This study aimed to explore changes in the incidence of depression-related health care encounters following the COVID-19 pandemic among patients diagnosed with depressive disorders and characterized those who had transitioned their care largely to telehealth. This retrospective study included adults diagnosed with depressive disorders in the 2018-2021 Medical Expenditure Panel Survey (MEPS). We assessed encounter rates and telehealth use in depression-related care. Encounter rates were compared through zero-truncated negative-binomial models. Weighted logistic regression models were used to explore factors associated with the transition of depression-related care to telehealth. We found a statistically significant increase in depression-related encounters following the COVID-19 pandemic (incident rate ratios: 1.42, 95% confidence interval: 1.20-1.68). Logistic regression results showed no statistically significant differences in telehealth transitions among the included sociodemographic variables. Patients with depressive disorders had significant increase in depression-related encounters. The odds of transitioning to telehealth for depression-related care were not statistically different among common sociodemographic groups.

How the absence of a physical examination in telehealth visits influences clinical decision-making in telehealth visits is not known. The aim of this study was to examine whether provision of patient self-collected vital signs influences telehealth management decisions for acute respiratory tract infections (ARIs). A consecutive sample of adult patients seeking care for ARIs completed a simulated telehealth visit either before or after their scheduled in-person evaluation. Patients were given instructions and devices to collect their vital signs before the telehealth visit. We compared the telehealth physician diagnostic and treatment recommendations with those made by the in-person treating physician. Forty-five patients completed the study. Compared to the in-person management decisions, telehealth evaluations yielded perfect agreement for when patients needed hospital admission. However, there was significant disagreement around the need for chest imaging and antibiotic treatment, with modest differences following the provision of patient self-collected vital signs.

This study evaluated the effectiveness of a patient portal (PP)-based telehealth outreach program, executed by a physician extender, in returning patients with open-angle glaucoma (OAG) who were lost to follow-up (LTFU) to care. Patients with OAG who were LTFU and not evaluated in the prior 6 months were randomized 1:1 to receive either a return-to-care notification via their PP or by standard operating procedures. PP messages alerted patients that they might be overdue for glaucoma care and encouraged them to make an appointment or refill medications, as appropriate. The rate of return appointments was assessed 90 days postintervention. Among 2,250 patients with OAG, 257 patients were identified as LTFU (11.4%). Not having an active PP was the factor most strongly associated with being LTFU (32% vs. 22%, < 0.001). LTFU patients with a PP were less likely to have recently accessed their portal compared with those not LTFU (20 days vs. 16 days, < 0.001). Patients contacted through their PP were more than twice as likely to return for eye care compared with those who did not receive this intervention (23% vs. 11%, = 0.033). Notably, visual field (VF) depression was less (-2.14 dB vs. -4.10 dB, = 0.028), and retinal nerve fiber layer thickness was greater (77 µm vs. 73 µm, = 0.028) in the patients who returned to care compared with those who remained LTFU. Engagement of patients with OAG through an online PP may improve glaucoma care by increasing the rate at which patients return for eye care.

Telenutrition offers scalable solutions for delivering nutrition care, yet postpandemic data on its adoption among registered dietitians' (RDs) in Saudi Arabia remain limited. This study assessed telenutrition practices, perceived barriers and benefits, and readiness for adopting national telenutrition platforms among Saudi RDs to inform digital health platforms. A cross-sectional survey using a validated 14-item Arabic questionnaire was distributed to RDs working in Saudi Arabia ( = 309). Respondents with prior telenutrition experience ( = 221) were included in the final analysis. Descriptive and chi-square tests were used to examine associations between demographic factors and telenutrition adoption preferences. Findings showed that 95% of RDs reported confidence in delivering telenutrition, with 74% using it weekly. Commonly delivered services included dietary consultation (71.9%) and nutritional assessments (52%), primarily conducted via phone calls (86.4%). Measurement-related barriers, such as inaccurate self-assessments (74.2%) and patients' difficulty in following instructions (68.6%), were significantly more prevalent than technology-related challenges (42.5%, < 0.001). Despite these limitations, 88% expressed interest in subscribing to a Saudi telenutrition platform, with 82% preferring part-time integration alongside existing roles. No statistically significant associations were found between demographic variables and adoption preferences; however, trends suggested greater interest among early to midcareer female RDs with postgraduate qualifications. Saudi RDs show strong confidence, active use, and readiness to engage with flexible, part-time telenutrition models. These findings provide foundational evidence to support the development of user-centered, nationally digital platforms tailored to the needs of RDs in Saudi Arabia.

Teletherapy is an increasingly common delivery platform that can increase access to mental health care for marginalized and underserved populations seeking competent therapy providers. To date, little empirical work details the teletherapy experiences of multiply marginalized populations, such as Two Spirit, transgender, and nonbinary people of color (2STNB POC). Participants in a parent open clinical trial ( = 49) engaged in the Healing through Ongoing Psychological Empowerment (HOPE) teletherapy psychotherapy intervention. Participants ( = 47) were interviewed postintervention to gather data about their experiences with teletherapy for the intervention. Reflexive thematic analysis was used to analyze the data and to identify common themes. Among positive experiences using teletherapy, we identified 10 subthemes, which included increased access, the ability to be in a familiar space, alignment with personal preference, and personalization with therapists. Among negative experiences with teletherapy, we identified 12 subthemes, which included distractions, technology issues, difficulties with body language, affect, and engagement with the therapy process, lack of privacy or a safe environment, and lack of a dedicated therapeutic or transition space. Overall, most participants reported a positive experience with teletherapy and satisfaction with the services received. Teletherapy appears to be a feasible and acceptable way to deliver psychotherapy to 2STNB POC, having many significant positive aspects. However, providers should be mindful of the challenging aspects of teletherapy to reduce barriers with the modality. The registration number for this clinical trial is ClinicalTrials.Gov: NCT05140174.

Access to safe and timely surgical care remains a major challenge in low- and middle-income countries (LMICs), where health systems are often limited by inadequate infrastructure, workforce shortages, and financial constraints. Despite representing a large share of the global population, LMICs perform only a small proportion of the surgical procedures required to meet their health care needs.

In 2013, Comanche County Memorial Hospital in Lawton, OK, in collaboration with the University of Oklahoma Medical Center, established a satellite level II neonatal intensive care unit (NICU) in southwest Oklahoma by utilizing a hybrid telemedicine model. The satellite level II NICU began offering telemedicine for retinal imaging (Tele-ROP) in July 2017. The availability of the Tele-ROP program has expanded access to retinopathy of prematurity (ROP) screening, allowing lower-risk premature infants to receive timely evaluations and continued intensive care closer to home. The objective was to evaluate the impact of the Tele-ROP program at a level II NICU with a hybrid telemedicine model. This retrospective study evaluated the use of the Tele-ROP program between July 2017 and December 2023. The inclusion criteria were infants transferred to a satellite level II NICU and "without severe ROP." Infants with major congenital anomalies, or "severe ROP," were excluded. Demographic data, image quality, and cost analysis were collected and analyzed. Over a 6-year period, 83 patients were able to be transferred to the satellite level II NICU, due to the availability of the Tele-ROP program. A total of 68 Tele-ROP examinations were performed, with telemedicine-based retinal image evaluation conducted in 55 patients, resulting in the capture of 816 images; 98.2% of the images were graded as good. No patients required referral for ROP treatment, and no complications were reported related to the imaging procedure. Cost analysis showed a reduction in travel-related expenses for families. Telemedicine for ROP screening in a hybrid level II NICU is safe and feasible and enhances health care affordability and access in underserved areas.

Rural communities face significant challenges in recruiting and retaining health care professionals (HCP) due to high workloads, lack of financial incentives, and demanding occupational requirements. Recent research shows that telehealth has the potential to enhance holistic care quality and reduce barriers to patient care; however, its potential to impact rural HCP retention remains unexplored. The purpose of this review was to assess the relationship between telehealth and rural HCP professional satisfaction and retention. A systematic review was conducted following the Cochrane guidelines. MEDLINE ALL and Embase were searched from January 2014 to February 2025. Studies assessing the use of telehealth in rural health care settings and reporting on retention rates or professional satisfaction were included. Due to significant expected heterogeneity, studies were analyzed narratively. The search identified 1,678 unique citations, with 38 studies proceeding to full-text review. Four studies were included in the final analysis: two mixed-methods studies and two qualitative studies. Each study assessed a different telehealth intervention, including tele-emergency, wound care, and general practice. Job satisfaction was reported in three studies, with personal fulfillment and professional development commonly reported. Retention was reported in two studies, with minimal actual impacts on retention but with HCPs perceiving considerable potential. Importantly, there were no quantitative measures of job satisfaction or retention reported. Despite telehealth being lauded as a way to improve retention and professional satisfaction in rural health care settings, there are very few studies assessing these outcomes. Though telehealth qualitatively improved professional satisfaction, there were minimal impacts on retention.

Teleradiology has become an integral component of modern health care, enabling remote access to radiological expertise but introducing new challenges related to communication, technology, and legal accountability. This study evaluates radiologists' perceptions of malpractice risks in teleradiology within the United Arab Emirates (UAE) and explores their implications for patient safety. A descriptive cross-sectional survey was administered to radiologists across public and private health care institutions in the UAE between August and November 2024. The survey examined participants' demographic profiles, teleradiology experience, awareness of malpractice claims, communication practices, and perceived challenges. Quantitative data were analyzed using descriptive and inferential statistics to identify risk patterns and contributing factors. Teleradiology was widely adopted among respondents, reflecting its essential role in current radiology practice. However, respondents identified several malpractice-related risks, most notably limited patient information, inconsistent communication protocols, and technical disruptions affecting image quality and transmission reliability. Many radiologists expressed uncertainty regarding the legal frameworks governing teleradiology and highlighted the need for clear national policies and institutional guidance. While teleradiology enhances accessibility and continuity of care, its safe implementation requires stronger governance, reliable technological infrastructure, and effective interdisciplinary communication. The study underscores the need for unified legal standards and targeted training to strengthen patient safety and minimize malpractice exposure.

Telehealth use surged during the COVID-19 pandemic and plateaued in recent years, yet factors influencing sustained use among patients remain underexplored. This study examines sociodemographic, health, digital literacy, and prior telemedicine experience related predictors of willingness to continue telehealth use in a postpandemic population of the United States United States. Data from 2,423 participants in the 2024 Health Information National Trends Survey were analyzed, focusing on respondents with prior telehealth experience. Ordinal logistic regression was employed to identify predictors of willingness to continue telehealth use. Predictors included sociodemographic factors, health conditions, digital literacy, and prior telehealth experiences. Among respondents, 59.1% (n = 1,432) were very willing and 30.99% (n = 751) somewhat willing to continue telehealth use. Significant predictors included age (35-49: OR = 2.12, 95% CI: 1.14-3.96, = 0.019; 50-64: OR = 2.26, 95% CI: 1.06-4.85, = 0.036; 65-74: OR = 2.87, 95% CI: 1.08-7.65, = 0.035), digital literacy (health information search skills: OR = 1.67, 95% CI: 1.19-2.34, = 0.004), convenience (OR = 3.12, 95% CI: 2.04-4.77, < 0.001), perceived telecare quality (OR = 1.79, 95% CI: 1.33-2.42, < 0.001), and recommendation likelihood (OR = 3.67, 95% CI: 2.44-5.50, < 0.001). Lower willingness was observed among males (OR = 0.57, 95% CI: 0.35-0.92, = 0.023), Non-Hispanic blacks (OR = 0.40, 95% CI: 0.20-0.80, = 0.010), audio-only visits (OR = 0.64, 95% CI: 0.40-0.89, = 0.05) and those used telehealth for rehabilitation/therapy purposes. This study uniquely highlights strong postpandemic telehealth willingness among U.S. adults, driven by age, digital literacy, and positive experiences, with novel insights into racial and gender disparities and the unsuitability of telehealth for rehabilitation. These findings have important implications for health policy makers and administrators to design targeted interventions to enhance digital access and video-based care quality to sustain telehealth use.

Cardiovascular diseases remain a leading cause of global morbidity and mortality. Cardiac rehabilitation (CR), particularly cardiac physiotherapy, is crucial for secondary prevention; yet access is suboptimal, especially for patients in rural and underserved populations due to logistical and socioeconomic barriers. Telehealth offers a promising solution to address these disparities. This systematic review aimed to synthesize evidence on the effectiveness, feasibility, and acceptability of telehealth-delivered cardiac physiotherapy interventions in rural and underserved populations and identify the associated barriers and facilitators. A comprehensive search was conducted across multiple databases. Studies investigating telehealth-delivered cardiac physiotherapy in rural/underserved populations were included. Due to heterogeneity in study designs, interventions, and outcomes, a narrative synthesis was performed. Qualitative and quantitative data were extracted on effectiveness, feasibility, acceptability, barriers, and facilitators. Nine studies were included, employing diverse designs (randomized controlled trials, multimethod, feasibility, qualitative, codesign, and mixed methods). Telehealth-delivered cardiac physiotherapy demonstrated effectiveness in improving exercise capacity, cardiac risk profiles, weight management, and quality of life. It also enhanced CR attendance and completion rates. High feasibility and acceptability were reported, with patients valuing convenience and home access. Key facilitators included personalized support, staff adaptability, and codesign approaches. Persistent barriers included digital literacy, technological infrastructure limitations, socioeconomic factors, staffing issues, and potential patient isolation. Telehealth-delivered cardiac physiotherapy holds significant promise for expanding access and improving outcomes for rural and underserved populations. While effective and acceptable, successful implementation requires addressing digital, technological, and socioeconomic barriers. Leveraging identified facilitators and designing patient-centered interventions are crucial for equitable cardiovascular care.

Interprofessional electronic consultations (eConsults) can improve access to specialty care and potentially reduce the need for in-person visits. However, their impact on health care utilization remains poorly characterized. We conducted a retrospective, 1:1 propensity score-matched cohort study comparing patients referred for neurology evaluations via an eConsult or a traditional (in-person) referral at an urban academic medical center. Groups were matched by sociodemographic characteristics. The primary outcome was attendance of an outpatient neurology visit within 12 months of a referral or an eConsult. The secondary outcomes included the time to the first neurology visit within 6 and 12 months. Multivariable logistic regression and Cox proportional hazards models evaluated the outcomes. We identified 828 patients in each group between October 2019 and December 2023. At 12 months, eConsult patients were significantly less likely to attain the primary outcome compared with traditional referral patients (50.0% vs. 57.7%, = 0.002), with multivariable analysis confirming significantly lower odds (odds ratios [OR]: 0.73, 95% CI: 0.60-0.89, = 0.002). In the 6-month analysis, eConsults were associated with a significantly faster time to visit (45 vs. 59 days, = 0.01), confirmed in adjusted Cox analyses (hazard ratio [HR]: 1.29, 95% CI: 1.12-1.49, < 0.001). Over 12 months, the time to the neurology visit was shorter for eConsult patients by 19 days ( = 0.044), but these differences were not significant in adjusted Cox analyses (HR: 1.11, 95% CI: 0.98-1.27, = 0.11). Neurology eConsults were associated with lower follow-up visit rates and faster access to care in the short term, supporting their potential role in accelerating access to neurological expertise and reducing the need for in-person visits.

After successfully implementing an acute care telemedicine program internally, health care institutions often consider expanding and scaling services externally beyond the initial organizational network. This report outlines important considerations when expanding acute care telemedicine services externally, including cultural alignment and agility, practice context, staffing models, telemedicine technology selection, interrelated services, legal and compliance considerations, quality assurance, risk management, financing, and integration with medical education. These factors may inform program leaders of major planning considerations, potential barriers, and could influence strategic planning. Prospectively identifying and resolving challenges prior to contracting with new external sites will facilitate smooth, successful implementation and high utilization of the acute care telemedicine service.

Telehealth can improve pediatric access to care; however, substantial telehealth disparities continue to persist. Publications describing the implementation of innovative strategies to improve telehealth equity across pediatric health care organizations are limited. We aimed to describe the degree of implementation of telehealth equity interventions, identify facilitators and barriers to their implementation, and develop a quality improvement framework for future implementation efforts. We conducted a national survey within the American Academy of Pediatrics' Supporting Pediatric Research on Outcomes and Utilization of Telehealth network from October to December 2023 to obtain an environmental scan of telehealth equity interventions adopted by pediatric health organizations since the onset of the COVID-19 pandemic. We used descriptive statistics to quantify intervention implementation and employed qualitative template analysis of open-ended responses to design a key driver diagram blueprint to advance pediatric telehealth equity. Of 134 organizations, members from 13 organizations completed the survey, mostly representing large, urban, academic children's hospitals. The most commonly implemented interventions included providing devices or internet access within health care facilities, offering on-demand help desk support, and integrating interpreter services within telehealth visit platforms. In contrast, less commonly implemented interventions included expanding broadband access in community settings, soliciting family visit preferences for telehealth versus in-person visits, and ensuring patient privacy during telehealth encounters. This study describes the degree of implementation of telehealth equity interventions among well-resourced pediatric health organizations. Our quality improvement framework provides a foundation for future multicenter, collaborative initiatives aimed at reducing telehealth disparities in pediatric populations.

To examine physical therapists' experience of providing telerehabilitation and their perceptions of telerehabilitation for patients with musculoskeletal conditions. Using a cross-sectional survey, members of the Academy of Orthopaedic Physical Therapy were invited to respond. We received 208 completed responses to our survey invitation. Physical therapists reported using little to no telerehabilitation prior to the pandemic but increased use during the pandemic, followed by the decreased use of telerehabilitation post-pandemic. Physical therapists reported that they believed that they could deliver effective care using telerehabilitation, but that it was not as effective as in-clinic care, and that they would prefer to use telerehabilitation as a part of a hybrid care model versus using only telerehabilitation. Physical therapists suggested that certain patients were more likely than others to benefit from telerehabilitation and identified specific factors (e.g., patient preference, self-efficacy) that influenced whom they consider to be appropriate for telerehabilitation. "Patient issues with technology" was identified as the most common barrier to telerehabilitation use. Most physical therapists reported planning to use telerehabilitation in the future and agreed that telerehabilitation plays an important role in expanding access to physical therapy in the United States. Physical therapists believed that telerehabilitation continues to play an important role in the post-pandemic world. Although physical therapists reported that they considered telerehabilitation to be an effective method for delivering care, they did not consider it to be a replacement for in-clinic care, and they believed that certain patients are more likely than others to benefit from telerehabilitation.

In the wake of COVID-19, widespread adoption of telehealth has led to variations in implementation that have implications for patient safety and access to health care. We developed a 60-item Telehealth Access Checklist, which aims to address this challenge by supporting health care organizations in assessing their telehealth platforms for issues that may pose access challenges. This feasibility study evaluates the Telehealth Access Checklist among three different large health care organizations. Eleven different reviewers ranging from primary care physicians to telemedicine directors evaluated the checklist's content for efficacy and utility. Suggestions were made for checklist improvement. The preliminary testing revealed overwhelming support for not only the concept of the 60-item checklist but also the checklist itself. Reviewers were able to identify aspects of their telehealth technologies that could be optimized to improve accessibility. They found the checklist to be an effective guide to delve deeper into their respective facility's capabilities and identify areas needed for improvement to meet the needs of all populations. Recommendations for improvements to the checklist ranged from changes in formatting and phrasing to enhancements such as broadening the scope to include other modes of telehealth, such as remote patient monitoring. A self-assessment checklist may serve to improve telehealth technology in meeting the needs of all populations by enabling the identification of technological features that should be optimized.

Alcohol and substance use disorders (ASUDs) are highly prevalent in the United States and are major causes of mortality, morbidity, and individual and societal costs. Adoption of telehealth policies for ASUD treatment may support access among underserved populations, such as those who are low-income and publicly insured. This study examined associations between state-level telehealth policies allowing for audio-only and text-based communication and patient utilization of ASUD services at Federally Qualified Health Centers (FQHCs). Data on state-level telehealth policies were obtained from the Medicaid and Children's Health Insurance Program Payment and Access Commission. FQHC-level data about patients' annual use of ASUD services in 2019 and 2020 were obtained from the Bureau of Primary Health Care Uniform Data System (UDS). Differences-in-differences models were used to evaluate associations between audio-only and text-based communication policies and ASUD treatment services (i.e., number of AUD and SUD visits, number of AUD and SUD patients), controlling for FQHC-level patient demographics (i.e., age, race, ethnicity, and income). We found a 76% relative increase in AUD visits (incidence rate ratios [IRR]: 1.76, < 0.05) and a 92% relative increase in SUD visits (IRR: 1.92, < 0.05) in states with Medicaid policies that enabled audio-only telehealth in 2020. We found no relative increase in the number of ASUD visits or patients in states with Medicaid policies allowing for text-based communication. State-level Medicaid policies that permit the use of audio-only telehealth for ASUD treatment may be important tools to address the needs of medically underserved populations with AUD and SUD across the United States.

There has been limited research on the mental health of those caring for individuals with chronic disorders of consciousness (DoCs), particularly in comparing caregivers of patients managed at home versus those admitted to Long-Term Care Specialized Units (LTCSUs). This prospective study assessed the psychological status of 79 caregivers of patients with chronic DoC, who were either admitted to an LTCSU with respect to those followed through a remote telemonitoring service called Oberon Service (OS). Patients' cognitive functioning and level of disability were assessed using Coma Recovery Scale-Revised, Wessex Head Injury Matrix, Nociception Coma Scale, Disability Rating Scale, and Level of Cognitive Functioning scales, whereas caregivers' psychological status was evaluated with the caregiver burden index and the Short Form Health Survey-36. Patients in the two groups were similar for demographic variables, years of hospitalization, and etiology. At the clinical level, patients in the LTCSU group had a significantly higher prevalence of gastrostomy feeding, tracheostomy tube, and respiratory support compared with the OS group. Caregivers belonging to the two groups did not show substantial differences in several sociodemographic variables. At follow-up, the relationship between patient cognitive functioning and mental health differed significantly between the OS and LTCSU groups. The higher burden and lower quality of life in the OS group were particularly pronounced when patients had lower levels of cognitive functioning, whereas in the LTCSU group, an opposite effect was detected. Our findings underscore how patient care settings and cognitive status interact to influence caregiver burden and quality of life, highlighting the need for tailored support strategies based on care settings.

Teleconsultation, especially via voice call without videoconferencing, became widely used during the COVID-19 pandemic. The French High Council of Public Health prioritized cancer treatment to ensure continuity during the pandemic. Recently, French authorities prohibited teleconsultation via voice call without videoconferencing and reverted to a video format. This retrospective study assessed the efficiency of preanesthesia teleconsultation via voice call without videoconferencing by comparing ambulatory surgery failure rates for breast cancer surgery based on the type of preanesthesia consultation during the COVID-19 crisis. The study included 1,006 women who underwent ambulatory breast surgery before and after the implementation of teleconsultations via voice call without videoconferencing at a cancer center. Ambulatory failure was defined as requiring an unplanned overnight stay. Efficiency of preanesthesia consultation was defined as the absence of ambulatory surgery failure. No significant difference in ambulatory failure rates was observed between the groups receiving teleconsultations via voice call without videoconferencing and those with in-person consultations: in-person consultation before COVID group 3.8%, teleconsultation via voice call without videoconferencing group 4%, and in-person consultation during the COVID period group 2.4%. No patients refused the proposed teleconsultation, showing strong acceptance. The results suggest that teleconsultations via voice call without videoconferencing are an effective and acceptable alternative to in-person consultations for ambulatory surgeries, without negatively impacting failure rates. However, further multicenter studies are needed to confirm these findings and assess the long-term integration of teleconsultation via voice call without videoconferencing in routine clinical practice.