The use of telemedicine, including direct-to-consumer telemedicine, has increased significantly, yet there are concerns about the quality and safety of care accessed via this model. The current study retrospectively analyzed survey data from individuals about their perceptions of the efficacy, safety, and quality of care they accessed through a telemedicine platform. An online survey, originally intended for the purposes of quality improvement, was sent to individuals who had accessed treatment via a national telemedicine platform. The survey, made available between June 30, 2025 and July 3, 2025, consisted of 22 questions that queried individuals about their experience with the platform. Data were de-identified and retrospectively analyzed, with descriptive statistics used to report on the number and percentage of participants who indicated agreement with survey items. The survey was completed by 2,399 participants. Overall, participants (>80%) reported a positive experience pertaining to the quality and safety of care accessed via the platform. The majority (>90%) of participants reported a positive experience with the online clinical intake and with providers on the platform. Participants consistently (>90%) rated their overall experience with the platform as equal to or better than prior in-person health care experiences. There was variability with regard to participants' awareness of specific safety practices implemented by the platform. Our findings indicate that the majority of individuals who engaged with the telemedicine platform had positive perceptions of the efficacy, quality, and safety of the care they received and viewed the experience as rivaling care they had previously received in an in-person setting.
Digital health is more relevant now than ever before, and interventions have a clear potential to improve the quality of care while reducing health care costs. Telemedicine has emerged as a transformative approach to health care delivery, particularly accelerated by the COVID-19 pandemic. In mission environments, telemedicine increasingly supports the management of acute injuries, chronic conditions, predeployment screening, and follow-up assessments, often using low-bandwidth store-and-forward modalities. By reviewing existing literature and considering several different (heterogeneous) programs for "telemedicine for mission support," the key performance indicators are explored to evaluate telemedicine in missions, following its implementation. Both acute and chronic care use cases, as well as operational, clinical, and technical determinants of feasibility, were considered. This article presents the clinical, operational, and economic benefits of "telemedicine in missions" and the metrics for a comprehensive cost-effectiveness analysis or cost-benefit analysis, considering its economic and clinical impacts. Telemedicine in missions shows considerable differences from other telemedicine applications depending on the actors and the resulting circumstances. Considering the heterogeneity of the metrics provided, even within the field of "telemedicine in missions," the analyses have to be conducted in accordance with the encountered conditions. Nevertheless, a set of metrics can be applied to nearly all use cases across the different applications and actors. A mission-adaptable minimum data set is proposed to support standardized evaluation across diverse operational contexts.
Technological advancements and legislation have led to the widespread use of electronic health records (EHRs) in the 21st century. Along with EHR implementation came improved health care quality, continuity of care, and data availability. However, EHRs are not without drawbacks. Physician burnout rates are rising, and EHRs are among the top causative factors. The consequences of burnout can offset the benefits of EHRs, prompting the health care community to seek solutions for the burnout epidemic. One proposed solution is to use artificial intelligence (AI) scribes, which utilize voice-recognition software to transcribe patient-physician interactions in real time, resulting in comprehensive documentation of the encounter. Since AI technology is in its infancy, limited research is available regarding provider perceptions and the real-world use of AI scribes. This study aimed to evaluate health care providers' experiences with documentation burden and perceived quality of patient interactions while using an AI scribe in a telehealth setting. Participants used the AI scribe exclusively during telehealth encounters. Provider attitudes and experiences were measured across the 3-month pilot period to assess changes in documentation burden, workflow efficiency, satisfaction, and perceived impact on patient interaction quality. Study results revealed that three-fifths of the providers experienced decreased burnout attributed to the AI scribe, and two-thirds of the providers reported enhanced satisfaction with documentation time and the time spent engaging with patients. Given our study results and the promising direction of AI technology, the use of AI scribes in the telehealth setting has the potential to mitigate burnout, improve the provider-patient relationship, and help restore patient-centered care.
Telemedicine has become an essential tool for providing health care to offshore workers. Despite its advancements, there is still a lack of understanding about its optimal use and the factors affecting it among health care providers in offshore settings. The objective of this work was to study and determine the level of telemedicine utilization among offshore health care workers and its associated factors in Malaysia. In this cross-sectional study, online questionnaires were distributed to health care workers involved in offshore medical services. The questionnaire includes sociodemographic information and the validated Malay version of the Telemedicine Acceptance Model (TAM) Questionnaire. A total of 73 offshore health care workers were recruited from a local company using universal sampling. Data analysis involved descriptive statistics as well as simple and multiple logistic regression. A total of 65.8% of offshore health care workers reported using telemedicine in their practice. Multiple logistic regression analysis indicated that Chinese and Indian workers were significantly more likely to use telemedicine compared with Malay workers, with adjusted odds ratios of 32.11 (p = 0.045) and 33.51 (p = 0.037), respectively. Workers with a good attitude toward telemedicine had 11.84 times higher odds of utilization (p = 0.004), while those with high behavioral intention were 25.80 times more likely to use telemedicine compared with their counterparts with low behavioral intention (p < 0.001). A majority of offshore health care workers utilize telemedicine, with Chinese and Indian ethnicity, good attitude, and high behavioral intention significantly predicting its utilization.
Metabolic syndrome (MetS) is a major risk factor for type 2 diabetes and cardiovascular disease. In recent years, telemedicine and digital health interventions have emerged as promising strategies to support lifestyle modification and the long-term management of cardiometabolic conditions. However, their clinical effectiveness in MetS remains heterogeneously reported. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2019 and 2024. Eligible studies included adults with MetS or its components and evaluated telemedicine or technology-enabled interventions, including mobile health (mhealth) applications, remote monitoring, wearable devices, or telecommunication-based care. Outcomes of interest included waist circumference (WC), glycemic parameters, blood pressure, and lipid profile. Twenty seven studies met inclusion criteria. Most interventions incorporated telemedicine components such as remote coaching, digital feedback, and continuous monitoring, frequently delivered through mobile platforms and wearable technologies. These interventions consistently resulted in reductions in WC, while modest but recurrent improvements were observed in glycemic control and blood pressure. Effects on lipid parameters were more variable, with more frequent improvements in high-density lipoprotein cholesterol than in low-density lipoprotein cholesterol. Higher intervention intensity and user engagement were associated with greater clinical benefits. Telemedicine and digital health interventions represent effective adjuncts to conventional lifestyle management of MetS, particularly for central obesity and glycemic outcomes. Their ability to deliver scalable, personalized, and remotely supported care highlights their potential role in cardiometabolic prevention and management. Further research is needed to standardize intervention components and optimize long-term effectiveness.
Although public interest in telemedicine is growing, limited research has examined the necessary conditions for its usage. Therefore, this study aims to identify these conditions in Japan and China. A self-developed questionnaire was administered between 2022 and 2023, yielding 787 valid responses in Japan and 840 in China. In addition, 241 Japanese and 194 Chinese supplemental responses were collected in 2025. Factor analysis and necessary condition analysis (NCA) were applied. Based on the initial samples, eight factors were extracted: cost and accessibility, social influence, safety and reliability, adaptive readiness, technology confidence, perceived data security, facilitating conditions, and perceived usefulness. NCA revealed cross-national differences. Japanese participants mainly regarded perceived usefulness (d = 0.12-0.31) and facilitating conditions (d = 0.15-0.29) as necessary conditions, whereas Chinese participants perceived a broader set of prerequisites. Subgroup analyses further indicated that safety and reliability were the most critical necessary conditions for experienced users in both countries (Japan: d = 0.44; China: d = 0.28). Hierarchical clustering analysis further revealed three bottleneck trajectories of constraints: gradual-bottleneck users (progressive constraints), high-bottleneck users (sudden demand surges), and early-bottleneck users (persistent initial constraints). Crucially, the supplemental samples further confirmed the reliability and validity of the eight-factor structure and the temporal consistency of the necessary conditions for sustained usage. The findings highlight the need for tailored telemedicine strategies. In particular, maintaining safety and reliability represents a nonnegotiable prerequisite for sustained telemedicine usage in both countries. The developed instrument, combined with NCA, offers a transferable approach for identifying constraints and developing more adaptive and equitable telemedicine strategies.
Military and peace-support operations increasingly depend on medical capability delivered under difficult circumstances: distance, limited number of specialists, disrupted connectivity, and mass-casualty risk. Consequently, military health care systems operate during missions in uniquely constrained and high-risk environments, ranging from remote bases and naval platforms to active combat zones and humanitarian missions. These mission contexts demand rapid, reliable, and scalable medical solutions that can function despite limited personnel, infrastructure, and connectivity. By reviewing existing literature and considering several different programs for military health care using telehealth and artificial intelligence (AI), the key performance indicators are explored to evaluate the synergy of telehealth and AI, following its implementation. Telehealth has become an increasingly important component of modern health care and holds the promise of increasing access to (special) health care without moving the patient but the information. Telehealth also enables continuity of care on missions and has already demonstrated its value in extending medical expertise across distance, while AI is evolving rapidly as a powerful enabler of decision support, automation, and predictive analytics in the medical field. As AI capabilities mature, several medical specialties may benefit, particularly in medical imaging, through faster triage, more consistent interpretation, and better prioritization of scarce specialist time. It also contributes to "decision support "while making proposals based on big data, machine learning and AI (e.g., in a Trauma registry). Telehealth provides the communication backbone that preserves these interactions and enables safe use of AI-enabled support in dispersed operations. The convergence of telehealth and AI in military health care will lead to a strategic capability with increased efficiency and enhance readiness, resilience, access to medical care, and quality of care for military personnel, including faster and more accurate diagnoses and better patient monitoring. Both technologies (AI and telehealth) are expected to continue to advance and play an even larger role in optimizing health care in the military.
In developing countries, satellite-based technology can aid critical telemedicine applications and other digital health services in critically underserved areas. Affordable, high-speed broadband services can and should be accessible to all citizens. Remote locations are necessary to support various critical services, including education and training, telehealth applications, remote patient monitoring, and warning systems, particularly during disasters. Currently, however, these services are limited to urban centers, leaving rural areas without access to specialized health care services. This digital divide significantly impacts health care delivery, with only 48% of rural populations having internet access compared with 83% in urban areas. The goal of this study was to assess the suitability of Geostationary Earth Orbit (GEO), Medium Earth Orbit (MEO), and Low Earth Orbit (LEO) satellites for telemedicine and health care backhaul connectivity. To achieve this, the study conducted a comparative analysis of the systems, highlighting their respective advantages and limitations in terms of latency, coverage, and deployment costs. A systematic literature review and the assessment of real-world case studies and worldwide datasets complemented this analysis. Case studies from Starlink deployments in North America and Sub-Saharan Africa and Amazon's Project Kuiper were evaluated. LEO satellites demonstrated significantly lower latency (20-50 ms) compared with MEO (100-300 ms) and GEO (600 ms) systems. Cost analysis revealed LEO services ($110-$500 per month) were substantially more affordable than MEO ($250-$1,000 per month) and GEO ($500-$2,000 per month) alternatives. Starlink deployments achieved download speeds of 50-250 Mbps with sub-50 ms latency, enabling real-time telemedicine consultations that met clinical standards. Rural telemedicine consultations increased by over 300% in areas with LEO satellite coverage. Our findings suggest that the LEO Starlink satellite technology would provide the most cost-effective backhaul broadband connectivity for real-time telemedicine services, given its low latency needs (20-50 ms), which enable high-quality video calls and remote diagnostics. We recommend using an LEO-based satellite network as the best approach to extend internet services to underserved remote communities due to its low latency and cost-effectiveness in aiding health care delivery in developing countries.
The increasing use of telemedicine has transformed communication between patients, physicians, and other health professionals through virtual platforms, offering new possibilities for healthcare delivery and accessibility. This study aimed to identify the factors influencing the acceptance of telemedicine services among women in Peru by applying an extended and conceptually adapted unified theory of acceptance and use of technology (UTAUT) model. A quantitative correlational design was used, involving a survey of 503 Peruvian women. Data were analyzed using the partial least squares structural equation modeling technique with SmartPLS 4 software. The analysis included a measurement model to assess convergent and discriminant validity of the constructs, followed by a structural model to test the proposed hypotheses. Findings revealed that performance expectancy, social influence, effort expectancy, and perceived safety are the most influential factors affecting women's intention to use telemedicine services. From a theoretical perspective, this study contributes to understanding telemedicine adoption among Peruvian women by validating the relevance and reliability of the extended UTAUT model in this context. Practically, the results provide valuable insights for designing public policies and training programs to promote the use of telemedicine in Peru.
Telehealth has emerged as a promising strategy to mitigate access barriers, particularly following rapid expansion during the COVID-19 pandemic; however, evidence on its role across care settings and populations remains fragmented. This scoping review synthesizes United States (U.S.)-based evidence on the role of telehealth in improving access to primary and specialized medical care for underserved, rural, and hard-to-reach adult populations. Guided by the Arksey and O'Malley framework and PRISMA-ScR guidelines, peer-reviewed studies were identified through PubMed, Embase, and the Cochrane Library. Eligible studies examined telehealth use in adult U.S. populations and reported outcomes related to health care access, social determinants of health (SDoH), or implementation strategies. Data were charted and synthesized narratively, with implementation approaches categorized using the ERIC framework. Of 9,212 records identified, 242 studies met inclusion criteria. Telehealth was associated with comparable or improved access and clinical outcomes across primary care, specialty care, behavioral health, palliative care, and perioperative settings. Commonly addressed SDoH and demographic characteristics included age, race/ethnicity, socioeconomic status, insurance coverage, geography, and digital access. While telehealth reduced barriers related to transportation, travel burden, and scheduling flexibility, disparities persisted for older adults, individuals with limited English proficiency, and those with low digital literacy or broadband access. Implementation strategies most frequently involved adapting interventions to local context, iterative evaluation, and clinician support, whereas financial and infrastructure-level strategies were less commonly reported. Extant literature suggests that telehealth has broad and firm support for its role in reducing access barriers and improving health outcomes across a wide range of conditions and populations. Therefore, future community-based approaches should focus on integrating telehealth into existing care delivery systems, tailoring interventions to the needs and preferences of different populations, and addressing structural barriers such as digital access, health literacy, and reimbursement to ensure sustained implementation.
Telehealth has emerged as a fundamental component for improving health efficiency and access in Latin America. In this regard, it is essential to investigate the quality of the services offered and structure best practices for their implementation, monitoring, and evaluation. This study aims to evaluate the quality of 15 telehealth services from 4 Latin American countries across 3 dimensions. An instrument for evaluating the quality of telehealth services was developed and validated by Latin American experts, based on the Service Planning, Risk Management, and Technology Management domains of ISO/TS 13131:2021. After validation, data from 15 services in Brazil, Mexico, Chile, and Peru were analyzed. The following tests were applied: Content Validation Index, Shapiro-Wilk, Analysis of Variance, Kruskal-Wallis, and Fisher to validate content and verify associations between countries and service quality, classified into low, medium, and high levels. The instrument showed S-CVI for Relevance = 0.96; Clarity = 0.86; General = 0.91. There was no statistically significant association between countries and service quality. Overall, 60% of services were classified as low (46.67%) or medium quality (13.33%), while 40% presented high quality. Mean scores were 9.8/15 for Service Planning, 8.5/12 for Risk Management, and 21.5/35 for Technology Management, resulting in a general mean of 39.8/62 points. The results highlight gaps in the quality of the evaluated telehealth services. The instrument's validation confirms its applicability as a tool for telehealth quality assessment.
To evaluate how patient characteristics are associated with telemedicine visit modality (video, phone, or converted from video to phone) and patient satisfaction, to better understand the digital divide in telemedicine. A retrospective cohort study conducted at a tertiary care center during the early phase of the COVID-19 pandemic (March-October 2020). Adult patients (≥18 years) who completed a telemedicine satisfaction survey following a visit during the study period were included. Visit modality was classified as video, phone, or converted (scheduled as video but completed as phone). Sociodemographic characteristics and broadband access data (by ZIP code and county) were linked to patient records. Multivariable logistic regression was used to identify predictors of visit conversion and satisfaction. Of 30,578 patients surveyed, 17,859 (58%) responded. The median age was 59 years; 63% were female, and 74% were White. Visit modalities included video (43%), phone (39%), and converted (18%). Conversion from video to phone was significantly associated with older age, Medicare insurance, lower income, and reduced broadband access. Patient satisfaction was highest for video visits, followed by phone, and lowest for converted visits (p < 0.0001). Satisfaction declined with increasing age for phone and converted visits, but not for video visits. A previsit phone call was consistently associated with higher satisfaction across all modalities. Conversion from video to phone visits is a marker of digital access barriers and is associated with reduced patient satisfaction. Interventions such as previsit support calls should be used to improve patient experiences and help mitigate disparities in telemedicine access and outcomes. Inclusion of phone visits as a form of telemedicine recognized and reimbursed by insurance companies will allow for our most vulnerable patients to have equitable access to the health care system.
To evaluate a brief telepsychotherapy service within the Brazilian Unified Health System in a Brazilian capital (April 2024-April 2025), analyzing its functioning, outcomes, and contribution to access in primary health care (PHC). A quantitative descriptive study using secondary data from the service's regulatory system and records. Individuals ≥18 years of age with a therapeutic outcome during the period were included. Descriptive, bivariate (chi-square, Welch's t, and Mann-Whitney), and binary logistic regression analyses were performed. One hundred and ninety-three users participated, predominantly women (88.1%) and adults aged 25-59 years (80.3%). The outcome was discharge in 37.8% and discontinuation in 62.2%. Reasons for discontinuation included absences (30.6%), unsuitability (13.5%), at the patient's request (12.4%), and referral to the psychosocial care center (5.7%). In the regulatory system, "Mental and behavioral disorders" (ICD F00-F99; n = 126) predominated, with frequent use of ICD Z codes, suggesting diagnostic difficulties in PHC. Most teleconsultations occurred in urban units (97.2%), with 77.7% of requests coming from units with multiprofessional teams in primary health care (eMULTI); the average attendance rate was 58.75%. In bivariate analyses, the outcome was associated with the presence of eMULTI (p = 0.0398) and the ICD chapter (p = 0.0056). The attendance rate differed significantly between high-level and low-level attendance (p < 0.0001). Telepsychology is a relevant strategy to expand access and reduce unmet demand in PHC. However, challenges regarding adherence and continuity persist. Effectiveness depends on clear workflows, qualified teams, and engagement and integration strategies between PHC and specialized services.
Performance of medical procedures in spaceflight beyond low Earth orbit (LEO) requires novel solutions to replace real-time ground support, which is hampered by growing communication latencies as distance from Earth increases. The Autonomous Medical Officer Support (AMOS) Software Technology Demonstrations on the International Space Station (ISS) trialed a novel software tool that shifts the emphasis from pre-flight training and real-time remote guidance (current ISS paradigm) to a new standard of multidimensional in-flight just-in-time instruction. The AMOS platform is a skill management tool for all mission phases and currently features comprehensive training and guidance modules for urinary bladder and renal ultrasound examinations. Using the AMOS software, two ISS crewmembers performed in-flight bladder and kidney ultrasound examinations with no guidance from the ground and with no pre-flight exposure to the software (n = 2 sessions). Images were graded for clinical quality using a strict evaluation rubric. Software use patterns were recorded, and participants provided both structured and free response feedback. Clinically adequate images were obtained for all but one of the attempted views. Participants rated AMOS as highly useable and primarily used linear navigation. Variability in subject anatomy, operator experience, and operator receptiveness to instruction during autonomous examinations is a persistent but manageable limitation. Despite these challenges, here we report the first successful demonstrations of autonomous imaging activities in the operational setting of spaceflight, validating this autonomous guidance proof-of-concept.
Telehealth utilization (TU) increased during the pandemic. Currently, there is limited literature on telehealth use among older adults. This study aims to examine the prevalence and predictive factors of telehealth use among seniors from wellness centers in Washington, DC and to explore barriers associated with TU during the pandemic. A cross-sectional study was done among members of senior wellness centers in DC who were ≥60 years old. Descriptive statistical analysis was conducted for all study variables. Logistic regression analyses were conducted to assess predictive factors of TU during the COVID-19 pandemic. Bivariable associations between telehealth barriers and study factors were also evaluated. All statistical analysis was conducted using SPSS version 28 at an alpha level of 0.05. A total of 105 seniors were included in the study. Of them, 72.4% were female, 57.7% had public health insurance, 88.6% were African American, and 48.6% reported they have remote visits using any type of device. Multivariable analysis showed that gender (p = 0.010), computer access (p < 0.001), communal housing (p = 0.039), and computer self-efficacy (CSE) (p = 0.047) were significant predictors of TU. Fear of fraud, navigation, and computer access were barriers identified as factors associated with gender, age, and having a remote connection, respectively. Findings showed that only 48.6% of seniors in DC used telehealth during the pandemic, with gender, computer access, communal housing, and CSE playing a significant role. More studies are needed to confirm our study findings. Targeted policies are needed to sustain telehealth use after the pandemic.
This scoping review examined available evidence in implementation and evaluation of virtual care in Canada. Virtual care saw recent uptake due to the COVID-19 pandemic; however, to ensure quality of care, rigorous implementation and evaluation frameworks are needed. Peer-reviewed and gray literature were searched to determine extent, range, and nature of evidence surrounding implementation and evaluation of virtual care based on the guidelines of the Joanna Briggs Institute. Although virtual care can encompass synchronous and asynchronous modalities, this review focused on synchronous virtual care, defined as real-time interactions between patients and providers via videoconferencing or telephone. Search included MEDLINE, EMBASE, Psych Info, and CINAHL databases and national and provincial health system, professional organization, and regulatory websites. Inclusion criteria included videoconferencing or telephone and English and French Canadian sources. Citations were screened by two researchers at title, abstract, and full-text levels. Two hundred and eight (208) manuscripts were included for analysis. High numbers of studies on patient satisfaction, process outcomes, and barriers were identified, with underrepresentation of health and systems outcomes and impact evaluations. There were very few studies examining hybrid care, planetary health, and use of virtual care with equity-deserving groups. This scoping review identified areas of importance for future research, including the use of virtual care in rural and remote regions, inpatient, long-term, and emergency settings, hybrid care, economic and planetary health impacts, and artificial intelligence. As well, enhancing standardization of implementation and evaluation guidelines will optimize quality of care and best practice.
Telemedicine (TM) is increasingly integrated into health care delivery; however, its safe and effective implementation depends on the competency of the nursing workforce. Although previous research has examined TM utilization among nurses, evidence regarding TM competency levels remains limited. To assess TM-related competencies across four domains: awareness, knowledge, attitudes, and skills among nurses in the United Arab Emirates, and identify factors associated with each domain. A cross-sectional survey was conducted among 434 nurses working in governmental health care facilities. TM competencies were measured using a structured online questionnaire incorporating demographic characteristics and the validated TM Awareness, Knowledge, Attitude, and Skills instrument. Descriptive statistics and multiple linear regression analyses were performed to evaluate competency levels and their predictors. Nurses demonstrated high TM knowledge (81.44 ± 22.27) and positive attitudes (81.42 ± 10.27), with 77.0% and 92.4% of participants scoring high in these domains, respectively. Awareness (55.89 ± 26.17) and skills (57.11 ± 23.01) were more moderate, with only 28.6% and 24.4% of nurses scoring high in these domains, respectively. Interest in TM was a positive predictor of competency across all domains (p < 0.001). Postgraduate education and TM training were associated with higher awareness, while male gender, postgraduate qualification, and higher interest predicted improved skill scores. Regression models explained 8-16% of variance across competency domains. Although nurses demonstrated strong knowledge and positive attitudes toward TM, gaps remain in awareness and practical skills. Competency-based, skill-focused TM training is needed to support safe and sustainable integration into nursing practice.
Telemedicine has gained increasing relevance as an innovative approach to support continuity of care for individuals with cognitive impairment. However, evidence regarding usability and short-term clinical effectiveness in patients with amnestic mild cognitive impairment (aMCI) is still limited. The present study aimed to assess the usability, feasibility, and preliminary clinical efficacy of a dedicated telemedicine platform integrating cognitive telerehabilitation and teleconsultation services for individuals with aMCI and their caregivers. A multicenter prospective study was conducted across 10 Centers for Cognitive Disorders and Dementia in the Calabria region, Italy. Subjects with aMCI (aged 50-80 years) and their caregivers were enrolled and participated in a 4-week intervention. The program included asynchronous tablet-based cognitive telerehabilitation and scheduled teleconsultations providing educational and psychological support. Usability was evaluated using the System Usability Scale (SUS). Secondary outcomes included adherence, satisfaction, changes in neuropsychological measures, and caregiver burden, assessed before and after the intervention. A total of 285 participants (144 patients, 141 caregivers) were enrolled, and 267 completed the study (retention rate: 93.6%). The overall mean SUS score was 79.03 ± 16.89, indicating good-to-excellent usability across patients, caregivers, and health care professionals. Significant improvements were observed in global cognition, episodic memory, disease insight, anxiety, depressive symptoms, neuropsychiatric manifestations, and caregiver burden (all p < 0.05). This telemedicine platform demonstrated high usability, strong adherence, and positive clinical effects after a short intervention period. These findings support the feasibility and potential value of digital telerehabilitation solutions for individuals with aMCI and their caregivers.
Health care systems are increasingly pressured by workforce shortages and increasing chronic conditions. Hypertensive disorders of pregnancy (HDP) require frequent monitoring. Telemonitoring of blood pressure (BP) offers a promising alternative for components of hospital care, potentially improving outcomes and reducing costs. Following cost-saving results from the SAFE@home pilot, this study conducts a cost-effectiveness analysis (CEA) of SAFE@home versus care as usual (CAU) at scale. A CEA was conducted within the SAFE@home II multicenter before-after study. Women with high risk of or established HDP received remote BP monitoring as part of hybrid care. The controls received CAU. Antenatal costs were calculated in euros. Cost-effectiveness was measured as the absolute risk reduction (ARR) in adverse outcome and the incremental cost-effectiveness ratio (ICER) as the cost per adverse outcome prevented. Mean antenatal costs per patient were €6,756 (standard deviation [SD] €5,144) in the SAFE@home group and €7,142 (SD €5,149) in the CAU group, corresponding with a cost reduction of €368 (5.4%) using telemonitoring. The ARR was 4.3% and resulted in a negative ICER. Health care consumption per adverse outcome revealed cost savings during pregnancy of €765 per participant with an adverse outcome. Fewer HDP-related admissions (12.0% vs. 15.5%, p = 0.039) in the SAFE@home group compared with CAU supported cost-effectiveness. This CEA demonstrated that at scale, SAFE@home modestly reduces costs. With lower costs per adverse outcome resulting in a negative ICER, SAFE@home dominates CAU. Future research should explore how telemonitoring can optimize use of resources. In conclusion, addressing adoption barriers is essential to sustainably integrate telemonitoring.
Comprehensive evaluation of teledermatology systems includes socioeconomic assessment. In 2021, we implemented an intervention to improve the use of teledermatology in the health care area of Alicante-Hospital General. This study aimed to evaluate the socioeconomic impact of our intervention by comparing the costs and waiting times associated with teledermatology compared with conventional in-person care. We designed a cost-effectiveness study from a health care system perspective using 2021 data. The monetary variables included the costs of the materials, application software, and training associated with teledermatology, as well as the costs of the consultations in both modalities. Our clinical outcome variable was waiting time until evaluation by a pediatric dermatologist. Using these data, we calculated an incremental cost-effectiveness ratio, then performed a sensitivity analysis. We also calculated the break-event point between the two modalities, based on the percentage of remote resolution of teleconsultations. There were 357 teleconsultations in 2021, and we estimated 3,108 conventional referrals. The average per-patient cost of teledermatology was EUR 22.97 more than conventional care, with a cost-effectiveness ratio of EUR 0.21/day saved, which increased to EUR 0.35/day saved in the sensitivity analysis. To balance the costs of the two modalities, 84% of teleconsultations would need to be resolved remotely. Teledermatology is more expensive than conventional in-person care but is a cost-effective option from a health care system perspective.