Telemedicine Journal And E-health[JOURNAL]
Sun
200 papers
The Caregiver Burden in Patients with Chronic Disorders of Consciousness: Differences Between Long-Term Tele-Assistance System and In-Hospital Care Facilities.
Contrada M, Cammarata IG, Scarfone F … +18 more , Vatrano M, Talarico R, Mantia I, Scarfone F, Romania L, Mercurio L, Gallo M, Liperoti S, Servidio R, Raso MG, Pignolo L, Cerasa A, Arabia G, Boca S, Pugliese G, Pugliese ME, Mauro A, Lucca LF
Telemed J E Health · 2026 Feb · PMID 41174915 · Publisher ↗
BACKGROUND: There has been limited research on the mental health of those caring for individuals with chronic disorders of consciousness (DoCs), particularly in comparing caregivers of patients managed at home versus tho...
BACKGROUND: There has been limited research on the mental health of those caring for individuals with chronic disorders of consciousness (DoCs), particularly in comparing caregivers of patients managed at home versus those admitted to Long-Term Care Specialized Units (LTCSUs). METHODS: This prospective study assessed the psychological status of 79 caregivers of patients with chronic DoC, who were either admitted to an LTCSU with respect to those followed through a remote telemonitoring service called Oberon Service (OS). Patients' cognitive functioning and level of disability were assessed using Coma Recovery Scale-Revised, Wessex Head Injury Matrix, Nociception Coma Scale, Disability Rating Scale, and Level of Cognitive Functioning scales, whereas caregivers' psychological status was evaluated with the caregiver burden index and the Short Form Health Survey-36. RESULTS: Patients in the two groups were similar for demographic variables, years of hospitalization, and etiology. At the clinical level, patients in the LTCSU group had a significantly higher prevalence of gastrostomy feeding, tracheostomy tube, and respiratory support compared with the OS group. Caregivers belonging to the two groups did not show substantial differences in several sociodemographic variables. At follow-up, the relationship between patient cognitive functioning and mental health differed significantly between the OS and LTCSU groups. The higher burden and lower quality of life in the OS group were particularly pronounced when patients had lower levels of cognitive functioning, whereas in the LTCSU group, an opposite effect was detected. CONCLUSIONS: Our findings underscore how patient care settings and cognitive status interact to influence caregiver burden and quality of life, highlighting the need for tailored support strategies based on care settings.
State Medicaid Telehealth Policies and Rates of Alcohol and Substance Use Treatment at Federally Qualified Health Centers: Does Modality Matter?
Wharton MK, Lipperman-Kreda S, Helgeson K … +1 more , Sanders E
Telemed J E Health · 2026 Feb · PMID 41173537 · Publisher ↗
BACKGROUND: Alcohol and substance use disorders (ASUDs) are highly prevalent in the United States and are major causes of mortality, morbidity, and individual and societal costs. Adoption of telehealth policies for ASUD...
BACKGROUND: Alcohol and substance use disorders (ASUDs) are highly prevalent in the United States and are major causes of mortality, morbidity, and individual and societal costs. Adoption of telehealth policies for ASUD treatment may support access among underserved populations, such as those who are low-income and publicly insured. This study examined associations between state-level telehealth policies allowing for audio-only and text-based communication and patient utilization of ASUD services at Federally Qualified Health Centers (FQHCs). METHODS: Data on state-level telehealth policies were obtained from the Medicaid and Children's Health Insurance Program Payment and Access Commission. FQHC-level data about patients' annual use of ASUD services in 2019 and 2020 were obtained from the Bureau of Primary Health Care Uniform Data System (UDS). Differences-in-differences models were used to evaluate associations between audio-only and text-based communication policies and ASUD treatment services (i.e., number of AUD and SUD visits, number of AUD and SUD patients), controlling for FQHC-level patient demographics (i.e., age, race, ethnicity, and income). RESULTS: We found a 76% relative increase in AUD visits (incidence rate ratios [IRR]: 1.76, < 0.05) and a 92% relative increase in SUD visits (IRR: 1.92, < 0.05) in states with Medicaid policies that enabled audio-only telehealth in 2020. We found no relative increase in the number of ASUD visits or patients in states with Medicaid policies allowing for text-based communication. CONCLUSION: State-level Medicaid policies that permit the use of audio-only telehealth for ASUD treatment may be important tools to address the needs of medically underserved populations with AUD and SUD across the United States.
Accessible by Design: Evaluating a Telehealth Accessibility Checklist.
Zabala G, Wyand S, Beninati W … +6 more , Parameswaran V, Krevat S, Spaar P, Booker E, Alexander K, Ratwani R
Telemed J E Health · 2026 Feb · PMID 41173536 · Publisher ↗
INTRODUCTION: In the wake of COVID-19, widespread adoption of telehealth has led to variations in implementation that have implications for patient safety and access to health care. We developed a 60-item Telehealth Acce...
INTRODUCTION: In the wake of COVID-19, widespread adoption of telehealth has led to variations in implementation that have implications for patient safety and access to health care. We developed a 60-item Telehealth Access Checklist, which aims to address this challenge by supporting health care organizations in assessing their telehealth platforms for issues that may pose access challenges. OBJECTIVES: This feasibility study evaluates the Telehealth Access Checklist among three different large health care organizations. Eleven different reviewers ranging from primary care physicians to telemedicine directors evaluated the checklist's content for efficacy and utility. Suggestions were made for checklist improvement. RESULTS: The preliminary testing revealed overwhelming support for not only the concept of the 60-item checklist but also the checklist itself. Reviewers were able to identify aspects of their telehealth technologies that could be optimized to improve accessibility. They found the checklist to be an effective guide to delve deeper into their respective facility's capabilities and identify areas needed for improvement to meet the needs of all populations. Recommendations for improvements to the checklist ranged from changes in formatting and phrasing to enhancements such as broadening the scope to include other modes of telehealth, such as remote patient monitoring. CONCLUSION: A self-assessment checklist may serve to improve telehealth technology in meeting the needs of all populations by enabling the identification of technological features that should be optimized.
Leadership, Legacy, and Impact.
Doarn CR
Telemed J E Health · 2025 Nov · PMID 41157838 · Publisher ↗
Abstract loading — click title to view on PubMed.
Evaluating Telehealth Quality Outcomes of a Pediatric Weight Management Program.
Simione M, Luo M, Rodriguez JA … +3 more , Zheng H, Edgman-Levitan S, Taveras EM
Telemed J E Health · 2026 Feb · PMID 41157813 · Full text
OBJECTIVE: To examine the extent to which patient-level characteristics are associated with telehealth quality outcomes (representing economic, functional, and equity outcomes) for children with obesity seen in primary c...
OBJECTIVE: To examine the extent to which patient-level characteristics are associated with telehealth quality outcomes (representing economic, functional, and equity outcomes) for children with obesity seen in primary care. METHODS: We evaluated the Connect for Health pediatric weight management program adapted for telehealth in an academic medical center in Boston, MA. Patient-level characteristics included insurance type, status of the social determinants of health screener, and preferred language. The outcomes were body mass index (BMI) documentation, Connect for Health tool usage, and mode of visit. We conducted multivariable logistic regression. RESULTS: We included 417 children who had a telehealth visit. Children had a mean (SD) age of 7.1 (2.9) years, 72% had public insurance, 35% spoke a language other than English, and 24% had one or more social risk factors. Children with public insurance, compared to private insurance, had higher odds of having their BMI documented (odds ratio [OR]: 3.12; 95% confidence interval [CI]: 1.04, 9.34), having had a clinician use the Connect for Health tools (OR: 2.08; 95% CI: 1.16-3.74), and having an audio-only visit (OR: 1.93; 95% CI: 1.14-3.27). Children with social risk factors, compared to no risk factors, had higher odds of having their BMI documented (OR: 3.35; 95% CI: 1.02-11.07). Children with a preferred language other than English compared to English had higher odds of having an audio-only visit (OR: 1.88; 95% CI: 1.18-2.99). CONCLUSION: We found associations between telehealth quality outcomes and children having public insurance, social risk factors, and a preferred language other than English. The findings suggest that telehealth programs can be developed to overcome known health disparities and achieve high-quality care.
Digital Transformation in Telemedicine Health Care: A Retrospective Analysis of Seha Virtual Hospital Outcomes in the Kingdom of Saudi Arabia.
Alabdulaali MK, Aldossary MS, Alsubaie MS … +2 more , Zaatari ES, Alhomod AS
Telemed J E Health · 2025 Dec · PMID 41081638 · Publisher ↗
Seha Virtual Hospital (SVH), established in February 2022, represents a significant development in the Saudi telemedicine health care system, aligning with the goals of Vision 2030. This study aims to analyze SVH's growt...
Seha Virtual Hospital (SVH), established in February 2022, represents a significant development in the Saudi telemedicine health care system, aligning with the goals of Vision 2030. This study aims to analyze SVH's growth, service delivery, and patient outcomes from 2022 to 2024. A retrospective descriptive analysis was conducted using data retrieved from SVH's electronic health records and administrative files between 2022 and 2024. It assessed variables including the number of centers, medical staff, beneficiaries, types of medical cases, and patient outcomes. Data were analyzed to identify trends and patterns in service delivery and patient care. SVH experienced substantial growth during the study period. From 2021 to 2024, the number of telemedicine centers, workforce, medical doctors, and beneficiaries increased substantially. Key medical cases, including oncology, cardiology, stroke, and pediatrics, saw notable increases, with oncology and stroke cases rising from 24 and 41 in 2022 to 714 and 4,393 in 2024, respectively. Outpatient visits dominated, increasing from 1,717 in 2021 to 27,896 in 2024. Patient satisfaction remained high, with 86% of outpatients reporting satisfactory outcomes in 2022 and 2024, though it dipped to 82% in 2023. SVH's rapid expansion and the increasing demand for its services reflect the hospital's pivotal role in enhancing health care access and quality in Saudi Arabia. The findings highlight SVH's alignment with Vision 2030 objectives, particularly in expanding telemedicine infrastructure and improving patient care outcomes. This study provides valuable insights into future health care and telemedicine development strategies within the Kingdom.
Language-Related Barriers to Digital Health Engagement in Pediatric Primary Care.
Fernandes-Junior S, Kalady SE, Chandawarkar A … +5 more , Brown CM, Clement J, Vundavalli S, Zhang X, Huang Y
Telemed J E Health · 2025 Oct · PMID 41074453 · Publisher ↗
Health care systems increasingly rely on digital tools, including patient portals such as Epic MyChart® and telemedicine platforms, to optimize communication between patients and providers. Families with language barrier...
Health care systems increasingly rely on digital tools, including patient portals such as Epic MyChart® and telemedicine platforms, to optimize communication between patients and providers. Families with language barriers face disproportionate challenges in accessing and utilizing these services equitably. This study examines the association between language preference and digital health engagement, with a particular focus on patient portal activation and telemedicine use among pediatric patients. We conducted a retrospective analysis of pediatric patients in a large primary care network, categorizing them into three groups based on language use: English Proficient (EP), Limited English proficiency (LEP), and Intermittent Interpreter Users (IIU). Patients are predominantly seen for office visits but are also offered telemedicine for clinically appropriate acute and chronic conditions. Measures of digital engagement included Epic MyChart activation status, the proportion of appointments scheduled online, and telemedicine utilization. Social Drivers of Health (SDOH) were also incorporated into the analysis to account for potential confounding factors. Of the total patients, 66% were classified as EP, 20.4% as LEP, and 13.6% as IIU. LEP patients showed significantly lower digital engagement across all measures. Telemedicine use was notably lower among LEP patients (EP = 95.5%, IIU = 2.2%, LEP = 2.3%). Epic MyChart activation rates were also lower in LEP (60.3%) and IIU (76.2%) groups compared with EP patients (82.2%). Online scheduling was least frequent among LEP patients (LEP = 2.3%, IIU = 5.7%, EP = 8.6%). When reviewing SDOH responses, among patients who used telemedicine, transportation-related challenges were more pronounced in the LEP group (EP = 12.4%, IUI = 0%, LEP = 16.7%). These findings underscore the need for targeted interventions to improve digital health access for non-English-speaking pediatric patients in the primary care setting.
Facilitators and Barriers to Participation in Exercise-Based Telerehabilitation in Individuals with Stroke: A Scoping Review of Quantitative and Qualitative Studies.
Wiley E, Moncion K, Noguchi KS … +7 more , Huynh E, Park S, Fang H, Brooks D, MacDermid JC, Sakakibara BM, Tang A
Telemed J E Health · 2025 Oct · PMID 41058538 · Publisher ↗
Barriers to stroke rehabilitation, including travel and other costs, impact women more, but may be mitigated with telerehabilitation. This scoping review aimed to identify and describe facilitators and barriers to partic...
Barriers to stroke rehabilitation, including travel and other costs, impact women more, but may be mitigated with telerehabilitation. This scoping review aimed to identify and describe facilitators and barriers to participation in exercise-based telerehabilitation after stroke. Our secondary aim was to explore whether gender-related facilitators or barriers exist to participation. Six electronic databases were searched for studies exploring facilitators and barriers to participation in exercise-based telerehabilitation in community-dwelling adults with stroke. A list of key constructs was developed and provided a definition, and mapped onto one or more domains of the Theoretical Domains Framework (TDF). Thirty-eight studies were identified ( = 882 participants). The most commonly reported facilitators were mapped onto the TDF domain "environmental context and resources," and included the following: acceptable audio and video features, accessibility, convenience/flexibility of the training schedule and variety of games, and therapist communication skills. Other facilitators included ease of use (TDF "skills" domain), comfort with technology ("knowledge," "skills"), self-perceived improvements in physical function ("reinforcement"), enjoyment ("emotion," "reinforcement"), positive feedback/encouragement from family/friends ("social influences"), and the usefulness of telerehabilitation ("intentions," "reinforcement"). Barriers included challenges with internet speed and connectivity and adjusting and/or wearing the device(s) ("environmental"). Men and women reported facilitators related to "skills" and "knowledge" to participate in telerehabilitation, but few studies described gender-related factors. We found that many facilitators and few barriers exist to participation in exercise-based telerehabilitation for men and women with stroke, whereby the environmental and resources domain of the TDF was represented by most constructs.
Who is More Likely to Attend Psychiatry Visits by Audio-Only versus Video or in-Person? A Comparison of Community Health Center Patients from 2020 to 2023.
Emery Tavernier RL, Johnson A, Juarez T … +2 more , McCann J, Armah T
Telemed J E Health · 2025 Oct · PMID 41058513 · Publisher ↗
To examine which patients have relied most heavily on audio-only versus video or in-person visits to attend psychiatric care since the COVID-19 pandemic at Federally Qualified Health Centers (FQHCs). This observational...
To examine which patients have relied most heavily on audio-only versus video or in-person visits to attend psychiatric care since the COVID-19 pandemic at Federally Qualified Health Centers (FQHCs). This observational study reviewed electronic health record data from all patients who attended psychiatric care at a large FQHC from January 2020 to December 2023. Patient sociodemographic characteristics (age, sex, race/ethnicity, preferred language) were extracted from the electronic health record, as was psychiatry visit information. Patients were categorized according to whether a majority of their psychiatry visits during the assessment period were attended by audio-only, video, or in-person. Among the 9,569 patients who received psychiatric care during the assessment period, 48% ( = 4,563) attended most of their psychiatry visits by audio-only compared with 37% ( = 3,534) who attended most visits by video and 15% ( = 1,472) who attended most visits in-person. Relative risk (log-binomial) regression analyses identified patient age, sex, and language as consistent correlates of audio-only psychiatry visits. For example, patients who preferred to receive their care in Spanish were 12% (95% confidence interval: 0%, 25%) more likely to attend most psychiatry visits by audio-only versus video compared with those who preferred English. The effect of patient race/ethnicity on audio-only psychiatry visits was more variable and less precise. This study demonstrates that audio-only modalities are the most popular means for attending psychiatric care among FQHC patients and reaffirms the importance of audio-only modalities for attending psychiatric care among underserved populations.
Telemedicine in Taiwan: A Bibliometric and Quantitative Analysis of Current Trends.
Chou HY, Ming Jing L, Wu FZ
Telemed J E Health · 2025 Oct · PMID 41058504 · Publisher ↗
Telemedicine has become a vital component of Taiwan's health care system, enhancing access, efficiency, and equity in medical services. Rapid growth has been fueled by advances in digital technologies, policy support, an...
Telemedicine has become a vital component of Taiwan's health care system, enhancing access, efficiency, and equity in medical services. Rapid growth has been fueled by advances in digital technologies, policy support, and increasing clinical applications, particularly during the COVID-19 pandemic. Despite this progress, a comprehensive overview of research trends is lacking. This study applies bibliometric and quantitative analyses to map current developments, identify key contributors, and guide future health care policy and practice. We conducted a bibliometric analysis of telemedicine research in Taiwan using the Web of Science Core Collection (to August 30, 2025). Publication characteristics, citation counts, and authorship patterns were analyzed. Keyword co-occurrence networks were generated with VOSviewer to identify research hotspots and thematic clusters, ensuring accuracy through independent verification. From 1998 to 2025, telemedicine research in Taiwan has shown steady growth, with publication counts rising sharply after 2010 and peaking in 2024. Key contributors include National Taiwan University, National Cheng Kung University, and Taipei Medical University, which lead in both publication volume and citation impact. Highly cited studies address telemedicine applications, COVID-19 responses, and digital health innovations. Co-occurrence network analysis highlights four major research themes: clinical telemedicine, health care management and policy, COVID-19-related digital health, and AI-driven technologies. Challenges remain in rural areas, including infrastructure, technology acceptance, and workforce shortages, underscoring the need for targeted strategies to expand telemedicine. Future telemedicine research in Taiwan should prioritize rural health care, leveraging 5G, AI, and smart technologies to enhance care efficiency, accuracy, and resource allocation, supporting sustainable, high-quality, and equitable medical services aligned with Environmental, Social, and Governance principles.
Crisis and Post-Crisis Virtual Mental Health Care: A Scoping Review.
Lemoine J, Svenne S, Ulrich R … +1 more , Hensel J
Telemed J E Health · 2025 Oct · PMID 41027405 · Publisher ↗
: Crisis services are often a first point of contact for individuals needing mental health assessment and intervention. The rapid expansion of virtual care in recent years has enabled remote assessment and introduced nov...
: Crisis services are often a first point of contact for individuals needing mental health assessment and intervention. The rapid expansion of virtual care in recent years has enabled remote assessment and introduced novel ways to support crisis stabilization in the community. This scoping review aims to summarize the extent of the literature on virtual crisis assessment and intervention models. : PubMed, PsycINFO, CINAHL, and ProQuest databases were searched for English- and French-language literature published between January 1, 2018, and June 30, 2024. Database search results were imported into the online Covidence review management program. A minimum of two reviewers screened titles and abstracts. Target information was extracted from included full texts and summarized thematically across study characteristics and outcomes. : A total of 5,345 titles were reviewed, with 45 publications included. Publications represented models from around the globe supporting youth and/or adult service users. Data synthesis highlighted the feasibility and potential for virtual care models supporting comprehensive crisis assessment (services that go beyond hotline de-escalation and triage), inpatient admission alternatives, and post-crisis follow-up. : The available literature suggests that virtual crisis care options are growing, especially during and in the aftermath of the COVID-19 pandemic. Although few rigorous evaluations exist, there is strong evidence of feasibility with emerging and encouraging evidence for effectiveness. Further research focused on outcomes, comparisons of virtual and in-person models, and cost-effectiveness is warranted. Additional research could focus on virtual care models for the geriatric population, which is underrepresented in the available literature.
Telecardiology Management of Hypertension in Brazilian Remote Populations.
Accorsi TAD, Geovanini GR, Eduardo AA … +6 more , Amaral BDR, Moreira FT, Köhler KF, Lima KA, Morbeck RA, Pedrotti CHS
Telemed J E Health · 2025 Sep · PMID 41022548 · Publisher ↗
Hypertension is highly prevalent worldwide, burdening health systems with inadequate control. Managing hypertension in remote areas of developing countries presents significant challenges. Telemedicine can enhance access...
Hypertension is highly prevalent worldwide, burdening health systems with inadequate control. Managing hypertension in remote areas of developing countries presents significant challenges. Telemedicine can enhance access to cardiologists and improve treatment adherence. To assess the effectiveness of telecardiology in managing hypertension in these regions, which remains inadequately understood. This retrospective cross-sectional study analyzed telecardiology consultations from a single center serving 365 primary health care facilities in North and Midwest Brazil. Patients over 18 years old who were referred to telecardiology and had a primary diagnosis of hypertension. Cardiologists, primary care physicians, and patients participated in real-time outpatient consultations, and data on demographics, blood pressure (BP) levels, diagnostic tests, medication adjustments, and follow-up outcomes were collected. Among 6,141 telemedicine encounters, 4,706 (76.63%) were first visits, and 1,435 (23.37%) were follow-ups. The mean age was 60.31 ± 13.81 years, and 3,657 (59.5) were female. Cardiovascular risk factors were common, including diabetes (24.5%), obesity (24.2%), and smoking (39.4%). Most were handled with basic testing, and only 2.39% had interventions proposed for the possibility of secondary hypertension. Medication adjustments took place in 43.9% of consultations. BP improved significantly in follow-ups ( < 0.05). Most patients (81.97%) needed at least one telemedicine follow-up. Only 0.56% were referred to tertiary care. Telecardiology optimizes hypertension management by enhancing BP control, diagnostic workups, and therapeutic adjustments while decreasing referrals to tertiary care. These findings underscore its potential to reduce health care disparities in underserved areas. Further research is necessary to assess long-term clinical outcomes and scalability.
Examining Factors Associated with the Intentions Toward and Use of Tele-Mental Health Services Among Medicaid Providers and Beneficiaries.
Seng S, Almogheer Z, Koyagi E … +4 more , Wang T, Makowski A, Stith H, Okoli C
Telemed J E Health · 2025 Sep · PMID 41005967 · Publisher ↗
Treatment adherence among individuals with mental illness remains a pressing public health issue. Tele-mental health care (TMH) can improve care access and continuity. This study applied the theory of planned behavior (T...
Treatment adherence among individuals with mental illness remains a pressing public health issue. Tele-mental health care (TMH) can improve care access and continuity. This study applied the theory of planned behavior (TPB) to examine how intrinsic motivations influence intentions and use of TMH among Medicaid beneficiaries and providers. A survey was provided to both Medicaid beneficiaries ( = 179) and providers ( = 188) across five Community Mental Health Centers in Kentucky. Electronic surveys collected demographic characteristics, frequency of TMH use, and TPB-based variables. Hierarchical linear regression models assessed predictors of intention toward TMH use (for beneficiaries) or care delivery (for providers), while logistic regressions examined predictors of the frequency of TMH use or care delivery. Among beneficiaries, attitudes (β = 0.30, < 0.001), subjective norms (β = 0.23, < 0.001), and perceived behavioral control (β = 0.33, < 0.001) significantly predicted intentions to use TMH (Adjusted = 0.75, < 0.001). For providers, subjective norms (β = 0.45, < 0.001) were the strongest predictor, followed by attitudes (β = 0.31, < 0.001) and perceived behavioral control (β = 0.21, < 0.001) (Adjusted = 0.72, < 0.001). The frequency of TMH care delivery was associated with intentions among providers (odds ratio [OR] = 2.16, = 0.02). Among beneficiaries, non-White ethnicity (OR = 3.70, = 0.007) and higher education (OR = 3.80, < 0.001) predicted frequency of TMH use. TPB-based variables predicted intentions to engage with TMH services among our sample of Medicaid beneficiaries and providers. However, TPB-based variables were limited in predicting frequency of TMH use. This finding highlights a critical intention-behavior gap, suggesting that structural and systemic barriers could be addressed to support TMH implementation within community mental health settings.
Health Measures and Willingness to Pay for Internet Services.
Rabbani M, Bogulski CA, Hayes CJ
Telemed J E Health · 2025 Sep · PMID 41005962 · Publisher ↗
With the rapid adoption of telehealth services, health measures are increasingly tied to internet access. However, there is limited literature on how internet connectivity correlates to health measures and health care ut...
With the rapid adoption of telehealth services, health measures are increasingly tied to internet access. However, there is limited literature on how internet connectivity correlates to health measures and health care utilization. We examined the links between willingness to pay (WTP) for internet services and health measures, namely, health insurance type, general health, physical health, mental health, health literacy, and cost/transportation barriers to health care access. We designed a custom survey and collected 5,200 responses in four U.S. states. We implemented a stratified conjoint analysis to estimate the WTP for internet speed and quality and its connections to health measures. Among insurance plan types, Medicare beneficiaries had the lowest WTP-lower than the uninsured. Respondents with more days of poor mental health had significantly higher WTP. We found no links between health literacy and WTP. Those who delayed care due to transportation barriers had lower WTP. Respondents who did not disclose health information consistently had lower WTP. We documented strong ties between health measures and WTP for internet services. At a time when health care utilization increasingly depends on internet connectivity, policymakers must identify and plan for technological factors that could hinder health care utilization or jeopardize population longevity and health.
Recommendations Regarding the Appropriateness of Virtual Care: A Systematic Review.
Alras A, Patel MA, Wang M … +6 more , Lovo S, Bath B, Hammond C, Mendez I, Babyn P, Adams SJ
Telemed J E Health · 2025 Sep · PMID 41005796 · Publisher ↗
To identify and analyze factors influencing the appropriateness of virtual and in-person care and to synthesize current evidence-based recommendations to assist health care providers in determining when virtual or in-per...
To identify and analyze factors influencing the appropriateness of virtual and in-person care and to synthesize current evidence-based recommendations to assist health care providers in determining when virtual or in-person care is most suitable. : Four databases (MEDLINE, CINAHL, Embase, and APA PsychInfo) and Google Scholar were searched to identify qualitative, quantitative, and mixed methods studies and clinical practice guidelines published between January 2014 and January 2024 focused on appropriateness of virtual care. Articles were extracted and uploaded to Covidence for screening. Two researchers screened the articles independently, and a third researcher resolved any conflicts. Data were extracted from articles, and factors influencing the appropriateness of virtual care were categorized using thematic analysis. : The search retrieved 5,136 articles, of which 75 met inclusion criteria and were included in the review. An additional eight articles were identified following a supplemental search of reference lists, resulting in a total of 83 articles included in the study. Six primary concepts influencing the appropriateness of virtual care were identified from the literature (patient characteristics, clinical presentation and disease, timepoint in the care process, burden of care, provider factors, and technology platform) and 22 subconcepts. A flowchart incorporating these concepts was developed to assist in clinical decision-making regarding the suitability of virtual and in-person care. : Findings from this systematic review provide clinicians with a structured approach to evaluating the suitability of virtual versus in-person care, supporting evidence-based decisions and effective integration of virtual care into the health care system.
Transforming Care: The Impact of COVID-19 on Telehealth Adoption in U.S. Home Health Care Agencies.
Perera UGE, Chastain AM, Dick AW … +4 more , Stone PW, Glance LG, Pogorzelska-Maziarz M, Shang J
Telemed J E Health · 2025 Dec · PMID 40996422 · Full text
The COVID-19 pandemic accelerated the adoption of telehealth in home health care (HHC). However, the extent and sustainability of telehealth use among Medicare-certified HHC agencies remain unclear. To examine the adopt...
The COVID-19 pandemic accelerated the adoption of telehealth in home health care (HHC). However, the extent and sustainability of telehealth use among Medicare-certified HHC agencies remain unclear. To examine the adoption and utilization of telehealth modalities among U.S. HHC agencies following the COVID-19 pandemic. A nationally representative survey of 474 Medicare-certified HHC agencies assessed telehealth use, modalities, and purposes, comparing adoption patterns between urban and rural agencies. Overall, 69% of agencies used telehealth, primarily for care coordination, virtual visits, monitoring, and care initiation. Urban agencies more often adopted video-based modalities, whereas rural agencies relied on audio-only modalities, reflecting broadband access and digital infrastructure disparities. Although telehealth utilization increased during the pandemic, some agencies later discontinued use. Telehealth supplements HHC but remains fragile without Medicare reimbursement and a strong infrastructure. Targeted investments and reimbursement policies are critical for equitable, sustainable integration of telehealth in post-acute care.
Effectiveness of Emergency Department Virtual Clinics: A Retrospective Study in a Large Tertiary Center in Saudi Arabia.
Aljumaa A, Jamiel K, Helal Q … +6 more , Aljumaa M, Mohamed G, Alghamdi R, Abdullah IA, Alsarraj B, Qureshi MN
Telemed J E Health · 2025 Dec · PMID 40986609 · Publisher ↗
This study aims to evaluate the impact of virtual clinics in the emergency department (ED) of a large tertiary center in Saudi Arabia by analyzing patient outcomes and resource utilization. A retrospective, observationa...
This study aims to evaluate the impact of virtual clinics in the emergency department (ED) of a large tertiary center in Saudi Arabia by analyzing patient outcomes and resource utilization. A retrospective, observational study was conducted at King Faisal Specialist Hospital & Research Center. Data from 3,595 patient encounters that utilized ED virtual clinics from March 2022 to October 2023 were analyzed. Key variables included appointment types, reasons for encounters, patient advisement for ED visits, duration of virtual clinics, and return rates. Statistical analyses included t-tests, chi-square tests, ANOVA, and multivariable logistic regression. Of the patients, 53.33% had emergency postdischarge follow-ups, 27.44% had emergency adult virtual follow-ups, and 19.22% had emergency urgent care adult virtual follow-ups. The most common reasons for encounters were follow-ups after discharge (35.16%), advice on new medical problems (28.54%), and review of investigations (24.43%). Only 4.5% of patients seeking medication advice were advised to visit the ED, while nearly 49% of those reporting new medical problems were advised to do so. About 23.35% represented to the ED within 7 days. The median duration of virtual clinics was 2 min. Patients with new medical problems showed the highest rates of return and need for rebooking. Virtual clinics in the ED setting offer a reliable approach to managing noncritical cases, minimizing avoidable ED visits, and optimizing the use of health care resources. Future studies should explore multicenter trials and long-term outcomes to further validate these findings and enhance the generalizability of virtual clinic models in emergency care settings.
Beyond Time-Based Billing: An AI-Enabled Complexity Model for Secure Message Reimbursement.
Ko DG, Tachinardi U, Warm EJ … +2 more , Rahim F, Schoenl SA
Telemed J E Health · 2025 Dec · PMID 40984817 · Publisher ↗
: Current telehealth reimbursement guidelines, based primarily on evaluation and management duration, inadequately capture the true clinical complexity and cognitive effort involved in provider responses to secure patien...
: Current telehealth reimbursement guidelines, based primarily on evaluation and management duration, inadequately capture the true clinical complexity and cognitive effort involved in provider responses to secure patient messages. There is a critical need for reimbursement frameworks that reflect the nuanced reality of clinical care delivered through asynchronous telehealth messaging. : We analyzed 149,499 secure messages (2023-2024) from a large health system. Given the impracticality of manually annotating all threads, we used supervised pseudo-labeling informed by rigorous annotation guidelines (interrater reliability: Cohen's κ = 0.816) applied to a representative subset. Clinical complexity was quantified through features of providers' electronic health records engagement (Domain Engagement [DE]) and message linguistic complexity (Cognitive Judgment [CJ]). A gradient boosting classifier leveraging these complexity-based features was developed and validated via stratified cross-validation, temporal validation, and leave-one-provider-out testing. Interpretability was assessed using permutation importance and Shapley Additive Explanations values. : The complexity-based model achieved strong predictive performance (area under the curve [AUC] ∼0.82), substantially outperforming a time-based baseline (AUC ∼0.57). Key predictors included unique medical concepts, breadth of clinical content, and emotional urgency. Traditional metrics like message length and duration were poor predictors. Billable threads showed significantly higher medical density (∼55 vs. ∼33 concepts) and emotional intensity (∼0.6 vs. ∼0.3), supporting DE and CJ validity. : Complexity-based features more accurately captured providers' cognitive effort than elapsed time alone, consistent with Cognitive Load, Complexity, and Sensemaking theories. : This AI-enabled complexity-based model provides a practical, accurate, and explainable foundation for telehealth billing reform, facilitating fairer provider reimbursement and improved telehealth sustainability.
Comparison of Video-Based Primary Care by Rurality for Chronic Health Conditions at the Veterans Health Administration.
Yoo CK, Chu K, Rose DE … +1 more , Der-Martirosian C
Telemed J E Health · 2025 Dec · PMID 40984801 · Publisher ↗
Chronic conditions present significant concerns in rural areas due to limited access to care, despite the need for frequent follow-up visits for their management. The video-based care has the potential to improve access...
Chronic conditions present significant concerns in rural areas due to limited access to care, despite the need for frequent follow-up visits for their management. The video-based care has the potential to improve access to care. In this study, we identified chronic conditions that were frequently managed by video visits at the Veterans Health Administration (VHA) and examined the use of video modality by rurality. It was a nationwide retrospective study of primary care visits in 2023 using the VHA electronic health records. The outcome was the use of video modality for a primary care visit. Multivariable logistic regressions were used to examine the association between the likelihood of a video visit and primary visit diagnosis, adjusting for patient-level characteristics associated with video use and clustering within patients. We examined the interaction between the rurality of the patient's residence and the visit diagnosis on video use. The sample included 4,346,777 patients and 18,861,266 primary care visits during the study period. Overall, video-based visits represented 3.9% of the total primary care visits (744,865 visits). Hypertension was the most common diagnosis in video-based care (104,038 visits), followed by diabetes (76,713), musculoskeletal pain (53,523), hyperlipidemia (30,353), and other cardiovascular diseases (24,703). For these conditions, patients living in urban areas were more likely to use video-based care for hypertension (8.3% [95% CI: 8.2-8.4] vs. 7.4% [95% CI: 7.3-7.5]), diabetes (6.0% [95% CI: 5.9-6.1] vs. 4.7% [95% CI: 4.6-4.8]), hyperlipidemia (9.4% [95% CI: 9.3-9.5] vs. 7.4% [95% CI: 7.2-7.6]), and musculoskeletal pain (8.6% [95% CI: 8.5-8.7] vs. 6.8% [95% CI: 6.7-6.9]), compared with patients living in rural areas. Our findings show that the use of video modality for chronic conditions was lower in rural areas compared to urban areas. Future research should identify ways VHA rural medical centers can improve access to video-based care, especially in the context of chronic care management.
Improvement in Cardiovascular Outcomes Using Telemedicine to Support Medical Decision in Acute Coronary Syndrome: Experience of Prehospital Public Emergency Care Units in Brazil.
Rocon C, Toth CPP, Ikawa JNR … +5 more , Silva PGMB, Rodrigues JM, Batista LA, Reque FA, Vendramim P
Telemed J E Health · 2025 Dec · PMID 40982372 · Publisher ↗
Cardiovascular diseases are the leading cause of mortality and disability in Brazil and worldwide. Among them, acute coronary syndrome (ACS) stands out as an acute event requiring early diagnosis and intervention, which...
Cardiovascular diseases are the leading cause of mortality and disability in Brazil and worldwide. Among them, acute coronary syndrome (ACS) stands out as an acute event requiring early diagnosis and intervention, which are decisive factors in the prognosis of these patients. Telehealth, through telediagnosis and cardiology teleconsultation, has emerged as a valuable tool for supporting early diagnosis and appropriate management of ACS cases in a country of continental dimensions and health care access disparities. A cardiological best-practices program implemented in partnership with the Brazilian Ministry of Health and a private tertiary hospital provided 24/7 tele-electrocardiogram (ECG) interpretation and cardiology teleconsultation support. The program included more than 300 public prehospital emergency care units distributed in 26 Brazilian states. Data from 13,311 eligible patients were analyzed between January 2021 and December 2023. Outcomes such as discharge, hospital transfer, antiplatelet therapy use, and mortality were compared between patients who did and did not receive teleconsultation using both mean differences and Propensity Score Matching models. Among 13,311 patients eligible for teleconsultation with an ECG performed between January 1, 2021, and December 31, 2023, 7,184 had complex arrhythmias (3,854 with success teleconsultation and 3,330 failure), and 6,127 had ST-segment elevation myocardial infarction (STEMI) cases (2,907 with success teleconsultation and 3,220 failure). Analysis indicates that teleconsulting was associated with a reduction in the mortality rate for STEMI in patients with contact when compared with those without contact (X% vs. Y%; = 0.019). There is also evidence of a lower mortality rate for complex arrhythmias and total eligible patients (STEMI plus complex arrhythmias). Integration of tele-electrocardiography and remote cardiology teleconsultation in prehospital emergency care significantly improves key clinical outcomes for ACS and arrhythmias. This model demonstrates the value of telemedicine to enhance access to specialist care and reduce geographic disparities in cardiovascular emergency treatment.
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