Background: Following the initial resurgence of telemedicine during the COVID-19 pandemic, higher levels of virtual ambulatory care utilization continue. This study aimed to identify factors that contribute to providers' perspectives about the utility of telemedicine across various medical and surgical clinical contexts within a single academic health system. Methods: A cross-sectional survey including an open-response question about the clinical appropriateness of telemedicine was distributed to Johns Hopkins Medicine clinical sites, including 6 hospitals and 40 ambulatory clinics in Maryland, the Washington, D.C., Capital Region, and Florida. Modified grounded theory was used to code responses about the clinical appropriateness of telemedicine. Responses from providers who perform >50% of both new patient and follow-up care via telemedicine were evaluated. Results: Analysis of 567 comments revealed domains of advantage/disadvantages to telemedicine including clinical factors (e.g., physical exam, interventions, testing), process factors (e.g., logistics, technology), information-sharing (teaching, history-taking), communication (e.g., rapport), patient factors (e.g., patient preference, child attention), clinician factors (e.g., clinician preference, reimbursement), and overall appropriateness. Domains of clinical and process factors were most commonly discussed. Conclusion: This study identifies features of telemedicine that may affect the provision of clinically appropriate care across medical and surgical fields. As health care spending continues to be assessed, traditional delivery models may adapt. Proactive identification of opportunities for additional virtual care implementation may assist systems in nimble responsiveness to changing landscapes.

Background/Objectives: The successful integration of video consultations in routine hospital care requires further research. This study explores how healthcare professionals experienced and engaged with a pilot training program in video consultations (VCs), focusing on patient-centred communication and technical skills. Methods: A qualitative study was conducted at a gynaecological outpatient clinic in a Danish university hospital. In October 2022, healthcare professionals (n = 8) piloted a training program in VCs with patients suffering from gynaecological disorders, followed by semi-structured interviews. Our data analysis was inductive and inspired by thematic analysis, as proposed by Braun and Clarke. Results: Our analysis resulted in an overall theme, namely feasible, with context-dependent considerations, and followed by four other themes:, namely that (1) pre in situ training presents benefits and challenges, (2) consultation via video can be an advantage to consultations via phone or in-clinic, (3) individual planning and organising is a must, and (4) video consultation calls for new competencies. Conclusions: Our study indicates that a training program focusing on patient-centred communication, technical skills and in situ training with peer feedback is relevant when implementing VCs. Visual contact was an advantage of VC versus phone; however, patient triage was identified as essential when planning VCs. Overall, VCs are feasible in a gynaecological outpatient setting when their implementation is supported by an in situ training program and with ongoing technical support available.

Infant and early childhood mental health (IECMH) is an important field within psychiatry and related disciplines. Historically, IECMH has been absent from mental health training and curricula. However, evidence shows that young children do experience mental health symptoms with clear benefits from early intervention. Some training programs have developed IECMH curricula with good results. A multidisciplinary approach with the inclusion of reflective supervision is beneficial to trainees and professionals. Important themes in IECMH include addressing systemic disparities, finding a balance between telehealth and in-person services, centralized certification/endorsement efforts, and workforce support and retention, including diversity, equity, and inclusion efforts.

The COVID-19 pandemic abruptly accelerated the use of digital health for cancer care. Previously, researchers identified a variety of digital health interventions for cancer prevention. The purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for racial/ethnic minority groups.

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and was guided by the Arksey and O'Malley methodological framework. A search of PubMed, Ovid MEDLINE, and CINAHL for peer-reviewed research articles published from database inception to August 21, 2023, was conducted. Peer-reviewed studies published in English that employed digital health interventions for cancer prevention, that were conducted among racial/ethnic minority groups, and that were conducted in the United States were included. Also included were cancer prevention interventions for people who did not have cancer, people who did have cancer, and cancer survivors. Excluded were interventions that included non-Hispanic White individuals, interventions performed outside the United States, interventions that combined face-to-face methods with digital strategies, and interventions that did not clearly include digital health. Articles that focused on technologies for collecting and transmitting health data (e.g., remote patient monitoring) without an explicit tie-in to cancer prevention intervention outcomes were also excluded.

Following screening, eight articles met the eligibility criteria. Six of the articles were published prior to the COVID-19 pandemic, and two were published during it. The digital health interventions for cancer prevention in racial/ethnic minority groups included screening (n = 5), emotional support and education (n = 1), human papillomavirus vaccination (n = 1), and education and treatment (n = 1). A consistently measured outcome was intervention efficacy. Four authors explicitly stated that theories or theoretical constructs were employed to guide intervention development. Also, no interventions were created using novel devices such as emerging technologies.

We identified several notable gaps regarding digital health for cancer prevention among racial/ethnic minority groups. Addressing these gaps may help guide continued innovation in the use of digital health for cancer prevention among racial/ethnic minority groups.

Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients' overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine.

To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach.

Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case.

Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; β=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; β=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; β=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; β=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; β=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; β=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; β=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; β=.053; P=.10).

In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice.

Paediatricians using instant messaging phone apps for informal medical discussions poses ethical and legal risks. We filled a gap in the research, by assessing the use of apps and the possible risks.

A national, cross-sectional, questionnaire study was conducted in Israel from 11 August to 20 November 2019. The frequency of informal discussions, clinical details and recommendations were compared to the paediatricians' expertise and work settings. The discussions included work and private phones, consultation with the parents of patients and advice to the paediatricians' friends and families.

The 305 paediatricians who responded had a median age of 37 (range 27-74) years: 42% were residents and 58% were specialists. The majority (99%) had carried out informal discussions using a messaging app in the last week and 65% had used them for 1-5 discussions. Specialists were more likely to use apps for more than 10 discussions per week than residents (24% vs. 5%, p < 0.001) and recommend treatment via apps (35% vs. 22%, p < 0.001). A third failed to provide disclaimers about the risks of app-based discussions.

Using instant messaging apps for informal medical discussions was common, but ethical and legal aspects were not always fully considered.

This study explores a hybrid approach to maternal-fetal care for gestational diabetes (GD), integrating virtual visits seamlessly with in-clinic assessments. We assessed the feasibility, time efficiency, patient satisfaction, and clinical outcomes to facilitate wider adoption of maternal-fetal telemedicine.

We conducted a 4-week prospective study involving 20 women with GD at ≥32 weeks of pregnancy, alternating between remote and in-clinic weekly visits. Remote assessments began with women self-measuring vital signs and using a digital urine dipstick. The remote encounter started with a midwife performing anamnesis and remotely connecting women to the fetal nonstress test. A physician concluded the meeting with remote sonographic assessment of amniotic fluid maximal vertical pocket that together with the nonstress test provided the modified biophysical assessment as well as a video encounter and ongoing glycemic control assessment. We assessed the feasibility of remote visits, compared visit durations, evaluated women's satisfaction using the Telehealth Usability Questionnaire, examined glucose documentation adherence during hybrid care compared with the following period until birth, and assessed GD-related clinical outcomes.

Remote visits had a success rate of 97.4% (38 of 39), with significantly shorter durations compared with in-clinic visits (median 59.0 min vs. 159.0 min, P < 0.001). Women expressed high satisfaction (6.6 of 7), and adherence with recording fasting glucose values during the study period was significantly higher than the following period until birth (92.2% vs. 61.8%, P = 0.001). Notably, none required induction of labor for glycemic control imbalance, and there were no cases of macrosomia, shoulder dystocia, or neonatal hypoglycemia.

The hybrid approach to maternal-fetal care for GD demonstrated feasibility, safety, time efficiency, improved patient satisfaction, and enhanced glycemic control adherence.

The purpose of this study is to determine baseline demographics and utilization trend of an on-demand, synchronous tele-ophthalmology triage program in evaluating acute ophthalmic concerns during the COVID-19 Public Health Emergency.

Setting: Single-center retrospective chart review of telemedicine visits conducted by ophthalmologists and optometrists from University of Miami's Bascom Palmer Eye Institute. Patient population: 6227 patients comprised 7138 telehealth encounters. All patient encounters were included in the retrospective review without exclusions and only the primary diagnoses were categorized from October 1, 2020 to April 30, 2023. Main outcomes measures: Descriptive statistics of the telemedicine model, utilization trends, baseline patient demographics, and primary diagnoses were performed for all virtual eye care encounters during the study period.

Utilization of the synchronous telemedicine platform increased during the study period. The median age of patients was 51 (IQR, 36-65) years. Patients predominantly self-identified as female (63.27%), White (72.7%), and non-Hispanic/Latino (48.2%). General external adnexa (44.1%), conjunctival disorders (15.5%) and ocular surface symptoms (15.4%), made up 75.0% of the visits during the study period. Furthermore, 63.4% of patients were new to Bascom Palmer Eye Institute, 67.1% had never engaged in telemedicine, and 96.5% of encounters were successfully completed through video conferencing.

During the COVID-19 pandemic, there was significant utilization of an on-demand synchronous ocular telemedicine program to address acute concerns. This retrospective chart review demonstrates the utility of telemedicine as an important and effective tool to triage and provide care during the COVID-19 Public Health Emergency.

As healthcare embraces telehealth, a need exists to understand factors that promote older adults' telehealth usage, including the influence of age-related sensory impairments. The objective of this study was to describe older adults' perceptions of telehealth and factors they considered before using telehealth within the framework of The Unified Theory of Acceptance and Use of Technology (UTAUT).

This descriptive qualitative study collected data through semi-structured interviews. Twenty-four older adults were randomly selected from a pool of 103 participants who completed the initial UTAUT survey study. Individual interviews were conducted by telephone. Reflective thematic analysis was used to identify themes within the UTAUT construct that influence older adults' use of telehealth.

Older adults identified preparedness, receptiveness, and willingness to use telehealth as important overarching factors to consider when using telehealth. These are connected to the UTAUT constructs: facilitating conditions, social influence, effort expectancy, and performance expectancy.

This study supports UTAUT as an appropriate framework for assessing telehealth readiness and predicting behavioral intention to use telehealth. Our findings provide limited evidence that sensory impairments do not impact telehealth readiness unless the individual lacks appropriate adaptations.

As in many other countries, the Dutch emergency healthcare system is under pressure due to increasing numbers of patients, limited budgets, and constrained (human) resources (TraumaNet AMC 19 May, 2016; Int J Emerg Med 6:41, 2013). eHealth, enlarged by the COVID-19 pandemic, has been advocated to substitute face-to-face care to alleviate the pressure of the burden of care (Ministry of Health Welfare and Sport, 2022; Dutch Society of Hospitals, 2022). In order for eHealth solutions to be adopted in daily practice, is it essential to assess healthcare professionals' attitudes toward its usefulness. As this is currently lacking, this study explores the use of eHealth in daily practice, opportunities of eHealth, implementation barriers, and desired functions and features amongst healthcare professionals working in Dutch orthopedic surgery and traumatology.

A cross-sectional, web-based survey among the 605 members of the Dutch Society of Trauma Surgery and related healthcare professionals on the attitudes towards eHealth in daily practice was performed between November 4, 2021, and March 31, 2022. The survey consisted of five sections with 42 questions, including close-ended questions, multiple-choice questions, 5-point Likert Scales, Visual Analogue Scales, and free-text questions.

Of the 111 responding healthcare professionals, 59/111 (53%) were male, and the median age was 40 years (IQR 26 to 67). Almost all participants owned smartphones (109/111, 98.2%). Most participants reported that the COVID-19 pandemic had influenced their attitude towards the usefulness of eHealth positively (80/111, 72%). Most participants (59%) would use a digital alternative instead of face-to-face follow-up if proven a safe technology, and expect that 64% of all patients would prefer a digital option. Most healthcare professionals stated that eHealth could reduce healthcare costs (94/111, 85%) and improve patient satisfaction (81/111, 73%) but is hindered most by a lack of financial support during implementation (57/111, 51%), followed by complex laws and regulations (54/111, 49%).

Results of this cross-sectional survey show that attitudes of orthopedic surgery or traumatology-related healthcare professionals toward the usefulness of eHealth are positive and may have increased during the COVID-19 pandemic. Even though healthcare professionals believe eHealth could reduce costs and improve patient satisfaction, daily clinical use remains low possibly due to a lack of long-term and short-term financial support and complex laws and regulations.

The 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.

We 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.

Our 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.

Adopting 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.

Rapid telehealth adoption happened at the onset of the coronavirus disease 2019 (COVID-19) pandemic, resulting in a move from in-person predominant to telehealth predominant care delivery. Later, in person visits rebounded with telehealth options remaining. This study aimed to assess differences in healthcare utilization during this changing landscape in terms of health equity determinants.

This was an observational cohort study of Johns Hopkins Medicine (JHM) patients. We analyzed utilization of video, telephone, and in-person patient-provider visits by eligible patients between March 16, 2019 and December 31, 2020. Percent changes in average weekly patient-provider visits from pre-pandemic (March 16, 2019-June 30, 2019) to early 2020 pandemic (March 16, 2020-June 30, 2020) and from pre-pandemic (July 1, 2019-December 31, 2019) to late 2020 pandemic (July 1, 2020-December 31, 2020). We used a quantile cut off technique to describe disproportionately smaller or greater drops in visits during the first year of the pandemic among health equity determinant groups and according to visit specialty, when compared to the total population.

There was a 39% drop in patient-provider visits from the pre-pandemic to the early 2020 pandemic period, and a 24% drop from pre-pandemic to the late 2020 pandemic period. We discovered 21 groups according to health equity determinates and visit departments with patterns of disproportionately smaller or greater drops in visits during the first year of the pandemic, when compared to the total population: Pattern 1 -smaller drop in visits early and late 2020 (age 45-64, Medicare insurance, high poverty and high unemployment; mental health and medical specialty visits -P < .001); Pattern 2 -greater drop in visits early 2020 only (age 65-84; OB/GYN and surgical specialty visits-P < .001); Pattern 3 -greater drop in visits early and late 2020 (age 0-5, age 6-17, age 85+, Asian race, Hispanic or Latino ethnicity, private insurance-P < .001); and Pattern 4-smaller drop in visits in early 2020 when compared to late 2020. The age 18-44 group showed a smaller drop in visits early 2020 and then visit levels similar to the total population late 2020. Primary care visits were similar to the total population early 2020 and then a smaller drop in visits late 2020 (P < .001).

Our study provides evidence of health equity determinant groups having disproportionally smaller or greater drops in visits during the first year of the pandemic. The observed differences may have been influenced by changing telehealth offerings during the first year of the pandemic. Groups with disproportionately smaller drops in visits early 2020 (Pattern #1 and age 18-44 group in Pattern #4), suggests more success with adopting telehealth among those groups. Whereas groups with disproportionately greater drops in visits early 2020 (Pattern #2 and Pattern #3), suggests less success with telehealth adoption. For Pattern #4, more clarification is needed on how changes in telehealth offerings contributed to the downward trend in visits observed from early to late 2020.

We describe 4 main patterns to characterize groups with disproportionately smaller or greater drops in visits during the first year of the pandemic. While this work did not specifically study vulnerable populations, these patterns set the stage for further studies of such groups.

Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management.

A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre-post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits.

The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed.

The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine.

The COVID-19 pandemic triggered policy changes in 2020 that allowed insurance companies to reimburse telehealth services, leading to increased telehealth use, especially in rural and underserved areas. However, with many emergency rules ending in 2022, patients and health care providers face potential challenges in accessing these services.

This study analyzed telehealth use across specialties in Arkansas before and after the pandemic (2017-2022) using data from electronic medical records from the University of Arkansas for Medical Sciences Medical Center. We explored trends in insurance coverage for telehealth visits and developed metrics to compare the performance of telehealth versus in-person visits across various specialties. The results inform insurance coverage decisions for telehealth services.

We used pre- and postpandemic data to determine the impacts of the COVID-19 pandemic and changes in reimbursement policies on telehealth visits. We proposed a framework to calculate 3 appointment metrics: indirect waiting time, direct waiting time, and appointment length. Statistical analysis tools were used to compare the performance of telehealth and in-person visits across the following specialties: obstetrics and gynecology, psychiatry, family medicine, gerontology, internal medicine, neurology, and neurosurgery. We used data from approximately 4 million in-person visits and 300,000 telehealth visits collected from 2017 to 2022.

Our analysis revealed a statistically significant increase in telehealth visits across all specialties (P<.001), showing an 89% increase from 51,589 visits in 2019 to 97,461 visits in 2020, followed by a 21% increase to 117,730 visits in 2021. Around 92.57% (134,221/145,001) of telehealth patients from 2020 to 2022 were covered by Medicare, Blue Cross and Blue Shield, commercial and managed care, Medicaid, and Medicare Managed Care. In-person visits covered by Medicare and Medicaid decreased by 15%, from 313,196 in 2019 to 264,696 in 2022. During 2020 to 2022, about 22.84% (33,123/145,001) of total telehealth visits during this period were covered by Medicare and 53.58% (86,317/161,092) were in psychiatry, obstetrics and gynecology, and family medicine. We noticed a statistically significant decrease (P<.001) in the average indirect waiting time for telehealth visits, from 48.4 to 27.7 days, and a statistically significant reduction in appointment length, from 93.2 minutes in 2020 to 39.59 minutes in 2022. The indirect waiting time for psychiatry telehealth visits was almost 50% shorter than that for in-person visits. These findings highlight the potential benefits of telehealth in providing access to health care, particularly for patients needing psychiatric care.

Reverting to prepandemic regulations could negatively affect Arkansas, where many live in underserved areas. Our analysis shows that telehealth use remained stable beyond 2020, with psychiatry visits continuing to grow. These findings may guide insurance and policy decisions in Arkansas and other regions facing similar access challenges.

To compare patient satisfaction, health care resource utilization, and adverse events among patients receiving a virtual video compared with in-office postoperative visit after urogynecologic surgery. We hypothesized that virtual video visits would be noninferior to in-office visits.

This was a randomized noninferiority clinical trial of patients undergoing surgery for pelvic organ prolapse and urinary incontinence at a single academic tertiary referral center. Participants were randomized to receive either a virtual video postoperative visit or a standard in-office postoperative visit. The primary outcome was patient satisfaction measured by the validated PSQ-18 (Patient Satisfaction Questionnaire-18) (noninferiority margin 5 points) at the 6-week postoperative visit. Secondary outcomes included PSQ-18 domain scores (noninferiority margin 0.5 points) and composite health care resource utilization and adverse events after the 6-week postoperative visit up to 12 weeks after surgery (noninferiority margin 10%). A sample size of 100 participants (50 per group) would allow 80% power to assess a 5-point noninferiority margin on the total PSQ-18 with an SD of 10 and α=0.05.

From January 2023 to September 2023, 265 patients were screened for eligibility, and 104 were randomized. A total of 100 participants (50 per arm) completed the study and were included in the analysis. The mean±SD age of all participants was 57.0±13.2 years. The mean±SD PSQ-18 total score was 75.18±8.15 in the virtual group and 75.14±8.7 in the in-office group. The mean PSQ-18 total score was 0.04 points higher (ie, greater degree of satisfaction) in the virtual group, with a 95% CI of -2.75 to 2.83, which met the criterion for noninferiority. Between-group differences for all PSQ-18 domain scores likewise met criterion for noninferiority. Composite health care resource utilization was 14.0% lower in the virtual group than in the in-office group (20.0% vs 34.0%, 95% CI, -28.0% to 1.0%). For composite adverse events, the between-group difference was 2.0% (2.0% in virtual group vs 0.0% in in-office group, 95% CI,-3.0% to 8.0%).

Virtual video postoperative visits were noninferior to in-office visits with regard to patient satisfaction, health care resource utilization, and adverse events and can be offered as an alternative to in-office visits for postoperative follow-up after urogynecologic surgery.

ClinicalTrials.gov , NCT05641077.

The COVID-19 pandemic has created new digital health care landscapes for the management of substance use and misuse. While telehealth was prohibited for addiction treatment prior to the pandemic, the severity of COVID-19 precipitated telehealth expansion for the delivery of individual and group-based treatment. Research has highlighted benefits and challenges of telehealth; however, little is known about the impacts of telehealth on the quality, use, and effectiveness of treatment. Fewer studies examine how these emerging digital geographies of care transform the spaces and landscapes of substance misuse. This article examines how telehealth affects landscapes of opioid use disorder care in Pennsylvania, West Virginia, and Kentucky during the COVID-19 pandemic. Our findings reveal that while telehealth extends access to treatment for opioid use disorder (OUD), it also creates new care inequities within and between providers and clientele that can undermine effective care and recovery.

Profound scientific evaluation of novel digital health technologies (DHTs) is key to enhance successful development and implementation. As such, we previously developed the eHealth evaluation cycle. The eHealth evaluation cycle contains 5 consecutive study phases: conceptual, development, feasibility, effectiveness, and implementation.

The aim of this study is to develop a better understanding of the daily practice of the eHealth evaluation cycle. Therefore, the objectives are to conduct a structured analysis of literature data to analyze the practice of the evaluation study phases and to determine which evaluation approaches are used in which study phase of the eHealth evaluation cycle.

We conducted a systematic literature search in PubMed including the MeSH term "telemedicine" in combination with a wide variety of evaluation approaches. Original peer-reviewed studies published in the year 2019 (pre-COVID-19 cohort) were included. Nonpatient-focused studies were excluded. Data on the following variables were extracted and systematically analyzed: journal, country, publication date, medical specialty, primary user, functionality, evaluation study phases, and evaluation approach. RStudio software was used to summarize the descriptive data and to perform statistical analyses.

We included 824 studies after 1583 titles and abstracts were screened. The majority of the evaluation studies focused on the effectiveness (impact; 304/824, 36.9%) study phase, whereas uptake (implementation; 70/824, 8.5%) received the least focus. Randomized controlled trials (RCTs; 170/899, 18.9%) were the most commonly used DHT evaluation method. Within the effectiveness (impact) study phase, RCTs were used in one-half of the studies. In the conceptual and planning phases, survey research (27/78, 35%) and interview studies (27/78, 35%) were most frequently used. The United States published the largest amount of DHT evaluation studies (304/824, 36.9%). Psychiatry and mental health (89/840, 10.6%) and cardiology (75/840, 8.9%) had the majority of studies published within the field.

We composed the first comprehensive overview of the actual practice of implementing consecutive DHT evaluation study phases. We found that the study phases of the eHealth evaluation cycle are unequally studied and most attention is paid to the effectiveness study phase. In addition, the majority of the studies used an RCT design. However, in order to successfully develop and implement novel DHTs, stimulating equal evaluation of the sequential study phases of DHTs and selecting the right evaluation approach that fits the iterative nature of technology might be of the utmost importance.

The coronavirus disease 2019 (COVID-19) pandemic led to disruptions of health service delivery in many countries; some were more resilient in either limiting or rapidly responding to the disruption than others. We used mixed methods implementation research to understand factors and strategies associated with resiliency in Rwanda and Bangladesh, focussing on how evidence-based interventions targeting amenable under-five mortality that had been used during the Millennium Development Goal (MDG) period (2000-15) were maintained during the early period of COVID-19.

We triangulated data from three sources - a desk review of available documents, existing quantitative data on evidence-based intervention coverage, and key informant interviews - to perform a comparative analysis using multiple case studies methodology, comparing contextual factors (barriers or facilitators), implementation strategies (existing from 2000-15, new, or adapted), and implementation outcomes across the two countries. We also analysed which health system resiliency capabilities were present in the two countries.

Both countries experienced many of the same facilitators for resiliency of evidence-based interventions for children under five, as well as new, pandemic-specific barriers during the early COVID-19 period (March to December 2020) that required targeted implementation strategies in response. Common facilitators included leadership and governance and a culture of accountability, while common barriers included movement restrictions, workload, and staff shortages. We saw a continuity of implementation strategies that had been associated with success in care delivery during the MDG period, including data use for monitoring and decision-making, as well as building on community health worker programmes for community-based health care delivery. New or adapted strategies used in responding to new barriers included the expanded use of digital platforms. We found implementation outcomes and strong resilience capabilities, including awareness and adaptiveness, which were related to pre-existing facilitators and implementation strategies (continued and new).

The strategies and contextual factors Rwanda and Bangladesh leveraged to build 'everyday resilience' before COVID-19, i.e. during the MDG period, likely supported the maintained delivery of the evidence-based interventions targeting under-five mortality during the early stages of the pandemic. Expanding our understanding of pre-existing factors and strategies that contributed to resilience before and during the pandemic is important to support other countries' efforts to incorporate 'everyday resilience' into their health systems.

Telehealth and telemedicine experienced remarkable growth during and after the recent COVID-19 pandemic. Telehealth is generally defined as nonclinical services that employ telecommunication technology. Telemedicine refers more specifically to remote clinical services including diagnosis, monitoring, and treatment. Nuclear medicine is no exception in employing telemedicine increasingly in clinical practice for image interpretation and treatment consultation and care delivery supervision. There is no doubt that soon, the use of tele-nuclear medicine will increase, comparable to the employment of telecommunication in other fields of medicine. We review the medicolegal and regulatory aspects of the evolution in the clinical practice of medicine through telehealth and telemedicine.

Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.

COVID-19 catalyzed rapid implementation of virtual cancer care (VC); however, work is needed to inform long-term adoption. We evaluated patient and staff experiences with VC at a large urban, tertiary cancer center to inform recommendations for postpandemic sustainment.

All physicians who had provided VC during the pandemic and all patients who had a valid e-mail address on file and at least one visit to the Princess Margaret Cancer Centre in Toronto, Canada, in the preceding year were invited to complete a survey. Interviews and focus groups with patients and staff across the cancer center were analyzed using qualitative descriptive analysis and triangulated with survey findings.

Response rates for patients and physicians were 15% (2,343 of 15,169) and 41% (100 of 246), respectively. A greater proportion of patients than physicians were satisfied with VC (80.1 v 53.4%; P < .01). In addition, fewer patients than physicians felt that virtual visits were worse than those conducted in person (28.0 v 43.4%; P < .01) and that telephone and video visits negatively affected the human interaction that they valued (59.8% v 82.0%; P < .01). Major barriers to VC for patients were respect for care preferences and personal boundaries, accessibility, and equitable access. For staff, major barriers included a lack of role clarity, dedicated resources (space and technology), integration of nursing and allied health, support (administrative, clinical, and technical), and guidance on appropriateness of use.

Patient and staff perceptions and barriers to virtual care are different. Moving forward, we need to pay attention to both staff and patient experiences with virtual care since this will have major implications for long-term adoption into clinical practice.

This mini review aims to provide an overview of the role of telemedicine in preventing multi-drug resistant tuberculosis (MDR-TB) in Nigeria. The specific objectives include examining the potential benefits of telemedicine, identifying the challenges associated with its implementation, and highlighting the importance of addressing infrastructure limitations and data privacy concerns.

This minireview is based on a comprehensive analysis of existing literature, including scholarly articles, and reports,. A systematic search was conducted using electronic databases, such as PubMed and Google Scholar, to identify relevant publications related to telemedicine and MDR-TB prevention in Nigeria. The selected articles were assessed for their relevance, and key findings were synthesized to provide an overview of the role of telemedicine in addressing the challenges of MDR-TB in Nigeria.

The review demonstrates that telemedicine has the potential to significantly contribute to MDR-TB prevention efforts in Nigeria. The benefits of telemedicine include improved access to specialized care, enhanced patient adherence to treatment, and potential cost savings. However, challenges such as infrastructure limitations and data privacy concerns need to be addressed for successful implementation. Integrating telemedicine into the healthcare system has the potential to strengthen MDR-TB prevention, particularly in underserved areas, including within Nigeria. Specifically, the integration of telemedicine into the healthcare system can enhance access to specialized care, improve patient adherence, and potentially reduce costs associated with MDR-TB management.

Addressing infrastructure challenges, ensuring data privacy and security, and fostering trust among healthcare providers and patients are critical for successful implementation of telemedicine. Further research and policy frameworks are needed to guide the effective implementation and scale-up of telemedicine in MDR-TB prevention efforts in Nigeria.

Background: The COVID-19 pandemic prompted the widespread adoption of telemedicine to deliver health care services while minimizing in-person contact. However, concerns persist regarding equitable access to telemedicine, especially for vulnerable populations. This study examines the utilization patterns of telemedicine by race in the United States, considering different modalities, medical specialties, and geographic regions. Methods: A comprehensive review of 26 articles published between January 2020 and August 2022 was conducted to analyze racial disparities in telemedicine use during the pandemic. Data from electronic health records and self-reported race were compiled for analysis. Variations based on geography, clinical care types, telemedicine modalities (audio or video), and study design were explored. Results: The findings indicate the presence of racial disparities in telemedicine utilization, with minority groups exhibiting lower usage rates compared with Whites. The location of outpatient clinics and clinical care types did not significantly influence telemedicine use by race. Among studies comparing telemedicine modalities, African Americans were more likely to choose audio/phone visits over video visits. Studies employing a pre-post design were less likely to identify disparities in telemedicine use by race. Conclusions: This study consistently demonstrates increasing racial disparities in telemedicine use. Future research should focus on identifying contributing factors and developing strategies to address these disparities. Policymakers should consider implementing initiatives promoting equitable access to telemedicine, including financial assistance, improved broadband infrastructure, and digital literacy programs. By addressing these barriers, telemedicine can play a crucial role in reducing health care disparities and improving access to care for all Americans.

Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic.

This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges.

A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations.

A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits ("Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?") was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73).

During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology.

The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care.

A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.

Telehealth utilization rapidly increased following the pandemic. However, it is not widely used in the Veteran surgical population. We sought to evaluate postoperative telehealth in patients undergoing general surgery.

Retrospective review of Veterans undergoing general surgery at a level 1A VA Medical Center from June 2019 to September 2021. Exclusions were concomitant procedure(s), discharge with drains or non-absorbable sutures/staples, complication prior to discharge or pathology positive for malignancy.

1075 patients underwent qualifying procedures, 124 (12 ​%) were excluded and 162 (17 ​%) did not have follow-up. 443 (56 ​%) patients followed-up in-person (56 ​%) vs 346 (44 ​%) via telehealth. Telehealth patients had a lower rate of complications, 6 ​% vs 12 ​%, p ​= ​0.013. There were no significant differences in ED visits, 30-day readmission, postoperative procedures or missed adverse events.

Telehealth follow-up after general surgical procedures is safe and effective. Postoperative telehealth care should be considered after low-risk general surgery procedures.

The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020-December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.

The COVID-19 pandemic led to visitor restrictions in many hospitals. Since care in the surgical intensive care unit (SICU) often engages visitors as surrogate decision-makers, we investigated whether there was an association between COVID-19-related visitor restrictions, goals of care discussions (GOCD), and patient outcomes in SICU patients.

We conducted a retrospective review of trauma and emergency general surgery (EGS) patients admitted to a rural tertiary SICU between July 2019 and April 2021, dividing patients into those admitted during COVID-19 visitor restrictions and those admitted at other times. Using univariate and multivariate logistic regression analyses, we compared the primary outcome, incidence of GOCD, and incidence of prolonged hospital (> 14 d) and intensive care unit length of stay (LOS, > 7 d) between the two groups.

One hundred seventy nine of 368 study patients (48.6%) presented during restricted visitation. The proportion of GOCD was 38.0% and 36.5% in the restricted and nonrestricted visitation cohorts, respectively (P = 0.769). GOCD timing and outcomes were similar in both groups. The use of telecommunication increased during restricted visitation, as did the proportion of trauma patients admitted to the SICU. On multivariable logistic regression, age and patient category were independent predictors of GOCD. On outcomes analysis, visitor restriction was associated with prolonged hospital LOS for EGS patients (odds ratio 2.44, 95% confidence interval 1.01-5.91, P value 0.048).

Restricted visitation was not associated with changes in frequency or outcome of GOCD, but was associated with prolonged hospital LOS among EGS patients who had SICU admissions. Further investigation of patient/surrogate satisfaction with virtual GOCD in the SICU setting is needed.

Introduction: Telemedicine practice experiences during the COVID-19 pandemic have not been well documented in resource-constrained settings, such as Nigeria. We set out to assess knowledge, attitude, and factors associated with telemedicine practice during the COVID-19 lockdown, as well as physician experiences in Kano, Nigeria. Methods: We employed a mixed-methods approach, utilizing structured questionnaires administered to 246 physicians, followed by in-depth interviews with a purposive subsample of 20 individuals. The data were analyzed using logistic regression and the framework approach. Results: Overall, 65.0% of the respondents demonstrated moderate to good knowledge of telemedicine. Before COVID, only 47.6% (n = 117) reported practicing telemedicine, compared with 77.2% (n = 190) during the COVID lockdown (p < 0.05). Factors associated with telemedicine practice included having at least 5 years of work experience, working in pediatrics, undergoing senior residency training, receiving formal telemedicine training, possessing good knowledge of telemedicine, and having a positive attitude toward it. The odds of engaging in telemedicine practice were four times higher (adjusted odds ratio = 4.10, 95% confidence interval: 1.79-9.40) for those who practiced it before the pandemic. Challenges identified included knowledge and skill gaps, slow internet connectivity, unstable electricity, and inadequate equipment. Conclusion: To enhance telemedicine practice in resource-limited settings, it is important to focus on strengthening information and communication infrastructure, providing comprehensive clinician training, implementing careful patient selection processes, and improving practice guidelines.

With a rise in remote clinical practice related to the COVID-19 pandemic, a novel remote psychotherapy curriculum was presented to psychiatry residents and fellows to address the urgent need to teach trainees how to adapt traditional psychotherapy skills to telepsychiatry settings.

Trainees completed a survey before and after receiving the curriculum to assess remote psychotherapy skills and areas for growth.

Eighteen trainees (24% fellows, 77% residents) completed the pre-curriculum survey, and 28 trainees (26% fellows, 74% residents) completed the post-curriculum survey. Thirty-five percent of pre-curriculum participants indicated no experience with remote psychotherapy. Technology (24%) and patient engagement (29%) were identified as the greatest challenges in providing teletherapy pre-curriculum. Content related to patient care (69%) and technology (31%) was of most interest to pre-curriculum participants and identified as most helpful post-curriculum (53% and 26%, respectively). After receiving the curriculum, most trainees planned to make internal, provider-related changes to their remote teletherapy practice.

The remote psychotherapy curriculum was well received by psychiatry trainees who had limited experience with remote clinical practice prior to the pandemic.

Despite significant progress in health technology and growing interest among countries in incorporating telemedicine into healthcare delivery, its usage remains limited in Iran. The aim of this study is to investigate the challenges related to telemedicine in Iran and pinpoint potential solutions from the viewpoint of health policymakers, marking the first such endeavor.

This qualitative study was conducted in Iran in 2022. Data were gathered from 19 health policymakers who were selected using purposeful and snowball sampling techniques via in-depth and semi-structured interviews. The research findings were analyzed using the content analysis technique, with coding performed using MAXQDA software. The content analysis approach developed by Erlingsson was utilized to analyze the data.

The study revealed eight main challenges that inhibit the widespread use of telemedicine in Iran. These challenges include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Furthermore, four key solutions to these challenges were identified. These include a national commitment to the development of telemedicine, the establishment of a telemedicine roadmap, the enhancement of e-health requirements and infrastructure, and the preparation of the community to accept telemedicine as a viable option for healthcare delivery.

The implementation of telemedicine in Iran faces significant challenges, some of which are related to the national healthcare system, while others stem from various policy-related institutions and organizations. Addressing these challenges will require extensive inter-organizational cooperation and strong leadership at the governance level. However, it should be noted that fully resolving these issues is a time-consuming process.

Introduction: The use of telemedicine (TM) for patient care greatly increased during the COVID pandemic. This study presents data from a single health system regarding physician's perspectives on TM, which could ultimately determine how it is used in the future. Methods: A questionnaire was distributed to physicians throughout the health system. Physicians were divided based on the standard level of patient interaction in each specialty, as well as practice locations and years in practice. Physician perspectives were categorized by their opinions on different aspects of telehealth visits. Results: Of 1,794 physicians, 379 (20.7%) responded to the survey. Psychiatrists used TM significantly more than other groups and project the most future use. Surgeons were least likely to incorporate TM in the future. Ability to perform a physical examination via TM differed significantly by specialty and practice environment, but not by years in practice. Frequency of being able to complete a treatment plan via TM differed significantly by specialty, but not by years in practice or practice environment. Overall, 76.3% of physicians reported feeling "satisfied" with performing TM visits. Satisfaction with TM varied significantly by specialty and practice environment, but not by years in practice. There were no significant differences regarding physician expectations on reimbursement or billing for TM visits based on specialty, age, or practice environment. Conclusions: Discrepancies exist among physicians with respect to their satisfaction and expected future use of TM. Consensus may be difficult to reach regarding reimbursement for these visits, and further work is needed to clarify the optimal practice setting for TM.

Around the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait.

The purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait's health care system for diabetes care and management.

The research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The "diffusion of innovation" model was used as a perspective to interpret the findings.

A total of 20 participants were included in this study-10 HCPs and 10 patients with diabetes-all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety.

The results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment.

Background: The COVID-19 pandemic forced the change of health care services, favoring the use of remote consultations. Objective: To assess the differences in asthma medical follow-up before and during the COVID-19 pandemic and to evaluate patients' satisfaction regarding remote consultations. Methods: A cross-sectional, observational, web-based study, including 335 Portuguese patients with self-reported physician-diagnosed asthma, was conducted. The survey was available between February and May 2021 and included questions about patients' sociodemographic and clinical characteristics and follow-up (consultations' type and satisfaction in 2019 and 2020). Satisfaction was assessed using 10 statements on different aspects of patient experience (Likert scale 1-5), with a total score between 10 and 50. Results: The 335 patients included had a median [P25-P75] age of 27 [21-43] years and 75% had uncontrolled asthma. Overall, fewer participants had consultations during the pandemic compared to 2019 (161 vs. 185; p < 0.001). Most patients had ≥1 face-to-face consultation both in 2020 and 2019 (131 vs. 184; p < 0.001). In 2020, there was an increase in the proportion of participants reporting ≥1 remote (telephonic plus video) consultation (40% vs. 3%; p < 0.001). This increase was mainly attributed to the use of telephonic consultation (38% vs. video 3%, p < 0.001). Patients' satisfaction was similar in 2020 and 2019 for face-to-face consultations (44 [38-47] and 44 [39-48], p = 0.136). In 2020, satisfaction with remote consultations was slightly lower than with face-to-face (43 [37-46] vs. 44 [38-47], p < 0.001). Conclusions: Even though patients were slightly more satisfied with face-to-face consultations, remote consultations can be an alternative in follow-up services for patients with asthma in the near future.

The COVID-19 pandemic necessitated a change in the provision of outpatient care in dermatology.

A novel, asynchronous, digital consultation platform was codeveloped with 2 National Health Service dermatology teams to improve access and enhance choice in outpatient care.

The rollout of the platform was accelerated during the initial COVID-19 lockdown, and its wider use across 2 Scottish health boards was retrospectively evaluated. Integrated with the hospital booking system and electronic patient record, the platform provides an alternative to face-to-face consultations, using information and images submitted by the patients.

In total, 297 new patient consultations and 108 return patient consultations were assessed, and 80% (324/405) of the images submitted were of satisfactory quality. The consultations were, on average, 3 minutes shorter than equivalent face-to-face interactions, and a total of 5758 km of patient travel was avoided. Outcomes included web-based reviews (66/405, 16.3%), face-to-face reviews (190/405, 46.9%), biopsies (46/405, 11.4%), discharge (89/405, 22%), and other treatments or investigations (14/405, 3.5%). High levels of patient satisfaction (92/112, 82.1%) were reported.

Digital dermatology assessments are now included in the choices for consultation types that are available to patients, helping to augment service capacity during pandemic recovery.

The COVID-19 pandemic has disrupted contraceptive service provision in the United States (US). We aimed to explore the impact of COVID-19 on the publicly supported family planning network at the provider level. This study adds to the literature documenting the challenges of the pandemic as well as how telehealth provision compares across timepoints.

We conducted a survey among sexual and reproductive health (SRH) providers at 96 publicly supported clinics in four US states asking about two timepoints-one early in the pandemic and one later in the pandemic. We used descriptive statistics to summarize the data.

We found that almost one-third of sites reduced contraceptive services because of the pandemic, with a few temporarily stopping contraceptive services altogether. More sites stopped provision of long-acting reversible contraception (LARC), Pap tests, and Human papillomavirus (HPV) vaccinations than other methods or services. We also found that sites expanded some practices to make them more accessible to patients, such as extending existing contraceptive prescriptions without consultations for established patients and expanding telehealth visits for contraceptive counseling. In addition, sites reported high utilization of telehealth to provide contraceptive services.

Understanding how service delivery changed due to the pandemic and how telehealth can be used to provide SRH services sheds light on how these networks can best support providers and patients in the face of unprecedented crises such as the COVID-19 pandemic.

This study demonstrates that providers increased provision of telehealth for sexual and reproductive health care during the COVID-19 pandemic; policymakers in the US should support continued reimbursement of telehealth care as well as resources to expand telehealth infrastructure. In addition, this study highlights the need for more research on telehealth quality.

Telemedicine and electronic medical records (EMRs) have revolutionized healthcare in recent years, offering numerous benefits that improve the delivery of care and the overall patient outcomes.

Telemedicine allows providers to diagnose and treat patients remotely, often eliminating the need for face-to-face visits. Its benefits include improved access to care, convenience for patients, and reduced costs both for patients and providers. When used with remote patient monitoring and remote therapeutic monitoring, continuous care becomes possible. EMRs allow providers to store, access, and share patient information more efficiently than paper charts. The benefits of EMRs include improved patient safety, increased efficiency, and reduced costs.

The combination of telemedicine with EMRs makes it possible to envision the advent of computer-assisted diagnosis (CAD). This technology uses artificial intelligence and machine learning algorithms to analyze medical information including images, clinical and physiologic data, test results and remotely obtained information to support healthcare providers in making accurate diagnoses. By providing providers with what is essentially a second opinion, CAD systems can help prevent misdiagnoses and improve the quality of care. Such systems are not meant to replace healthcare providers, but rather to support them in making more informed and accurate diagnoses.

This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic.

Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test.

In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777).

Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Telemedicine was increasingly used to provide patients with an alternative to in-office visits during the COVID-19 pandemic. While previous studies have described the role of telemedicine for preoperative visits for other surgical specialties, the role of this modality in preoperative visits for gynecologic surgery has not been thoroughly explored.

The aims of the study are to explore and compare patient experience, decision making, and satisfaction among women undergoing telemedicine or in-person preoperative visits.

This was a qualitative study of women who underwent a preoperative appointment with a urogynecologic surgeon or minimally invasive gynecologic surgeon at a single academic institution from April to May of 2021. Data were collected using semistructured phone interviews, which focused on visit content, visit type decision making, surgical preparedness/confidence, and past surgical experiences. Interviews were thematically analyzed until theoretical saturation was achieved in accordance with grounded theory.

Theoretical saturation occurred with 20 interviews. Participants were evenly divided between in-person and telemedicine visits. Major themes included visit content, experience/quality, surgeon perception, and surgical preparedness. Advantages of telemedicine visits were convenience and safety. Advantages of in-person visits were social factors, perceived medical or surgical severity, and preoperative physical examination. Disadvantages for telemedicine visits included technology concerns and difficulty accessing preoperative materials. The disadvantage of an in-person visit was the inability to have family present because of COVID hospital policy restrictions. Participants in both groups felt prepared for surgery and reported high satisfaction with their care.

Decision making for selecting an in-person or telemedicine visit is complex and involves balancing multiple advantages and disadvantages. Participant experience was similar for both visit types with high satisfaction.

(1) Background: Hidradenitis suppurativa is a chronic, inflammatory skin disease. It is characterized by the transformation of normal skin into skin with abscesses, nodules, tunnels, and scars. The most commonly affected areas are the armpits, groins, buttocks, and subscapular area. Patients with HS require constant care under the supervision of the outpatient clinic. Due to the COVID-19 pandemic, consultations have been introduced in the form of telemedicine. The aim of this study was to evaluate the availability of HS treatment during the COVID-19 pandemic and to assess patient satisfaction, problems with access to medical care, and the impact of the pandemic on the course of the disease. (2) Methods: An internet survey with an anonymous questionnaire was used to assess the effectiveness of telemedicine consultations. The survey consisted of 25 closed questions, and responses were kept fully anonymous. (3) Results: Most respondents reported minor problems with accessing specialized HS medical care during the COVID-19 pandemic (n = 25, 35.71%). However, 35.71% (n = 25) of them reported major problems with appointments for specialized ambulatory treatment during the last few months of the pandemic, mainly due to delayed appointments. Almost half of the respondents had been diagnosed with COVID-19 (n = 34, 48.57%), and 58.57% (n = 41) of respondents did not see a correlation between COVID-19 infection and HS progression. (4) Conclusions: Our study showed that the pandemic significantly limited access to medical advice, and patients with hidradenitis suppurativa prefer standard consultations.

The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making.

We performed a mixed-methods, prospective, observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was the level of shared decision-making as captured by top box scores of the CollaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire and satisfaction with consultation survey. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed.

During a 13-month study period, 387 patients were enrolled, of which 301 (77.8%) underwent in-person visits and 86 (22.2%) underwent telemedicine visits. The groups were similar in age, sex, employment, education, and generic quality-of-life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the CollaboRATE top box score (odds ratio 1.27; 95% CI 0.74 to 2.20) or 9-item Shared Decision-Making Questionnaire (β -0.60; p = 0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality.

In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.

Telehealth has been increasingly utilized with a renewed interest by surgical specialties given the COIVD-19 pandemic. Limited data exists evaluating the safety of routine postoperative telehealth follow-up in patients undergoing inguinal hernia repair, especially those who present urgent/emergently. Our study sought to evaluate the safety and efficacy of postoperative telehealth follow-up in veterans undergoing inguinal hernia repair.

Retrospective review of all Veterans who underwent inguinal hernia repair at a tertiary Veterans Affairs Medical Center over a 2-year period (9/2019-9/2021). Outcome measures included postoperative complications, emergency department (ED) utilization, 30-day readmission, and missed adverse events (ED utilization or readmission occurring after routine postoperative follow-up). Patients undergoing additional procedure(s) requiring intraoperative drains and/or nonabsorbable sutures were excluded.

Of 338 patients who underwent qualifying procedures, 156 (50.6%) were followed-up by telehealth and 152 (49.4%) followed-up in-person. There were no differences in age, sex, BMI, race, urgency, laterality nor admission status. Patients with higher American Society of Anesthesiologists (ASA) classification [ASA class III 92 (60.5%) versus class II 48 (31.6%), P = 0.019] and open repair [93 (61.2%) versus 67 (42.9%), P = 0.003] were more likely to follow-up in-person. There was no difference in complications, [telehealth 13 (8.3%) versus 20 (13.2%), P = 0.17], ED visits, [telehealth 15 (10%) versus 18 (12%), P = 0.53], 30-day readmission [telehealth 3 (2%) versus 0 (0%), P = 0.09], nor missed adverse events [telehealth 6 (33.3%) versus 5 (27.8%), P = 0.72].

There were no differences in postoperative complications, ED utilization, 30-day readmission, or missed adverse events for those who followed-up in person versus telehealth after elective or urgent/emergent inguinal hernia repair. Veterans with a higher ASA class and who underwent open repair were more likely to be seen in person. Telehealth follow-up after inguinal hernia repair is safe and effective.