Journal Of Telemedicine And Telecare[JOURNAL]
Sun
200 papers
Improving access and management of skin tumours: Over a decade of teledermoscopy in northern Sweden.
Zazo V, Lindfors A, Michaëlsson G … +4 more , Bucharbajeva Z, Hajdarevic S, Af Klinteberg M, Andersson N
J Telemed Telecare · 2026 Apr · PMID 41954490 · Publisher ↗
IntroductionTeledermoscopy (TD), introduced in Västerbotten, northern Sweden in 2014, enables dermatological consultation in primary care via high-resolution images. As skin cancer incidence increases in Sweden, TD offer...
IntroductionTeledermoscopy (TD), introduced in Västerbotten, northern Sweden in 2014, enables dermatological consultation in primary care via high-resolution images. As skin cancer incidence increases in Sweden, TD offers potential for diagnostic efficiency and resource optimisation. Despite increasing referrals, TD remains unevaluated. This study examines TD's impact on equitable access to dermatological assessment for skin tumours in this region.MethodsThis descriptive study analysed 67,137 TD referrals submitted between 2014 and 2024, excluding 2,384 due to incomplete data. Variables included age, diagnosis (benign vs malignant), and referral origin (public/private; urban/rural). A survey examined TD routines across primary care centres (PCCs), staff roles, training, and frequency of internal TD discussions.ResultsOver the 11-year period, mean age increased from 50 (2014) to 61 years (2024) ( < 0.001). The proportion of benign referrals decreased from 80% to 69% ( < 0.001). Private PCCs referred 78% benign lesions versus 75% from public PCCs ( < 0.001); urban PCCs referred 77% versus 73% PCCs in remote areas ( < 0.001). Assessment by a nurse was associated with higher benign referral rates (odds ratio (OR) 1.132, 95% confidence interval (CI) 1.052-1.219), whereas internal TD discussions (OR 0.714, 95% CI 0.669-0.763) and lack of dermoscopy training (OR 0.893, 95% CI 0.882-0.971) were associated with lower benign referral rates.DiscussionTD has enhanced access to dermatological evaluation for suspected skin tumours in Västerbotten. The increasing age of referred patients and higher proportion of tumour diagnoses imply improved targeting of high-risk groups. Local routines influenced referral quality, underscoring the need for structured TD implementation.
Can video reduce conflict between dispatcher and caller during emergency medical calls? A randomized substudy of the CAM-VISION trial.
Søhoel JE, Gehrt TB, Bohnstedt-Pedersen NH … +3 more , Dalgaard AK, Væggemose U, Gude MF
J Telemed Telecare · 2026 Apr · PMID 41944280 · Publisher ↗
IntroductionThis substudy examined whether video-assisted emergency calls affected perceived conflict, call pleasantness, and help received among callers and dispatchers.MethodsThe study was nested within the cluster-ran...
IntroductionThis substudy examined whether video-assisted emergency calls affected perceived conflict, call pleasantness, and help received among callers and dispatchers.MethodsThe study was nested within the cluster-randomized CAM-VISION trial at the Emergency Medical Dispatch Center (EMDC) in the Central Denmark Region. Between April 17 and May 1, 2023, dispatchers were assigned to either video-enabled or telephone-only communication. After each call, dispatchers and callers rated conflict, pleasantness, and help on 7-point Likert scales. Outcomes were analyzed using proportional-odds logistic regression (video vs telephone) with 95% confidence intervals (CIs) and supporting sensitivity analyses.ResultsDuring the 14-day period, 26 dispatchers completed 1522 questionnaires from 2600 emergency calls (response rate 58.5%), including 711 (47%) in the video group and 811 (53%) in the telephone group. Video calls were associated with significantly lower dispatcher-reported conflict (OR 0.39, 95% CI 0.16-0.94; mean difference -0.2, 95% CI -0.5 to 0.0) and fewer severe conflicts (1.4% vs 0.3%; RD -1.1 pp, 95% CI -2.1 to -0.03). Among 322 linked caller-dispatcher pairs, callers rated conflict slightly higher compared with dispatchers (+0.5 points). Caller-reported conflict was similar between groups (OR 0.92, 95% CI 0.55-1.54). Ratings of pleasantness (OR 1.18, 95% CI 0.77-1.80) and perceived help (OR 1.42, 95% CI 0.90-2.24) were uniformly high and did not differ significantly between groups.ConclusionVideo during emergency calls reduced dispatcher-perceived conflict but did not significantly affect caller-perceived conflict or satisfaction, though results consistently trended towards favoring video.Trial RegistrationClinicalTrials.gov Identifier: NCT05742412.
Telemedicine in neurosurgery: A systematic review of global implementation, outcomes, and barriers to access.
Palmiero HOM, Figueiredo EG
J Telemed Telecare · 2026 Apr · PMID 41925237 · Publisher ↗
IntroductionTelemedicine has evolved into an integral component of neurosurgical care, especially in expanding access to specialized services in remote or resource-limited areas. This systematic review summarizes worldwi...
IntroductionTelemedicine has evolved into an integral component of neurosurgical care, especially in expanding access to specialized services in remote or resource-limited areas. This systematic review summarizes worldwide evidence on the implementation, outcomes, and barriers of tele-neurosurgery in emergency and outpatient settings.MethodsFollowing PRISMA guidelines, a comprehensive PubMed/MEDLINE search (2000-2025) identified English-language studies on telemedicine applications in neurosurgery. Eligible studies included emergency cases (trauma, stroke, intracerebral hemorrhage) and outpatient settings. Data on design, interventions, outcomes, and limitations were extracted and analyzed qualitatively.ResultsThirty-six studies met inclusion criteria, covering programs within high-, middle-, and low-income regions. Emergency networks using teleradiology and teleconsultation achieved significant reductions in time-to-specialist evaluation-from about 160 to 38 min-and prevented up to 44% of potential patient transfers, with low failure rates among locally managed cases. Outpatient programs reported patient satisfaction above 80%, surgical decision agreement comparable to in-person visits, and notable travel and cost savings, especially in pediatric teleclinics. Across various settings, telemedicine improved access, workflow efficiency, and cost-effectiveness, though challenges remained regarding connectivity, imaging interoperability, licensure differences, and digital inequality.ConclusionTele-neurosurgery is a safe, effective, and cost-efficient addition to traditional neurosurgical care. It enhances response times, improves triage, and maintains high patient satisfaction across various health systems. Overcoming infrastructural and regulatory barriers through standardized digital networks and equitable access programs will be essential for consolidating telemedicine as a core element of global neurosurgical practice.
The effectiveness of telepractice for speech-language pathology intervention with children younger than 12 years: A meta-analysis.
Vanderauwera J, Vanden Bempt F, D'haenens W … +3 more , Leysen H, Leclercq AL, Van Eerdenbrugh S
J Telemed Telecare · 2026 Mar · PMID 41847737 · Publisher ↗
BackgroundSince Coronavirus disease 2019, telepractice delivery has become increasingly integrated in the standard practice of speech-language pathologists and audiologists. It is therefore important to synthesize existi...
BackgroundSince Coronavirus disease 2019, telepractice delivery has become increasingly integrated in the standard practice of speech-language pathologists and audiologists. It is therefore important to synthesize existing knowledge on this intervention modality. However, limited evidence exists regarding its use in children. This meta-analysis evaluated evidence on the effectiveness of telepractice compared to in-person intervention for children aged ≤ 12 years.MethodA systematic search was conducted for systematic reviews, meta-analyses and randomized controlled trials comparing telepractice and in-person intervention for children ≤12 years. Eight databases were searched: PsychINFO, Linguistics and Language Behaviour Abstracts, Education Resources Information Centre, Web of Sciences, PubMed, Embase, the Joanna Briggs Institute database, and Cumulative Index to Nursing and Allied Health Literature.ResultsSeven studies on speech-language pathology intervention met the inclusion criteria; no audiology studies could be included. Effect sizes were calculated for 31 outcomes reported across both conditions (telepractice and in-person intervention). Eight effect sizes were inverted, allowing all positive values to indicate favourable intervention outcomes. Overall, interventions resulted in moderate to high effects, with telepractice intervention resulting in equal or larger effect sizes compared to in-person intervention.ConclusionTelepractice intervention demonstrated outcomes comparable or better than in-person intervention across speech-language pathology subdomains. This applies to both child-related and caregiver-related outcomes, as well as for child-directed (typically for children ≥ 4 years) and caregiver-mediated approaches, where caregivers are trained to implement the strategies at home with their child. These findings suggest that telepractice intervention is an effective alternative to in-person intervention.
From the ground up: Learnings from the development of an innovative statewide adult urgent virtual care service.
Tait P, Daff D, Davidson J … +6 more , Everingham P, Leahy A, Morphett M, Nouju D, Perry R, Morris D
J Telemed Telecare · 2026 Mar · PMID 41823293 · Publisher ↗
Virtual Care (VC) enables clinicians to remotely assess and manage healthcare needs. While many healthcare services have integrated virtual components into existing in-person care models, the COVID-19 pandemic prompted o...
Virtual Care (VC) enables clinicians to remotely assess and manage healthcare needs. While many healthcare services have integrated virtual components into existing in-person care models, the COVID-19 pandemic prompted organisations worldwide to rapidly develop new VC services from the ground up. This article outlines the establishment of a statewide adult urgent VC Service, detailing its conception, development and the first 6 months of operations. The conceptual phase (7 weeks) involved the project team collecting data and insights from stakeholders to build a business case for the VC Service, with a focus on two referral pathways. The development phase (7 weeks) included creating the model and establishing infrastructure, a workforce, and governance to ensure a high-quality, timely and safe service. The initial operations phase (26 weeks) fully integrated the first two referral pathways. During this time, the leadership team completed recruitment, developed a learning system, expanded operating hours and built a model to expand its referral pathways. The leadership team plans to enhance VC by improving assessment capabilities and by enabling new referral pathways into settings such as aged care. Including research methods in this model is essential to capture the benefits and risks associated with these important changes in healthcare delivery.
Determinants of digital health literacy of healthcare professionals: A systematic review.
Özatkan Y, Şenel Tekin P
J Telemed Telecare · 2026 Mar · PMID 41810765 · Publisher ↗
BackgroundDigital health literacy (DHL) is essential for ensuring effective, safe, and equitable healthcare delivery. Understanding the DHL levels of healthcare professionals and the factors shaping them is critical for...
BackgroundDigital health literacy (DHL) is essential for ensuring effective, safe, and equitable healthcare delivery. Understanding the DHL levels of healthcare professionals and the factors shaping them is critical for guiding workforce development and managing digital transformation processes. This study aimed to identify determinants of DHL among healthcare professionals and examine their implications from a managerial perspective.MethodsA systematic review was conducted following PRISMA guidelines on August 13 to 14, 2024. Web of Science, Scopus, PubMed, MEDLINE, and CINAHL were searched without time restrictions using terms such as "digital health literacy," "e-health literacy," and terms related to healthcare professions, yielding 2702 records. Peer-reviewed full-text studies in English involving healthcare professionals were included, while non-research articles and studies on non-healthcare populations were excluded. Screening and selection were performed independently by two reviewers.ResultsEleven studies published between 2022 and 2024 were included. Content analysis identified several determinants of DHL, including education level, professional experience, access to digital infrastructure, and technological competence. Younger professionals tended to report higher DHL, while more experienced staff demonstrated strong adaptability when required by evolving clinical processes. Some studies noted that digital health tools could create time pressures and affect communication with patients, potentially hindering effective DHL use.ConclusionsStrengthening DHL among healthcare professionals is essential for optimising healthcare quality, safety, and operational efficiency. Integrating digital health competencies in undergraduate curricula, providing role-specific training, and implementing organisational strategies that support digital adoption are key priorities. Although this review is based on a limited number of heterogeneous studies, it provides important insights and highlights the need for more robust and standardised research on DHL in healthcare settings.
The sedentary business of telemedicine: A review of ergonomic interventions for physicians working from home and recommendations to reduce work-related musculoskeletal disorders.
Commaroto SA, Chin N, Sun A … +2 more , Smith L, Albers S
J Telemed Telecare · 2026 Mar · PMID 41810754 · Publisher ↗
Previous investigations of work-related musculoskeletal disorders (WMSDs) and proper ergonomics in physicians have largely focused on interventionalists and surgeons, given the nature of their jobs. However, with the soc...
Previous investigations of work-related musculoskeletal disorders (WMSDs) and proper ergonomics in physicians have largely focused on interventionalists and surgeons, given the nature of their jobs. However, with the societal shift toward increased desk work and the widespread adoption of telemedicine, it is essential to examine the ergonomic challenges associated with remote care. Understanding and addressing these factors is critical to prevent musculoskeletal (MSK) strain among physicians and to ensure they can continue delivering high-quality patient care in the long run. Therefore, the goal of this review is to summarize recent interventions targeting ergonomic workspace improvements to mitigate WMSD in physicians practicing telemedicine. A database search was conducted in August 2024 using PubMed, Embase, CINAHL, and Scopus. Studies published in the last 15 years were included if they examined adults in interventional designs measuring musculoskeletal outcomes or sitting time. A total of 47 studies met the inclusion criteria, exploring various ergonomic interventions including: ergonomic training, active workstations, exercise programs, standing desks, backrests, ergonomic chairs, forearm supports, head-alignment devices, and biofeedback devices. Most studies had a positive impact on WMSD. This review highlights the importance of integrating movement, posture optimization, and personalized workspace adjustments to alleviate MSK discomfort and enhance workplace health for physicians.
Wearable device monitoring reduces the MACEs in patients with atrial fibrillation: A systematic review and meta-analysis.
Wang J, Bai S, Huang D … +3 more , Zhu K, Zhi H, Wang L
J Telemed Telecare · 2026 Mar · PMID 41810749 · Publisher ↗
ObjectiveAtrial fibrillation (AF), the most common type of arrhythmia, significantly impacts patients' prognosis. While wearable devices are increasingly integrated into cardiovascular monitoring, their effect on clinica...
ObjectiveAtrial fibrillation (AF), the most common type of arrhythmia, significantly impacts patients' prognosis. While wearable devices are increasingly integrated into cardiovascular monitoring, their effect on clinical outcomes in AF remains unclear. This review demonstrates the impact of wearable technology on major adverse cardiovascular events (MACEs) and assesses its role in AF management and prognosis.MethodsA systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines across PubMed, Embase, Web of Science, and the Cochrane Library databases. Included studies investigated AF patients using wearable devices and reported clinical outcomes. Evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Statistical analyses were performed using R 4.4.2 and Review Manager 5.4.ResultsEleven articles were included in this meta-analysis, comprising 10 studies (seven randomized controlled trials and three observational studies). Compared with usual care, wearable devices uses significantly reduced risks of MACEs (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.47-0.93), all-cause mortality (RR, 0.49; 95% CI, 0.29-0.85), ischemic stroke (RR, 0.13; 95% CI, 0.07-0.26), bleeding events (RR, 0.48; 95% CI, 0.33-0.70), and hospitalization (RR, 0.85; 95% CI, 0.74-0.97). Subgroup analyses suggested that the composite endpoint definitions and follow-up duration primarily explained heterogeneity. Evidence certainty ranged from high to low across outcomes. Sensitivity analysis confirmed the robustness of the findings for MACEs and hospitalization outcomes.ConclusionWearable devices for cardiac monitoring significantly reduce the MACEs risk and improve prognosis in AF patients. This review supports the effectiveness of wearable technology in AF management.
Co-designing DESI-Heart: Conversational agent based self-care intervention for people with cardiovascular disease.
Sebastian AT, Daryabeygi-Khotbehsara R, Jansons P … +1 more , Maddison R
J Telemed Telecare · 2026 Mar · PMID 41776164 · Publisher ↗
BackgroundCardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide and in Australia. Although self-care is essential for CVD management, many individuals face barriers such as complex treat...
BackgroundCardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide and in Australia. Although self-care is essential for CVD management, many individuals face barriers such as complex treatment regimens, limited health literacy, and lack of culturally appropriate support. Conversational agents (CAs) offer a promising solution by providing AI-driven, voice-based support that enables human-like interaction. However, most existing CAs primarily target mainstream populations, overlooking the needs of culturally and linguistically diverse communities. This study aimed to co-design and develop Diaspora Engaged Self-care Intervention (DESI-Heart), a culturally tailored CA to support self-care among individuals with CVDs from the Indian diaspora in Australia.MethodsA participatory co-design study was conducted with members of the Indian diaspora in Australia living with Three online workshops were conducted using established design methods, including the 'think-aloud' approach, 'bento-box reflections', and the 'MoSCoW' method, to capture user preferences and inform culturally responsive intervention features. Workshop recordings were transcribed and thematically analysed using NVivo.ResultsOverall, the study included 15 individuals (aged ≥18 years) and identified six themes identified through the co-design process, which informed the design and key features of the DESI-Heart program. The themes included: (1) cultural context of self-care and unique ideas for the DESI-Heart program, (2) medication management features, (3) culturally appropriate dietary support, (4) physical activity support, (5) mental wellbeing support, and (6) user experience and implementation considerations.ConclusionsThis study provided insights into the needs of culturally and linguistically diverse populations, helping address cultural and linguistic barriers and inform the development and feasibility testing of the DESI-Heart program.
Effects of telerehabilitation monitored home-based therapies on upper extremity function-related outcomes in children and adolescents with unilateral cerebral palsy: A systematic review.
Usman JS, Wong TW, Mei Ng SS
J Telemed Telecare · 2026 Feb · PMID 41678347 · Publisher ↗
Children and adolescents with cerebral palsy (CP) demonstrate proficient function if they can perform all tasks required for daily living. Telerehabilitation (TR) and monitoring can facilitate the execution of home-based...
Children and adolescents with cerebral palsy (CP) demonstrate proficient function if they can perform all tasks required for daily living. Telerehabilitation (TR) and monitoring can facilitate the execution of home-based (HB) therapies. This systematic review aimed to assess the scientific evidence regarding the effects of TR-monitored HB therapies on outcomes related to upper extremity function in children and adolescents with unilateral cerebral palsy (UCP).MethodsComprehensive searches were conducted across online databases, including the Cochrane Library, EMBASE, PubMed, Web of Science, and PEDro, as well as additional sources, from inception to October 2025. The inclusion criteria encompassed randomized controlled trials, whose risk of bias and methodological quality were evaluated using the Cochrane Risk-of-Bias Tool and the PEDro scale, respectively. A narrative synthesis approach was employed for data analysis.ResultsTR-monitored HB therapies showed positive improvements in hand coordination, dexterity, bimanual hand function, ADL motor and processing skills, occupational performance, and execution of functional goals in children and adolescents with UCP (predominantly spastic UCP studies) compared with the control interventions.ConclusionsTelerehabilitation-monitored HB therapies showed potential to improve upper extremity function-related outcomes in children and adolescents with unilateral cerebral palsy (predominantly spastic UCP studies).
Telemedicine versus in-person primary care visits for upper respiratory infections: Comparison of antibiotic prescribing.
Garrett L, Zhang Z, Felrice J … +3 more , Gent J, Graetz I, Kulshreshtha A
J Telemed Telecare · 2026 Feb · PMID 41666239 · Publisher ↗
IntroductionAntibiotic resistance is a growing public health threat, resulting in challenges in effectively treating bacterial infections. Primary care providers account for the majority of antibiotic prescriptions, high...
IntroductionAntibiotic resistance is a growing public health threat, resulting in challenges in effectively treating bacterial infections. Primary care providers account for the majority of antibiotic prescriptions, highlighting their critical role in antimicrobial stewardship. As telemedicine becomes more prevalent in primary care, there is limited data on how this shift has influenced antibiotic prescribing behavior. Our objective was to examine differences in antibiotic prescription rates for upper respiratory infections (URIs) between in-person and telemedicine appointments in a large primary care health system.MethodsIn this retrospective cohort study, we included patients 18 years and older treated in primary care clinics in the Greater Atlanta area from May 2020 to September 2023. Eligible encounters were billed with a diagnostic code related to URI. The main measures included patient demographics, insurance status, and visit modality. A multivariable logistic regression model evaluated differences in antibiotic prescriptions by visit type.ResultsThere were 33,008 (66%) in-person visits and 16,965 (33.9%) telemedicine visits, totaling 49,973 encounters. The average age of patients was 56.8 (SD 17.5) years, 67.1% patients were female, and 37.6% were Black. There were no significant differences in antibiotic prescribing between telemedicine and in-person appointments (adjusted odds ratio 1.00, 95% CI 0.14-4.86, > 0.5).DiscussionRates of antibiotic prescribing did not differ significantly between in-person and telemedicine primary care visits for URI. As a healthcare quality indicator, this result provides evidence that in-person and telemedicine appointments are comparable modalities of patient care.
Global perspectives on telemedicine-enabled medications for opioid use disorder: Practices, priorities, and barriers.
Schofield J, Baldacchino AM, Ambekar A … +17 more , Anaba H, Butner JL, Day N, Ekhtiari H, Elomari F, Ferri M, Kokkolis K, Kouimtsidis C, Levola J, Long J, Martell D, Parker DG, Rahimi-Movaghar A, Siste K, Steiger S, Zonoozi AK, Tay Wee Teck J
J Telemed Telecare · 2026 Jan · PMID 41564277 · Publisher ↗
IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, we...
IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, web-based survey (July to November 2024) of clinicians and clinical leaders via the International Society of Addiction Medicine, World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine facilitated medication for opioid use disorder (TMOUD) practices, priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.ResultsSixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), more often in high-income than LMIC settings (58% vs 11%). Barriers to prescribing were identified, and few settings reimbursed video and telephone consultations equally. Improving treatment retention (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.DiscussionTMOUD remains uneven and concentrated in high-income countries. Updated clinical guidance, digital connectivity investment and interoperable e-health systems, and targeted workforce development, particularly in LMICs, are needed to realise TM's potential for equitable and effective treatment of opioid use disorder. This global survey fills a critical knowledge gap by documenting expert perspectives across income settings, offering cross-national evidence to inform equitable expansion of TMOUD worldwide.
Program cost and return on investment analysis of remote patient monitoring for hypertension management in the cardiology department of a large healthcare system.
Zhang DS, Millet L, Bellows BK … +2 more , Lee S, Mann D
J Telemed Telecare · 2026 Jan · PMID 41549700 · Full text
ObjectivesRemote patient monitoring (RPM), combining home blood pressure measurements with telehealth services, effectively manages hypertension. Successful implementation of RPM programs at scale requires understanding...
ObjectivesRemote patient monitoring (RPM), combining home blood pressure measurements with telehealth services, effectively manages hypertension. Successful implementation of RPM programs at scale requires understanding program costs and financial sustainability. We evaluated the financial performance of an RPM program.MethodsConducted from March to June 2024 in the Cardiology Division at New York University Langone Health, the study used field observation, surveys, and micro-costing methods. A costing tool was developed to quantify program costs in 2024 US dollars, including personnel, equipment, and supplies. RPM-related services reimbursement rates were estimated using Medicare billing information. The return-on-investment (ROI) ratio was calculated by dividing net return (profit) by the RPM program costs. Sensitivity analyses assessed the impact of varying parameters on the ROI of RPM.ResultsThe average RPM program cost was estimated at $330 per patient (range: $208-$452). Major expenses included data review by staff ($172 per patient), blood pressure devices ($48 per patient), and phone communications ($36 per patient). ROI varied based on patient compliance with home blood pressure monitoring (≥16 days per month), with an average estimate of 22.2% (range: -11.1%-93.3%) per patient at a 55% compliance rate. The ROI was most sensitive to changes in data-review costs, insurance reimbursement rates, patient compliance, device setup, and communication costs.ConclusionsThe RPM program achieved a positive ROI from the perspective of a clinical division in a large healthcare system. Successful implementation and financial sustainability of RPM require efforts to reduce human resource costs and enhance patient engagement.
Analysis of the application effect of new rehabilitation nursing methods in orthopedic postoperative rehabilitation: A systematic review and meta-analysis of randomized controlled trials.
Cao F, Shi L, Wang X
J Telemed Telecare · 2026 Jan · PMID 41525304 · Publisher ↗
ObjectiveTo quantify the impact of technology-enabled rehabilitation nursing on patient-reported function after lower-limb arthroplasty and to explore effect modification by surgical procedure and by technological modali...
ObjectiveTo quantify the impact of technology-enabled rehabilitation nursing on patient-reported function after lower-limb arthroplasty and to explore effect modification by surgical procedure and by technological modality.MethodsTen databases were searched from inception to 2 May 2025. Randomised controlled trials (RCTs) comparing an innovative digital or electromechanical rehabilitation intervention with usual postoperative care and reporting WOMAC, KOOS or HOOS outcomes were eligible. Risk of bias was assessed with Cochrane RoB 2.0. Standardised mean differences (Hedges g) were pooled using a Hartung-Knapp REML random-effects model; heterogeneity was quantified with I. Sub-group analyses were prespecified for surgery type (TKA vs THA) and technology class (virtual reality VR, web/app telerehabilitation WB, robot/sensor RB). Publication bias was evaluated with funnel-plot inspection and Egger's regression. The certainty of evidence was assessed with the GRADE framework.ResultsFifteen RCTs (1012 experimental, 954 control participants; 11 TKA, 3 THA, 1 mixed) met the criteria and were all rated overall "low risk" by RoB 2.0. Across trials, technology-enabled care conferred a small but significant improvement in patient-reported function (g = 0.28; 95% CI 0.00 to 0.56; p = 0.049; I = 86%). VR produced the largest point estimate (g = 0.62; 95% CI -0.18 to 1.41; 4 trials); WB yielded a modest, non-significant benefit (g = 0.18; 95% CI -0.24 to 0.59; 8 trials); RB showed a comparable, non-significant effect (g = 0.14; 95% CI -0.23 to 0.50; 3 trials). The χ test for subgroup differences was not significant (p = 0.16). Egger's test revealed no evidence of small-study effects (p = 0.73). Leave-one-out and influence analyses confirmed robustness of the pooled estimate. The certainty of evidence was rated as moderate (GRADE).ConclusionsNext-generation digital and electromechanical rehabilitation programmes achieve at least non-inferior- and potentially clinically relevant-improvements in self-reported function after lower-limb arthroplasty while reducing in-person therapist time. Virtual-reality platforms appear most promising, but heterogeneity suggests that dose, feedback fidelity and sensor precision are key effect drivers. Large, standardised multicentre trials with cost-utility endpoints are needed to clarify which technological components add value for which patients.
Telehealth-delivered group-based exercise therapy and education for knee osteoarthritis: A non-inferiority randomised clinical trial disrupted by COVID-19.
Barton CJ, Pazzinatto M, Perraton Z … +5 more , Crossley KM, Russell T, Dundules K, De Oliveira Silva D, Kemp JL
J Telemed Telecare · 2026 Jan · PMID 41505342 · Publisher ↗
ObjectiveInability to attend in-person care is a common barrier to accessing exercise therapy and education programs for knee osteoarthritis. The primary aim of this randomised clinical trial (RCT) was to determine if te...
ObjectiveInability to attend in-person care is a common barrier to accessing exercise therapy and education programs for knee osteoarthritis. The primary aim of this randomised clinical trial (RCT) was to determine if telehealth was non-inferior to 'in-person' delivery of a group-based exercise therapy and education program (GLA:D) for knee-related burden at 3 (primary timepoint), 12 and 24 months in people with knee osteoarthritis.DesignThis pre-registered (ACTRN12619000235101) two-arm (in-person v telehealth) non-inferiority limited-disclosure RCT commenced in April 2019, with a planned sample of 110. Knee-related burden was evaluated at baseline, 3- (primary timepoint), 12- and 24-month following intervention commencement by summating four Knee injury and Osteoarthritis Outcome Score subscales (KOOS: pain, symptoms, activities of daily living, quality of life [QoL]). Secondary outcomes included health-related QoL, pain severity, physical activity, functional performance, patient satisfaction and global rating of change.ResultsRecruitment ceased in March 2020 due to COVID-19 restrictions. Forty-four participants enrolled at baseline (22 per group). Forty-three (98%), 40 (91%) and 29 (66%) participants provided 3-, 12- and 24-month follow-up data, respectively. The lower limit of the 95% confidence interval (CI) was above the non-inferiority threshold (i.e. -10 points) for KOOS at 3 (mean difference, 95%CI = 6, -2 to 15) and 12 months (0, -9 to 9). Compared to in-person, mean reduction in worst pain was greater for telehealth delivery at 3 months (16.5, 95%CI 0.8 to 32.2). No other secondary outcomes were different between groups.ConclusionKnee-related burden outcomes following telehealth-delivered group-based exercise therapy and education in people with knee osteoarthritis might not be different to in-person delivery.
Quantifying the cost savings of the South Australian Telestroke Service.
Lee P, Bivard A, Kurunawai C … +13 more , Willcourt M, Tan A, Mahadevan J, Waters M, Harvey J, Van Eunen J, Dixon K, Piantedosi B, Davis S, Donnan G, Jannes J, Kleinig T, Gao L
J Telemed Telecare · 2026 Jan · PMID 41490035 · Publisher ↗
BackgroundFew studies have explored the cost and clinical impacts of enhanced telehealth interventions for stroke in contemporaneous practice. As such, we sought to compare the cost-effectiveness of a clinical service su...
BackgroundFew studies have explored the cost and clinical impacts of enhanced telehealth interventions for stroke in contemporaneous practice. As such, we sought to compare the cost-effectiveness of a clinical service supported by a purpose built platform for stroke telehealth in South Australia.MethodsMarkov decision analytic models were constructed to model the implementation of an enhanced telehealth programme versus historical controls with limited referral support. The models were profiled on a minimum dataset of 470 patients with stroke symptoms presenting across eight regional/rural hospitals in South Australia. Clinical outcomes and costs were derived from published sources. Incremental cost-effectiveness ratios were used to estimate the cost-effectiveness of the telehealth platform over a lifetime time horizon, from the perspective of the Australian healthcare system compared with a historical control.ResultsImplementation of the South Australia Telestroke programme was associated with a gain of 0.10 quality-adjusted life years and a cost saving of $3873 per patient. That is, over a 5-year period, the introduction of technology-enabled telehealth resulted in a total projected cost saving of $8.7 million (M). This was driven by a reduction in the costs attributed to management (per patient -$2676; total projected: -$6.0 M), nursing home care (per patient: -$3268; total projected: -$7.3 M), non-medical costs (per patient: -$510; total projected: -$1.1 M) and futile transfers (per patient: -$111; total projected: -$250,248), which offset higher intervention costs (per patient: $2674; total projected: $6.0 M) and hospital costs (per patient: $18; total projected: $41,092). Sensitivity analyses confirmed the robustness of these findings.ConclusionThe implementation of an enhanced telehealth programme improves patient outcomes and is cost-saving relative to a telestroke programme with limited referral support. Our findings support ongoing implementation of the enhanced telehealth programme across South Australian hospitals.
The effectiveness of the ECHO model™ for patient navigation capacity building in Malaysia.
Chakraverty KH, Adam A, Jaganathan M … +10 more , Awg Isa JB, Muniandy K, Zainal H, Ghazali AF, Muniandi M, Roimin FO, Yanam YC, Joseph Ngadan SM, Boten L, Kanapathy J
J Telemed Telecare · 2025 Dec · PMID 41399842 · Publisher ↗
BackgroundThe patient navigation programme (PNP) is an effective health intervention to address barriers in accessing timely and equitable cancer care. However, its expansion in Malaysia for breast cancer care faces chal...
BackgroundThe patient navigation programme (PNP) is an effective health intervention to address barriers in accessing timely and equitable cancer care. However, its expansion in Malaysia for breast cancer care faces challenges due to limited capacity building among nurses and navigators, particularly nurses who are actively involved in the operation of the PNP centres. The Extension for Community Healthcare Outcomes (ECHO) model, a tele-mentoring approach, offers a scalable and sustainable solution for capacity building among the nurses and navigators. This study aims to evaluate the feasibility and impact of using the ECHO model to train nurses and navigators on patient navigation competencies focused on improving breast cancer care delivery.MethodsThe study involved nurses in breast cancer care from Ministry of Health (MOH) state referral hospitals in Malaysia and newly recruited nurses and social workers by Cancer Research Malaysia to subsequently be placed as nurse and community navigator for the upcoming new centres. Participants received an ECHO-based training programme comprising bi-weekly virtual sessions of a six-domain curriculum covering 12 topics on patient navigation competencies. Pre- and post-session assessments were conducted to measure satisfaction, knowledge and confidence in conducting patient navigation.ResultsMost participants were within the age range of 31-35 (n = 38; 40.4% [95% CI, 30.5%-50.3%]) with majority being female (n = 87; 92.6% [95% CI, 87.2%-97.9%]) and MOH nurses (n = 71; 75.5% [95% CI, 66.8%-84.2%]). An average of 28 participants attended each session. Participants expressed high level satisfaction while showing improvements in knowledge and confidence with an average increase in mean score of (1.45 [95% CI, 0.84-2.13]; p < .05) and (0.61 [95% CI, 0.51-0.65]; p < .05) respectively following the intervention.ConclusionThe study demonstrates the feasibility and effectiveness of the ECHO model for patient navigation capacity building among nurses and navigators. Findings support broader implementation of the ECHO model to strengthen breast cancer care delivery.
The out-of-pocket costs of Medicare-reimbursed telepsychiatry consultations since telehealth expansion in Australia: An administrative data linkage analysis.
Woon LS, Maguire P, Reay RE … +3 more , Bastiampillai T, Looi JC, Liu WM
J Telemed Telecare · 2025 Dec · PMID 41384915 · Publisher ↗
IntroductionTelepsychiatry has been widely adopted following changes to the Medicare Benefits Schedule (MBS) telehealth policy. This study aimed to examine the effect of telehealth policy changes on the out-of-pocket cos...
IntroductionTelepsychiatry has been widely adopted following changes to the Medicare Benefits Schedule (MBS) telehealth policy. This study aimed to examine the effect of telehealth policy changes on the out-of-pocket costs of MBS-subsidised psychiatric consultations.MethodsWe extracted records of relevant face-to-face, video, and telephone consultations from linked MBS claims data, Pharmaceutical Benefits Schedule data (2017-2023) and the 2021 Census data. For each consultation mode, we calculated the average monthly bulk-billing rate and average fee gap for non-bulk-billed consultations. Multivariate regression analyses were conducted to examine the determinants of bulk-billing and the fee gap.ResultsIn total, 13,507,907 consultations involving 1,234,328 unique individuals were analysed. The average bulk-billing rate was 50.9%, decreasing over time. Fee gaps increased across all consultation modes. Face-to-face consultations were generally less likely to be bulk-billed and incurred higher fee gaps than other modes. Over successive policy periods, video consultations had an increasingly lower likelihood of bulk-billing and were associated with higher fee gaps. Patients in rural and remote areas were likely to bear greater out-of-pocket costs, including for video consultations. Attention Deficit Hyperactivity Disorder (ADHD) prescription-related consultations were associated with lower bulk-billing rates and higher fee gaps, especially in the video mode.DiscussionWhile the expansion of telepsychiatry increased service availability, it did not consistently reduce the financial burden of psychiatric care, especially for rural and remote Australians. The higher out-of-pocket costs associated with ADHD prescription-related consultations warrant closer policy attention.
Telemedicine for triage: A systematic review of virtual consultation in hand trauma.
Langille C, Dow T, Pouramin P … +2 more , Grue B, Wheelock M
J Telemed Telecare · 2026 Jul · PMID 41384913 · Publisher ↗
IntroductionTelemedicine involves the use of electronic communication systems to exchange medical information between health professionals or with patients. With the increasing demand for telemedicine delivery, catalyzed...
IntroductionTelemedicine involves the use of electronic communication systems to exchange medical information between health professionals or with patients. With the increasing demand for telemedicine delivery, catalyzed by the COVID-19 pandemic, it is important to investigate the use of telemedicine within the field of hand surgery. The aim of this study is to present the current state of telemedicine use in hand trauma, with a particular focus on accuracy of diagnosis, cost effectiveness, and access to care.MethodsAn online systematic review of MEDLINE, EMBASE, Pubmed and The Cochrane Library from inception to 16 May 2025 was completed. Data extracted included telemedicine medium used, accuracy of diagnosis, cost, impact on patient transfer volume, and timeline for assessment. Study quality was assessed using the MINORS scale.ResultsOf the 15 included studies, eight assessed diagnostic accuracy, four evaluated cost savings, four examined patient transfers, five reported on efficiency, and three investigated access to care. All studies assessing accuracy found telemedicine to be an accurate method of triaging and diagnosing patients. All studies assessing cost-effectiveness found telemedicine to be an effective cost-savings instrument. Telemedicine was also demonstrated to improve healthcare efficiency by decreasing the number of unnecessary patient transfers, reducing extra visits and unnecessary consultations and improve access to specialist care for patients in rural communities.ConclusionsThe current literature suggests that the application of telemedicine in initial hand trauma consultation was found appears satisfactory diagnostic accuracy, cost savings, reduced patient transfers, increased efficiency, and improved access to care when compared to traditional face-to-face triaging and diagnosis of hand traumas although evidence is largely observational.
Rendezvous transport plus prehospital computed tomography angiography on mobile stroke unit for large vessel occlusion: Achieving 103 min call-to-puncture time in 106 km distance.
Wang L, Wu X, Guo S … +5 more , Li J, Wu X, Yang F, Ji X, Guo X
J Telemed Telecare · 2025 Dec · PMID 41379589 · Publisher ↗
AimInvestigate the role of mobile stroke unit (MSU) and rendezvous transport with emergency medical service (EMS) in timely large vessel occlusion (LVO) identification and direct transfer to the comprehensive stroke cent...
AimInvestigate the role of mobile stroke unit (MSU) and rendezvous transport with emergency medical service (EMS) in timely large vessel occlusion (LVO) identification and direct transfer to the comprehensive stroke center.MethodsThe fifth-generation MSU (5G-MSU) program was first implemented in 2019, directly dispatched through the 120 emergency medical services. The rendezvous transport was initiated in 2020. We report the first case of rendezvous transport plus prehospital computed tomography angiography (CTA) on 5G-MSU for endovascular treatment of LVO.ResultsA 5G-MSU was dispatched for a patient with reported right-sided hemiparesis and reduced consciousness at a primary stroke center, located at a distance of 106 km. The 5G-MSU and EMS coordinated a rendezvous transport to transfer the patient. CTA performed on the 5G-MSU revealed basilar artery occlusion, prompting immediate contact with the main hospital's angiography suite. Upon arrival, the patient was directly transferred to the angiography suite for endovascular therapy, achieving successful recanalization. Consequently, the call-to-puncture time was successfully achieved within 103 min, across a distance of 106 km.DiscussionRendezvous transport combined with prehospital CTA on the 5G-MSU in rural areas is feasible. This approach allows the MSU to extend beyond its conventional treatment coverage, rapidly identify large vessel occlusions, and thereby significantly reduce call-to-treatment time.
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