findings should prompt clinicians to consider when an in-person postpartum visit should be offered or recommended over telehealth, especially when a patient may not have a preference or reported barriers to accessing an in-person visit.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>Telemedicine is comparable in quality to in-person care, adequate for many primary care concerns, acceptable to patients, and can overcome barriers to care. However, patients are reluctant to pay the same for telemedicine as in-person care and uncertainty about future payor reimbursement makes it risky to base a clinical practice primarily on telemedicine. Physical exam-supported information collection and relationship-building are limited in telemedicine, but can be mitigated through remote patient monitoring and ample access to a provider and clinical team. Subscription-based direct primary care models disconnect payment from episodes of care, which can support enhanced communication between the patient and care team and support time for asynchronous tasks such as remote patient monitoring data review. A “telemedicine first, direct primary care” model in which most care is provided through telemedicine and financed via subscription would retain the convenience of telemedicine, mitigate relationship-limiting deficiencies due to the lack of physical contact, and provide a stable revenue stream to support a telemedicine-based approach to care. Paired with specialist access via eConsults and options to refer to in-person care when necessary, this model would support telemedicine as the foundation for practice and connect underserved populations to primary and specialty care.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionThe COVID-19 pandemic dramatically affected the financial performance of hospitals across the U.S. The prompt availability of telehealth options likely impacted both a hospital's healthcare options and opportunities for revenue in the short-term. The aim of this study was to explore the association between early adoption of telehealth and changes in revenue during the early phase of the pandemic, and to compare whether the results differed between rural and urban hospitals.MethodsWe performed first-difference regressions on a cross-sectional dataset of 1,742 U.S. hospitals. Our dependent variables were percent changes in four categories of revenue between 2019 and 2020: inpatient, outpatient, gross, and net. The adoption of telehealth and remote patient monitoring as of 2019 served as the primary independent variables of interest. We controlled for changes in hospital characteristics from 2019 to 2020, including case mix index and number of employees.ResultsOur results suggest that telehealth adoption prior to the COVID-19 pandemic was associated with significant increases in all four revenue categories from 2019 to 2020, ranging from 1.79% (net patient revenue) to 2.92% (outpatient revenue). However, RPM implementation in 2019 was associated with significant declines in gross patient (0.08%) and outpatient revenue (1.50%). The results were largely similar across rural and urban locations.DiscussionAdopting telehealth before the onset of COVID-19 helped hospitals increase revenue during the initial phase of the pandemic. Alternatively, implementation of remote patient monitoring was associated with revenue declines, likely due to limited ability for monetization. Whether these relationships have persisted needs further investigation.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionThe rapid evolution and implementation of virtual care technologies for clinical use often exceeds the development of standardized implementation protocols, leading to gaps in the equitable and sustainable adoption of virtual care services, particularly in rural and remote areas. This paper introduces a comprehensive evaluation tool designed to assess community capacity and readiness for virtual care.MethodsThe development of the tool was informed by experiences from the Virtual Care and Robotics Program at the University of Saskatchewan. It involved a collaborative, multi-stakeholder approach that engaged healthcare leaders, IT experts and community healthcare workers. This iterative process included defining evaluation categories, mapping evaluative domains and refining the tool into a user-friendly checklist manual.ResultsThe tool identifies three key domains for assessing readiness: clinical needs, technology infrastructure and human resources/workflows. It was piloted in the remote community of Fond du Lac, Saskatchewan, where it successfully qualified the community for implementing telerobotic ultrasound services. The tool facilitated local engagement and highlighted the community's specific needs and readiness, enhancing the implementation process.ConclusionThis evaluation tool contributes to bridging the gap between the rapid deployment of virtual care technologies and the need for comprehensive, standardized implementation protocols. It offers a structured, practical approach to assessing and enhancing community readiness for virtual care while promoting successful clinical implementation and equitable access to healthcare.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundInadequate counseling at patient discharge from the emergency department can lead to adverse patient outcomes. Virtual discharge counseling can address gaps in discharge counseling and improve patients’ understanding of instructions.MethodsA previously established virtual discharge counseling program was scaled across three emergency departments and expanded to 13 diagnoses. Utilizing a standardized protocol and script, counselors performed virtual discharge counseling via a remote, secure teleconference platform in the patients’ preferred language.ResultsVirtual discharge counseling was performed with 166 patients. COVID-19, back pain, and headache were the most frequent diagnoses. The median counseling time was 14 min. Median counseling time for English was 11 min, versus 20 min for other languages (p < 0.001). Counseling times were the longest for COVID-19 and diabetes (18 min for each).ConclusionWe demonstrate the scalability of a virtual discharge counseling program. Our findings can assist in targeting virtual discharge counseling resources for limited English-proficiency patients and specific diagnoses that require longer counseling times.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionElectronic consultations (eConsults) have been implemented by numerous academic medical centers (AMCs) to improve communication and address access to specialty care. As these models proliferate, we must understand their comparative benefit and use in various settings.MethodsThis retrospective, descriptive analysis compares eConsult utilization trends at an AMC that has deployed an internal effort and an external pivot. Relevant metrics are presented using counts and proportions or median and range where appropriate.ResultsThe internal AMC program demonstrated sustained growth from years 1 through 6, while the external pivot demonstrated considerable growth in year 1, followed by a steady decline in subsequent years. Endocrinology generated the highest number of eConsult orders in both programs (AMC 21%, external pivot 16%). Conversion rates to in-person visits were higher in the external pivot (22%) than in the internal AMC program (14%). Median response time across all specialties was faster (17 hours) for the AMC program than the external pivot (23 hours). The median number of eConsults ordered by any single primary care provider was 3 in both programs. The percentage of providers using the eConsult ordering system only once was approximately 30% in both programs. eConsults were primarily ordered by physicians (68%) at the AMC and physician assistants (40%) in the external pivot.DiscussionThe current study highlights similarities and differences between internal and external eConsult programs that can inform future “right-sizing” of care according to patient needs while promoting local care delivery and improving efficiencies at the AMC.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>ObjectivesTo explore patients’ preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals’ assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care.MethodsA cross-sectional survey was conducted among patients with an in-person consultation at the outpatient clinic for internal medicine and among healthcare professionals who treated the patients. The prevalence of preference was determined using descriptive statistics based on cross-tabulated frequencies. Percentages are presented with 95% confidence intervals (95%CI).ResultsIn total, 218 patients (response rate 67%) completed the questionnaire; 79 patients (36%) preferred a virtual consultation (95%CI: 30%–43%); telephones were the most popular and preferred by 72 patients (33%; 95%CI: 27%–39%) followed by video preferred by 54 patients (25%; 95%CI: 19%–31%). Regarding contextual factors, male gender and previous experiences with telephone or video consultations were statistically significant predictors in favour of virtual consultations. Healthcare professionals estimated that 58 consultations (21%; 95%CI: 17%–26%) could have been conducted virtually with the same professional and clinical quality as the current in-person consultations.ConclusionsCurrent practice does not fully align with patient preferences for virtual visits in internal medicine outpatient clinics. Patients should be given the choice of virtual consultations whenever they are deemed professionally and clinically possible to enhance patient autonomy and satisfaction, while being mindful of speciality-specific considerations.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionSeveral barriers can preclude people with type 2 diabetes (T2D) from in-person exercise session participation. Telehealth may be an alternative mode of service delivery to increase uptake. We evaluated the feasibility, safety and preliminary efficacy of delivering group exercise via telehealth for people with T2D.MethodsSixteen people with T2D (age 59.9 ± 12.7 years, 63% male, duration of T2D 11.5 ± 11.1 years) underwent an 8-week telehealth-delivered group exercise intervention. Weekly supervised sessions incorporated whole-body aerobic and resistance exercises, followed by education. Feasibility was evaluated by recruitment, enrolment, attendance and attrition rates, the practicality of telehealth delivery, and participant feedback. Adverse events were monitored throughout (safety). Preliminary efficacy was determined from changes in glycaemic control, body composition, blood pressure, exercise capacity, neuromuscular strength/fitness, quality of life and physical activity levels. The agreement/reliability of in-person clinician-measured versus telehealth-supervised participant-self-measured assessments was also evaluated.ResultsFeasibility was supported by high attendance (97.1%) and low attrition (81%). All (100%) participants reported they would participate in telehealth-delivered exercise interventions in the future and would recommend them to other people with T2D. No serious adverse events were reported. There were improvements in hip circumference (Cohen's d −0.50), diastolic blood pressure (–0.75), exercise capacity (1.72), upper body strength (1.14), grip strength (0.58), health-related quality of life (0.76–0.81) and self-reported physical activity (1.14). Participant-self-measured assessment of body weight, 2-min step test and 30-sec sit-to-stand test were deemed acceptable.DiscussionTelehealth-delivered group exercise appears feasible, safe and efficacious for people with T2D. These findings warrant further exploration in a powered trial.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN12622000379718).

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundHypertension, characterized by high blood pressure, poses a significant risk for cardiovascular diseases, stroke, and heart attack. Managing it is particularly challenging in areas with limited healthcare access and for patients who cannot attend regular in-person visits. Telemedicine interventions offer a promising solution by improving patient adherence and facilitating timely treatment adjustments. This study aims to systematically evaluate the impact of these telemedicine interventions on reducing systolic and diastolic blood pressure.MethodsA comprehensive search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. Two independent reviewers screened and selected eligible articles, extracting key data using a standardized form. The quality of the included studies was assessed with the Mixed Methods Appraisal Tool (MMAT). A random effects model was used to combine the results, with treatment effects measured using standardized mean differences (Hedges's g). Consistency of findings was evaluated through statistical tests, including the Q test and I² statistic, to assess heterogeneity. Data analysis was conducted using Stata statistical software version 17.0.ResultsOf the 2700 articles retrieved, 35 studies were selected for inclusion in the analysis. Using a random-effects model, the overall effect size was Hedges's g = −0.22 (95% CI: −0.30 to −0.15; p-value < 0.001), indicating a small but meaningful reduction in blood pressure (systolic and diastolic). Telemedicine interventions had a greater impact on systolic blood pressure (Hedges's g = −0.27, 95% CI: −0.39 to −0.15; p-value < 0.001) compared to diastolic blood pressure (Hedges's g = −0.17, 95% CI: −0.26 to −0.07; p-value < 0.001), though both reductions were clinically relevant.ConclusionThis study demonstrates that telemedicine interventions significantly reduce both systolic and diastolic blood pressure, with a more pronounced effect on systolic pressure. The overall effect size indicates a small but meaningful improvement in hypertension management. These findings highlight the potential of telemedicine as an effective strategy for enhancing patient outcomes in hypertension care.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionVirtual care and remote monitoring were widely used during the COVID-19 pandemic. However, early evaluations of effectiveness were often inconclusive due to low rates of enrolment and limited data. The aim of this study was to evaluate the effectiveness of virtual care in managing individuals in community-based self-isolation and quarantine in Australia during this pandemic.MethodsA retrospective cross-sectional study was conducted of individuals admitted to a virtual hospital in Sydney who either tested positive for COVID-19 and required self-isolation, or tested negative but still needed to self-isolate, amidst the Delta wave of the COVID-19 pandemic. Outcome measures included health service utilisation, in-hospital mortality, patient-reported experience measures (PREM), and cost savings resulting from avoided emergency department (ED) presentations.ResultsOut of 9571 individuals admitted, 8544 (89.3%) had COVID-19. Clinical deterioration or acute illness occurred in 2477 (25.9%) individuals, of whom 890 (9.3%) were referred to ED for further assessment or investigation, and 614 (6.4%) were admitted for inpatient treatment. Overall mortality was 0.2%. Out of 1020 individuals who completed the PREM survey, 846 (82.9%) rated the overall virtual care experience as ‘good’ or ‘very good’. Avoided ED presentations possibly resulted in cost savings estimated between AU$691,214 and AU$2,994,540.ConclusionVirtual care was successfully used to manage a large number of individuals in community-based self-isolation and quarantine during the COVID-19 pandemic. Scalable pathways for triage, monitoring and clinical escalation via telehealth ensured patient safety and acceptability, and alleviated strain on the broader health system.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionTelehealth has been effectively used for managing chronic disease conditions; however, utilization patterns vary across populations. This study aims to examine the prevalence of telehealth utilization, the associated factors of telehealth modality (e.g., audio, video) among patients with chronic diseases, and the role of health literacy.MethodsParticipants with at least one diagnosed chronic disease from the 2022 Health Information National Trends Survey (HINTS 6) data (n=3686) were analyzed. Differences in participant characteristics between telehealth users and non-users were compared using χ² statistics. Multinomial logistic regression models were employed to investigate factors associated with telehealth modality.ResultsAbout 52% of participants reported using telehealth in the past 12 months, with 34.7% using audio-only modality. Telehealth use was highest among participants with depression (61.6%) and lowest among those with high blood pressure (47.6%). Participants over 75 years old (OR, 3.11 [95% CI, 1.99–4.85]; P < 0.001) were more likely to use audio-only modality compared to the youngest group (18–34 years). Respondents with a higher educational level (bachelor's degree: OR, 0.77 [95% CI, 0.59–1.00], P = 0.049; post-baccalaureate degree: OR, 0.60 [95% CI, 0.43–0.82]; P < 0.001) and higher health literacy (OR, 0.81 [95% CI, 0.66–0.99]; P =0.04) were more likely to use audio-video modality compared to their counterparts.DiscussionTelehealth use varied across demographics and chronic diseases, revealing significant disparities. Elderly individuals, those with lower socioeconomic status, and those with lower health literacy tended to use the audio-only modality. Providing support for digital platforms and health literacy can empower patients with chronic diseases to effectively use telehealth for self-management.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionTelehealth is a growing part of the healthcare field, and healthcare professionals and trainees require training not only on the clinical skills relevant to telehealth but also on professionalism skills or telehealth etiquette. As healthcare outcomes are influenced by the patient-provider relationship, training healthcare professionals on telehealth etiquette skills is imperative.MethodsForty-eight healthcare professionals across different disciplines, work settings, and experience levels participated in a telehealth etiquette skills educational intervention workshop wherein their knowledge and readiness to use the skills (specific to technology, environment, confidentiality, and communication) were assessed before and after the workshop.ResultsPaired sample t-tests revealed that participating in the educational intervention resulted in statistically significant improvements in knowledge and perceived readiness to use telehealth etiquette skills pertinent to technology, environment, and communication. There were no associations between participants’ personal factors and post-educational intervention changes.DiscussionStudy findings are significant and suggest that training healthcare professionals in telehealth etiquette have a positive impact. Since there is a known positive association between provider communication and patient satisfaction and a known association between patient satisfaction and healthcare outcomes, gaining telehealth etiquette skills is critical for promoting a positive patient-provider relationship via telehealth.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>Endometriosis affects a significant portion of women during their reproductive years, causing substantial pain and impacting their quality of life. Telehealth services have emerged as a promising avenue for enhancing endometriosis care, especially in the post-COVID-19 era. For endometriosis patients, who often require frequent appointments and specialized care, telehealth offers a convenient and accessible solution, particularly for addressing pain management and interdisciplinary concerns. Despite the challenges posed by the lack of physical examinations in telehealth, studies show that it can be a viable option for endometriosis care. Integrating telehealth with in-person visits for initial assessments can build trust and ensure comprehensive care delivery. Moreover, telehealth facilitates collaboration among multidisciplinary teams, including gynecologists, psychologists, and physiotherapists, to provide holistic treatment plans addressing physical, psychological, and interpersonal aspects of endometriosis. Here, we explore the potential benefits of telehealth in managing endometriosis, highlighting its role in providing comprehensive, multidisciplinary care while overcoming barriers like diagnostic delays and limited access to specialists. Further research and integration of telehealth into routine practice are warranted to maximize its benefits and address the complex challenges associated with endometriosis management.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionMeta-analysis shows that home tele-monitoring (HTM) improves glycaemic control in patients with type-2 diabetes mellitus (T2DM) up to 12 months, but their health outcomes after HTM cessation remains unclear. This study aimed to determine the health outcomes of these patients 18 months after completing 6 months of HTM, compared to standard care.MethodsPatients with T2DM were enrolled in an open-labelled randomised controlled trial, aged 26 to 65 years, and suboptimal glycaemic control (HbA1c = 7.5%–10%). Patients in the intervention group (n = 165) undertook HTM using the OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) HTM system for 6 months followed by usual care for another 18 months, while control group (n = 165) had usual care for 24 months. The OPTIMUM HTM system includes in-app video-based tele-education, tele-monitoring of the blood pressure (BP), capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based telecare by the investigators. They were assessed using the Self-Care Inventory Scale (SCIR) and medication adherence (Medication Adherence Report Scale 5) at baseline, 6-month and 24-month time-points.ResultsThe data from 146 (intervention) and 152 (control) patients, with comparable baseline demographic profiles were eventually analysed. The decrease in HbA1c over 24 months was comparable between intervention and control group. Those in the intervention group were more likely to maintain their glycemic control (HbA1c ≤ 8%) (adjusted odds ratio (AOR) = 1.9, 95%confidence interval (CI) = 1.1–3.2; p = 0.028), had higher SCIR score (p = 0.004), and less likely to “never forget” (p = 0.022), or “stop medications” (p = 0.048), at 24-month time-point as compared to subjects in the control group.ConclusionThe glycaemic control of patients with T2DM continued to be maintained for another 18 months after 6 months of HTM, which were attributed to sustained self-care behaviour and medication adherence.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>IntroductionUkraine's health and trauma system has been detrimentally impacted since the start of the Russian invasion in February 2022. Use of telemedicine became critical to providing timely medical care. As such, the aim of this study was to describe telemedicine's use in the health and trauma system of Ukraine following the full-scale invasion.MethodsWe conducted qualitative key informant interviews with military and civilian health care workers using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on telemedicine use. Thematic content analysis was used to derive key telemedicine themes from interviews.ResultsWe conducted 36 key informant interviews. Most respondents described using telemedicine through informal means of communication such as messaging apps to meet patient care needs. Concerns and challenges with use of telemedicine included weapons targeting, internet connections and safety of communications from Russian hackers. A unified system for telemedicine would greatly improve use in country both during and post conflict.DiscussionTelemedicine use has rapidly increased in Ukraine during the current conflict particularly in the scope of providing trauma care when numerous specialties are needed. Development of a unified, secure telemedicine system with mechanisms for integrating multinational medical support would aid in providing swift medical care to persons injured in the conflict or unable to access a specialty provider in their proximity.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundThe rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions.MethodsFive dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated.ResultsTriage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty.DiscussionExpert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0–0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundThere is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services.MethodsWe searched Medline, Embase and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson's disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated.ResultsNine randomized controlled trials were included; eight evaluated video and one evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI −0.4 to 0.6, p = 0.70). For people with Parkinson's disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI −1.2 to 2.5, p = 0.49). Four trials investigated interventions for speech sound disorder, voice disorder and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery.ConclusionsEvidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson's disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction and economic outcomes.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundWhile telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations.MethodsWe included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities.ResultsOur cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5–14.9; p < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4–1.0; p < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6–1.3; p < 0.001) per 100 index encounters compared to in-person visits.ConclusionsContrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>Background and objectiveObesity and its associated health challenges represent a pressing global concern. Telemedicine interventions offer a promising solution for effective weight loss support. This study examines the impact of telemedicine interventions on weight loss support.MethodsWe conducted a search of PubMed, Scopus, and Web of Science, starting from their inception. Both researchers systematically selected articles and extracted data using a designated data collection form. To assess the risk of bias in the included studies, we employed the Mixed Methods Appraisal Tool. Publication bias was evaluated through funnel plots and Egger's and Begg's tests. Utilizing the gathered data, we computed the standardized mean differences (Hedges's g) between the treatment and control groups. We estimated heterogeneity variance using the Q test and I2 statistic. The analysis was carried out using Stata 17.0.ResultsOut of a total of 2626 retrieved articles, 30 studies were included in the analysis. Telemedicine interventions can cause weight loss in people (Hedges's g = 0.09, 95% CI: −0.13, 0.39; p-value < 0.001). The type of telemedicine intervention and target population were a significant moderator of the heterogeneity between studies (p < 0.05).ConclusionThis study highlights the potential of telemedicine interventions as valuable tools in weight loss programs. Embracing these technologies can enhance the effectiveness of weight management strategies for diverse populations.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundProviding telehealth care requires unique professionalism skills (i.e. telehealth etiquette) to ensure patients have a positive experience. Given the effect of patient–provider relationships on healthcare outcomes and the limited evidence for healthcare professionals to learn and practice these skills, developing a telehealth etiquette competency tool is necessary.MethodsThis multiround Delphi study utilized subject matter experts’ opinions to validate a telehealth etiquette competency checklist, using Lawshe's content validity measurements. Panelists were diverse in professional backgrounds, years of experience, telehealth teaching, clinical experience, and involvement in telehealth professional society and governmental policy making.ResultsConsensus and validation were achieved on the checklist by the 17 panelists in Round 1 for 19 of 20 competencies. Following revisions based on their expert opinions, consensus was achieved by all 16 panelists in Round 2 for 20 competencies.DiscussionThe Telehealth Etiquette Competency Checklist (TECC) provides a validated telehealth etiquette tool that can be used by health professionals to improve their telehealth videoconsultations, thus enhancing patient satisfaction.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>BackgroundMobile applications for mental health have the potential to aid people with mental health disorders, especially depression, by providing them with tools and coping mechanisms. Adolescents and young adults, being at risk of depressive symptoms and leading mobile users, are among the main targets of using mobile applications to alleviate symptoms.ObjectiveThis study aimed to evaluate the impact of mobile application–based psychological interventions in reducing depression symptoms in adolescents and young adults compared to those not exposed to the intervention.MethodsWe conducted a meta-analysis focusing on mobile applications for reducing depressive symptoms. We searched two databases: MEDLINE and EMBASE and included randomized controlled trials conducted in English among participants aged 18–35 years old who were assessed for depressive symptoms using a validated screening measure and used mobile applications–based psychological interventions. Two of six independent reviewers conducted study selection, data extraction, and bias assessment. A pooled mean standardized difference (Cohen's d) and 95% CI were calculated using random-effects meta-analysis. Risk of bias was assessed using I2 statistics and forest plot. Egger's test was used for assessing publication bias.ResultsAfter screening 740 references, we identified 12 trials with 1869 participants, with a mean age of participants ranging from 14.70 to 25.1 years. The interventions ranged from cognitive behavioral therapy (CBT)-based mobile apps to interactive story-telling apps and apps delivering a mix of CBT, interpersonal psychotherapy for adolescents, and dialectical behavior therapy elements. Control groups included information-only, waitlist, no intervention, and treatment as usual. Seven studies used Patient Health Questionnaire-9 (PHQ-9) to assess the severity of depressive symptoms, while the other five used different scales. There was no evidence of publication bias (p = 0.325). The mobile applications reduced depression score by 0.08 units of standardized difference more than the control, with a 95% CI of −0.19 to 0.03 (p = 0.294, I2 = 15.4%) using standardized mean difference (SMD) as the effect estimate. In a sensitivity analysis including only studies that used PHQ-9, we found a similar trend, SMD −0.72 (95%CI −1.48 to 0.03). However, both findings were not significant.ConclusionsCurrent evidence is insufficient to support mobile applications to relieve depression symptoms in adolescents and young adults. Further trials with larger sample size are needed to confirm our findings of a positive trend. With emerging technologies and the high exposure of apps in this population, mobile applications for depression hold promise for the future of treatment and awareness of mental health disorders in this population.

Journal of Telemedicine and Telecare, Ahead of Print. <br/>In this case, we describe the completion of emergency front-of-neck access by a novice provider facilitated by specialist telehealth support. A facility with limited advanced airway skills requested telehealth support for a critically unwell patient with severe hypoxic respiratory failure and acute delirium. Attempts to temporise his physiology with ketamine-facilitated non-invasive ventilation were unsuccessful, and he proceeded to rapid sequence intubation. Ultimately, intubation was unsuccessful and attempts at ventilation by laryngeal mask also failed. A Cannot Intubate, Cannot Oxygenate scenario was identified. The referring team had significant anxiety about performing a surgical front-of-neck access procedure. However, with telehealth support, this was ultimately completed by a novice provider, and the patient stabilised. The key issue identified was the need for the telehealth provider to take clinical governance of the procedure. The referring team also required assistance in completing an adequate neck incision, responding to bleeding, and determining the preferred technique.