Telemedicine Follow-up Research Articles

Comparative Effectiveness of Teledermatology Versus In-person Consultations: A Systematic Review of Diagnostic Information Elements

Context: Teledermatology is delivered through two primary methods: Live video conferencing, which enables real-time interaction between patients and doctors, and the store-and-forward technique, where images of skin lesions are sent over the internet for later examination. Objectives: This systematic review evaluates the concordance between in-person and telemedicine follow-up methods in dermatology. Methods: In February 2024, a comprehensive literature search was conducted across PubMed, Medline, ISI Web of Science, and the ACM Digital Library. Keywords such as "teledermatology," "telemedicine," and "mobile health" were used, following the PICOS criteria. Results: Initially, 716 articles were identified from the databases, along with four studies from the gray literature search. After removing duplicates, screening studies, and applying the inclusion and exclusion criteria, 21 studies were selected for the final review. These studies detailed follow-up procedures and assessed both direct and indirect costs and effectiveness. The consensus indicates that teledermatology reduces costs and satisfies both patients and healthcare professionals. Conclusions: Teledermatology has been shown to potentially increase the efficiency of follow-up care compared to traditional methods. However, further research is needed to develop standardized evaluation protocols and to more accurately measure and validate key variables. Publications suggest that teledermatology is cost-effective, reduces patient wait times, extends access to dermatological care in remote areas, and enhances satisfaction among patients, doctors, and nurses.

Characterization of postintensive care syndrome in a prospective cohort of survivors of COVID-19 critical illness: a 12-month follow-up study

PurposeStudies integrating an exhaustive longitudinal long-term follow-up of postintensive care syndrome (PICS) in critically ill COVID-19 survivors are scarce. We aimed to 1) describe PICS-related sequelae over a 12-month period after intensive care unit (ICU) discharge, 2) identify relevant demographic and clinical factors related to PICS, and 3) explore how PICS-related sequelae may influence health-related quality of life (HRQoL) in critically ill COVID-19 survivors.MethodsWe conducted a prospective cohort study in adult critically ill survivors of SARS-CoV-2 infection that did or did not need invasive mechanical ventilation (IMV) during the COVID-19 pandemic in Spain (March 2020 to January 2021). We performed a telemedicine follow-up of PICS-related sequelae (physical/functional, cognitive, and mental health) and HRQoL with five data collection points. We retrospectively collected demographic and clinical data. We used multivariable mixed-effects models for data analysis.ResultsWe included 142 study participants in the final analysis, with a median [interquartile range] age of 61 [53–68] yr; 35% were female and 59% needed IMV. Fatigue/dyspnea, pain, impaired muscle function, psychiatric symptomatology and reduced physical HRQoL were prominent sequelae early after ICU discharge. Over the 12-month follow-up, functionality and fatigue/dyspnea improved progressively, while pain remained stable. We observed slight fluctuations in anxiety symptoms and perception of cognitive deficit, whereas posttraumatic stress disorder (PTSD) and depressive symptoms improved, with a mild rebound at the end of the follow-up. Female sex, younger age, and the need for IMV were risk factors for PICS, while having higher cognitive reserve was a potential protective factor. Physical HRQoL scores showed a general improvement over time, whereas mental HRQoL remained stable. Shorter ICU stay, better functionality, and lower scores for fatigue/dyspnea and pain were associated with better physical HRQoL, while lower scores for anxiety, depression, and PTSD were associated with better mental HRQoL.ConclusionsPostintensive care syndrome was common in COVID-19 critical illness survivors and persisted in a significant proportion of patients one year after ICU discharge, impacting HRQoL. The presence of risk factors for PICS may identify patients who are more likely to develop the condition and who would benefit from more specific and closer follow-up after ICU admission.Study registrationClinicalTrials.gov (NCT04422444); first submitted 9 June 2020.

Application of bidirectional telemedicine in home CPAP for children with obstructive sleep apnea syndrome

BackgroundTraditional telemedicine follow-up proves unsuitable for home continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea syndrome (OSAS). Accompanying advancements in mobile internet, this study explores the feasibility and effectiveness of a mobile communication and remote monitoring system as a novel bidirectional telemedicine approach to enhance adherence to home CPAP in children with OSAS. MethodsA prospective cohort utilizing bidirectional telemedicine follow-up from January to December 2022 (TM) was compared with a retrospective cohort receiving conventional phone follow-up from August 2018 to December 2021 (CP). Participants in TM group were subdivided into two groups based on the number of inquiries in the first week: a high-question group and a low-question group. The main endpoints included successful CPAP adaption and adherence at 2 months of follow-up. ResultsThe TM group exhibited a significantly lower termination rate within 2 months compared to the CP group (1/24 vs. 6/22, p = 0.037). In the first week of home CPAP, the high-question group reported shorter average nightly usage and fewer days with usage of ≥4 h compared to the low-question group (5 h per night vs. 8.5 h per night, 4.5 days vs. 7 days, both p < 0.001). However, the high-question group showed significant improvement in adherence from the second week onward for the remainder of the study period. ConclusionsBidirectional telemedicine represents an effective and feasible method to improve adherence to home CPAP therapy in children with OSAS. Considering the costs, researchers recommend applying bidirectional telemedicine for at least 1 week to better enhance long-term adherence.

Telemedicine Follow-up After Medication Management of Early Pregnancy Loss.

Objective: Our objective was to evaluate the feasibility of a new protocol for telemedicine follow-up after medication management of early pregnancy loss. Study Design: The study was designed to assess the feasibility of planned telemedicine follow-up after medication management of early pregnancy loss. We compared these follow-up rates with those after planned in-person follow-up of medication management of early pregnancy loss and planned telemedicine follow-up after medication abortion. We conducted a retrospective cohort study, including patients initiating medication management of early pregnancy loss <13w0d gestation and medication abortion ≤10w0d with a combination of mifepristone and misoprostol between April 1, 2020, and March 28, 2021. As part of a new clinical protocol, patients could opt for telemedicine follow-up one week after treatment and a home urine pregnancy test 4 weeks after treatment. Our primary outcome was completed follow-up as per clinical protocol. We also examined outcomes related to complications across telemedicine and in-person follow-up groups. Results: Of patients reviewed, 181 were eligible for inclusion; 75 had medication management of early pregnancy loss, and 106 had medication abortion. Thirty-six out of 75 patients elected for telemedicine follow-up after early pregnancy loss. Of patients scheduled for telemedicine follow-up, 29/36 (81%, 95% CI: 64-92) with early pregnancy loss and 64/69 (93%, 95% CI: 84-98) undergoing medication abortion completed follow-up as per protocol (p = 0.06). Completed follow-up was also similar among patients undergoing medication management of early pregnancy loss who planned for in-person follow-up (p = 0.135). Complications were rare and did not differ across early pregnancy loss and medication abortion groups. Conclusions: Telemedicine follow-up is a feasible alternative to in-person assessment after medication management of early pregnancy loss.

A New Method for the Follow-Up of Patients with Alopecia Areata.

Background: Teledermatology is the application of information and telecommunication technologies in the field of dermatology to provide remote care services based on the exchange of clinical information within a network of professionals or between professionals and patients. Tele-trichoscopy is a non-invasive, inexpensive, and easy-to-use method that applies the principle of surface microscopy at different magnifications. Alopecia areata is a non-scarring alopecia with a chronic evolution, which often needs a close follow-up. Objectives: The aim of our work was to analyze the possible benefits of telemedicine for the follow-up of patients with alopecia areata. Materials and Methods: We enrolled patients with alopecia areata, identified during the first trichological evaluation, and we divided the patients into two groups. One group was provided with the devices necessary for a telemedicine follow-up. The other group had a conventional follow-up. The total follow-up time was one year. All of the patients' photos were blindly evaluated by a team of expert dermatologists who were asked to indicate the quality of the images. The photos were also evaluated to identify disease markers. During the follow-up period, questionnaires were administered to both groups of patients to assess the quality of the visit, the level of patient satisfaction, and to identify any issues encountered by the patients. Results: There was a high degree of concordance between the images obtained by outpatient trichoscopy and those obtained by telemedicine. The satisfaction levels were the same between the patients followed via telemedicine and those seen in the outpatient clinic. Conclusions: Telemedicine applied to trichology using trichoscopy was proven to be a valid system for managing the follow-up of patients suffering from chronic recurrent scalp diseases and, above all, for maintaining continuity of care.

Accuracy and safety of an autonomous artificial intelligence clinical assistant conducting telemedicine follow-up assessment for cataract surgery

Artificial intelligence deployed to triage patients post-cataract surgery could help to identify and prioritise individuals who need clinical input and to expand clinical capacity. This study investigated the accuracy and safety of an autonomous telemedicine call (Dora, version R1) in detecting cataract surgery patients who need further management and compared its performance against ophthalmic specialists. 225 participants were recruited from two UK public teaching hospitals after routine cataract surgery between 17 September 2021 and 31 January 2022. Eligible patients received a call from Dora R1 to conduct a follow-up assessment approximately 3 weeks post cataract surgery, which was supervised in real-time by an ophthalmologist. The primary analysis compared decisions made independently by Dora R1 and the supervising ophthalmologist about the clinical significance of five symptoms and whether the patient required further review. Secondary analyses used mixed methods to examine Dora R1's usability and acceptability and to assess cost impact compared to standard care. This study is registered with ClinicalTrials.gov (NCT05213390) and ISRCTN (16038063). 202 patients were included in the analysis, with data collection completed on 23 March 2022. Dora R1 demonstrated an overall outcome sensitivity of 94% and specificity of 86% and showed moderate to strong agreement (kappa: 0.758-0.970) with clinicians in all parameters. Safety was validated by assessing subsequent outcomes: 11 of the 117 patients (9%) recommended for discharge by Dora R1 had unexpected management changes, but all were also recommended for discharge by the supervising clinician. Four patients were recommended for discharge by Dora R1 but not the clinician; none required further review on callback. Acceptability, from interviews with 20participants, was generally good in routine circumstances but patients were concerned about the lack of a 'human element' in cases with complications. Feasibility was demonstrated by the high proportion of calls completed autonomously (195/202, 96.5%). Staff cost benefits for Dora R1 compared to standard care were £35.18 per patient. The composite of mixed methods analysis provides preliminary evidence for the safety, acceptability, feasibility, and cost benefits for clinical adoption of an artificial intelligence conversational agent, Dora R1, to conduct follow-up assessment post-cataract surgery. Further evaluation in real-world implementation should be conducted to provide additional evidence around safety and effectiveness in a larger sample from a more diverse set of Trusts. This manuscript is independent research funded by the National Institute for Health Research and NHSX (Artificial Intelligence in Health and Care Award, AI_AWARD01852).

Economic impact of outpatient follow-up using telemedicine vs in-person visits for patients in general surgery: A secondary analysis of a randomized clinical trial

IntroductionInnovation in internet connectivity and the Covid 19 pandemic have caused a dramatic change in the management of patients in the medical field, boosting the use of telemedicine. A comparison of clinical outcomes and satisfaction between conventional face-to-face and telemedicine follow-up in general surgery, an economic evaluation is mandatory.The aim of the present study was to compare the differences in economic costs between these two outpatient approaches in a designed randomized controlled trial (RCT). MethodsA RCT was conducted enrolling 200 patients to compare conventional in-person vs. digital health follow-up using telemedicine in the outpatient clinics in patients of General Surgery Department after their planned discharge. After a demonstration that no differences were found in clinical outcomes and patient satisfaction, we analyzed the medical costs, including staff wages, initial investment, patent’s transportation and impact on social costs. ResultsAfter an initial investment of 7527.53€, the costs for the Medical institution of in-person conventional follow-up were higher (8180.4€) than those using telemedicine (4630.06€). In relation to social costs, loss of productivity was also increased in the conventional follow-up. ConclusionThe use of digital Health telemedicine is a cost-effective approach compared to conventional face-to-face follow-up in patients of General Surgery after hospital discharge.

Telemedicine: Does it have a place in surgical oncology practice?

Telemedicine has gained traction in surgical subspecialties, particularly since the COVID-19 pandemic. This study aims to identify whether telemedicine can be appropriately integrated within surgical oncology practice. This retrospective study evaluated patients who received either telemedicine or office follow-up after undergoing surgical oncology operations between 2016 and 2021. The telemedicine group (TG) and office group (OG) received a 15-question survey regarding their satisfaction with their care. Patient outcomes and responses were analyzed utilizing propensity-score matching in 1:1 fashion. Telemedicine group and OG each had 21 patients. Length of stay, complication frequency, follow-up frequency, and readmissions frequency within 90-days were comparable between groups. Telemedicine group expressed comparable satisfaction with postoperative care relative to OG (95.2% vs. 85.7%, p = 0.61). All telemedicine patients said they would utilize telemedicine again in the future and would recommend its use to others. Patient satisfaction with postoperative telemedicine follow-up is comparable to those with in-person follow-up.

Economic impact of outpatient follow-up using telemedicine vs in-person visits for patients in general surgery: A secondary analysis of a randomized clinical trial

IntroductionInnovation in internet connectivity and the Covid 19 pandemic have caused a dramatic change in the management of patients in the medical field, boosting the use of telemedicine. A comparison of clinical outcomes and satisfaction between conventional face-to-face and telemedicine follow-up in general surgery, an economic evaluation is mandatory.The aim of the present study was to compare the differences in economic costs between these two outpatient approaches in a designed randomized controlled trial (RCT). MethodsA RCT was conducted enrolling 200 patients to compare conventional in-person vs. digital health follow-up using telemedicine in the outpatient clinics in patients of General Surgery Department after their planned discharge. After a demonstration that no differences were found in clinical outcomes and patient satisfaction, we analyzed the medical costs, including staff wages, initial investment, patent’s transportation and impact on social costs. ResultsAfter an initial investment of 7527.53€, the costs for the Medical institution of in-person conventional follow-up were higher (8180.4€) than those using telemedicine (4630.06€). In relation to social costs, loss of productivity was also increased in the conventional follow-up. ConclusionThe use of digital Health telemedicine is a cost-effective approach compared to conventional face-to-face follow-up in patients of General Surgery after hospital discharge.

Telemedicine maintains good glucose control in children with type 1 diabetes but is not time saving for healthcare professionals: KITES randomized study

AimsTo evaluate glucose control non-inferiority and time benefits of telemedicine follow-up in children with type 1 diabetes (CwD). MethodsIn a single-center 9-month-long randomized controlled study (clinicaltrials.gov NCT05484427), 50 children were randomized to either telemedicine group (TG) followed-up distantly by e-mail, or to face-to-face group (FFG) attending standard personal visits. The primary endpoint was non-inferiority of HbA1c at final visit (level of non-inferiority was set at 5 mmol/mol). The secondary endpoints were subcutaneous glucose monitoring parameters and time consumption from both study subjects’ and the physicians’ point of view. ResultsNon-inferiority of HbA1c in the TG was proven (mean HbA1C 45.8 ± 7.3 [TG] vs. 50.0 ± 12.6 [FFG] mmol/mol, 6.3 vs. 6.7 % DCCT, p = 0.17; between groups HbA1C difference 95 % CI −10.2 to 1.9 mmol/mol). Telemedicine saved time for participants (mean visit duration [MVD] 50 [TG] vs. 247 min [FFG], p < 0.001). There were no other differences between groups neither in CGM parameters nor physician’s time consumption (MVD 19 [TG] vs. 20 min [FFG], p = 0.58). ConclusionsNine-month telemedicine follow-up of the children with well-controlled T1D is not inferior to standard face-to-face visits. Telemedicine visits saved time for the participants but not for their diabetologists.

Comparison of Telemedicine versus In-Person Visit for Control of Asthma in Children aged 7-17years: A Randomized Controlled Trial.

To compare asthma control between telemedicine and in-person visit in children aged 7 to 17 y. A non-inferiority randomized-controlled trial was conducted at a pediatric chest clinic, involving a total of 192 patients, with 96 children in each group of telemedicine and in-person follow-up. There was a significant improvement in the mean asthma control test (ACT)/ Childhood asthma control test (C-ACT) scores from baseline to three months in both groups, with no significant difference in the change of means between the two groups. The mean difference in ACT/C-ACT score at three months in the telemedicine and in-person visit group was -0.35; 95% CI (-1.30 to +0.10) [p-value 0.09]. There was a significant change in the mean Pediatric Quality of Life index (PQLI) scores from 57.2 ± 10.2 to 66.82 ± 7.99 in the telemedicine group and from 56.1 ± 11.7 to 66.71 ± 4.66 in the in-person visit group, however the mean difference in PQLI score in both the groups was not significant (p = 0.91). There was no significant difference in the number of asthma exacerbations (4 vs. 1) between telemedicine and in-person visit (p = 0.10). The mean telemedicine satisfaction questionnaire score in this study was 3.8 ± 0.7, which indicates that most of the parents were satisfied with the telemedicine follow-up process. This study revealed that telemedicine is non-inferior to in-person visit for follow-up of children with asthma and can be used as an alternative to in-person visit for the management of asthma, especially in remote settings and pandemic situations.

Low Response Rate to Follow-Up Using Telemedicine after Total Knee Replacement during the COVID-19 Pandemic in Italy.

This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool.

Identifying and Managing Patients with Life-Threatening Hematology Disorders By Doing Telemedicine Inpatient Hematology Consults in Underserved Hospitals

Background: Life-threatening hematology disorders require urgent intervention by expert hematologists. In many hospitals, there are no hematologists available to meet this need. This occurs in “underserved” hospitals, including many rural hospitals and many urban hospitals that do not have hospital-affiliated or hospital-employed hematologists on staff. Patients who present to these hospitals with life-threatening hematology conditions may have worse outcomes than those who present to hospitals that have hematologists on staff. The problem is created by the shortage of hematologists and the challenge of providing in-person consults in these hospitals. To address this problem, our telemedicine-based hematology practice joined the staffs of four underserved hospitals. We sought to identify and manage patients who require urgent hematology evaluation and intervention. Methods: We created telemedicine-based heme/onc consult services in four underserved hospitals that had little or no access to hematology experts. These facilities included one rural hospital, one critical access hospital (CAH), and two urban hospitals. In one urban site, we provided “hybrid” telemedicine-based service, in which we evaluated patients in-person alternating with telemedicine. Inpatients were seen on A/V devices with the help of the patient's nurse or with a “telepresenter” who brought the devices to the patients. Hospital EMR's were accessed by our hematology provider team. To identify patients who needed our services, we educated hospitalists about the need for urgent telemedicine heme/onc consults for select patients with clotting, bleeding, abnormal blood counts and emergency heme/onc conditions. Results: 3,202 patients were evaluated during a three-year period, including 180 patients in rural hospitals, 126 patients in a CAH, 349 patients in an urban hospital, and 2,547 patients in an urban “hybrid” hospital (mixed telemedicine and in-person consults). Consultations were mostly requested for non-malignant hematology patients, including those with bleeding, clotting, or abnormal blood count disorders. Heme malignancy and solid tumor patients were also referred. Several patients with life-threatening hematology or heme-malignancy conditions were identified, including 34 with acute life-threatening ITP, 23 with HIT, five with life-threatening high blood counts due to myeloproliferative disorder or newly diagnosed chronic myelogenous leukemia (CML), two with TTP, and two with atypical HUS. Two patients with acute promyelocytic leukemia (APL) were identified, stabilized, transferred to tertiary care hospitals, and ultimately cured of their conditions. Telemedicine enabled our hematology practice to provide same-day consults and weekend coverage for hospitals located far apart and outside our home region. Some patients were transferred to tertiary care hospitals more promptly because of our service, while others were deemed safe to avoid a hospital transfer that would otherwise have been requested. In some cases, we provided stewardship for blood transfusions and guidance for blood transfusion refusal. Finally, in some cases we enabled safe discharge by planning prompt telemedicine follow-up. Some of the challenges we faced included slow internet connections and less sophisticated EMR's in rural and CAH hospitals that required more time to complete a consult than would otherwise be needed. It was sometimes challenging to plan A/V televisits at convenient times. Sometimes we felt hindered by lack of in-person assessment. Some of the tests and interventions we would have requested in larger hospitals were not possible, resulting in delays of care or requiring transfers to tertiary care hospitals. Finally, some patients who may have otherwise received inpatient chemotherapy or radiation were discharged instead of being transferred. Conclusions: Telemedicine inpatient hematology consults for underserved hospitals are feasible, though challenging. It is possible to identify and manage patients who have life-threatening hematology disorders via telemedicine.

A single centre study of the level of parents' satisfaction with the COVID-19 telemedicine consultation.

Telemedicine is an effective tool for video consultation of COVID-19 patients in the setting of the COVID-19 pandemic. Weprospectively determined the level of parents' satisfaction with the COVID-19 telemedicine consultation. This was asingle centre prospective study. COVID-19 paediatric patients who were seen in the children's emergency department of KK Women's and Children's Hospital, Singapore, and deemed fit for home recovery were discharged with a COVID-19 telemedicine follow-up in two to three days' time. Paediatric patients who were seen in the COVID-19 telemedicine visits were included in the parents' satisfaction survey. We excluded patients who defaulted their telemedicine visits. The telemedicine satisfaction survey was conducted using an online form consisting of 16 Likert scale questions, sent via text messaging. Our primary outcome was telemedicine satisfaction scores. Our secondary outcome was children's emergency department reattendance or hospital admission within 10days after the telemedicine consultation. 1238 patients attended the COVID-19 video consultation clinic from 15 December 2021 till 25 March 2022, out of which 476 parents of the COVID-19 patients completed the survey questionnaire. The mean age of the COVID-19 patients was 3.6years. There was a high level of overall satisfaction among parents of the COVID-19 patients, with a mean score of 6.1 out of 7. 12 out of 16 questions had a positive response (mean score of 6 or more). There was a total of 9 reattendances to children's emergency department, out of which 3 cases needed hospital admission. Conclusion: There was a high level of overall satisfaction with the use of telemedicine in symptomatic COVID-19 paediatric patients. What is Known: • Telemedicine is a cost-effective and feasible mode of delivering health care for conditions such as diabetes, heart disease, and depressive disorder, especially in the setting of the COVID-19 pandemic. What is New: • To gauge the parents' satisfaction with the COVID-19 telemedicine visit, in order to improve the patient and caregiver experience with telemedicine, and to improve the telemedicine service delivery. • Information from this study is crucial in order to prevent unnecessary hospital reattendance due to parental concern from poor telemedicine delivery.

Telemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology’s Headache Study Group

IntroductionThe COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. MethodThe study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology’s Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. ResultsCOVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. ConclusionsThe GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre’s management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.

Patient and provider perspectives on telemedicine use in an outpatient gynecologic clinic serving a diverse, low-income population.

To evaluate patient and provider experiences using telemedicine for gynecologic visits among a diverse, low-income population. Patients attending telemedicine visits at a resident-run gynecology clinic completed a modified Telemedicine Usability Questionnaire and providers completed a survey addressing satisfaction and barriers for each visit. The Telemedicine Usability Questionnaire included six subscales to assess telemedicine usability with 1-5 Likert-scale responses. Statistical analyses included Chi-square, Fisher's exact, Wilcoxon rank sum, Wilcoxon signed-rank, and two-sample t-test. Of 192 patients enrolled, 157 (82%) completed the surveys (87% video visits, 13% telephone visits). Most patients were ethnic minorities (non-Hispanic White-16%, Hispanic-32%, Black-28%, Asian-10%), median age was 40 years (range 18-69), and 63% reported income under $40,000. The total mean Telemedicine Usability Questionnaire score was 4.3/5. The reliability subscale score (3.72/5) was lower compared to all other subscales (p < 0.001). Older respondents were more likely to find telemedicine unreliable (mean age >44 vs <39, p = 0.02). Without telemedicine, 54% would have traveled ≥1 h to appointments, with 46% spending over $35 on travel, and 27% missing ≥ 1 workday. Patients preferred telemedicine for follow-up rather than initial visits (81% vs 33%, p < 0.01). Among providers, residents felt less adequately trained in telemedicine compared to nurse practitioners and fellows (54% vs 46%, p = 0.039). Low-income women utilizing telemedicine for outpatient gynecologic care report positive experiences with improved access to healthcare, cost, and time savings compared to in-person visits. Provider experiences were also positive; however, teaching hospitals must evaluate whether trainee providers feel adequately trained to deliver telemedicine visits.

A Novel Ophthalmic Telemedicine Program for Follow-Up of Minor Ophthalmic Emergencies.

Background: Near-term follow-up for minor ophthalmic emergencies is important to ensure positive patient outcomes but can impose logistical challenges for patients and ophthalmology practices. While ophthalmic telemedicine has been used for screening and triage, its feasibility and safety for follow-up care for minor ophthalmic emergencies have not been reported. The objective of this study was to report initial results of a novel virtual emergency department (ED) follow-up clinic. Methods: Retrospective cross-sectional study of patients discharged from the ophthalmic ED who required near-term follow-up and carried diagnoses suitable for virtual evaluation, between December 6, 2021, and June 26, 2022, at a single tertiary eye care center. Main outcome measures included missed appointment rate, time interval between ED encounter and virtual follow-up, clinical diagnoses, and referrals after telemedicine follow-up (including for urgent ambulatory and ED evaluation). Results: A total of 145 virtual visits were scheduled with 99 (68.3%) completed appointments, yielding a no-show rate of 31.7%. Of the completed visits, the mean time interval between ED evaluation and virtual follow-up was 8.3 days (standard deviation ±3.9). Eighty-four (84.9%) visits were video-based and 15 (15.1%) were audio-only. Seventy-nine (94%) had at least one aspect of the ophthalmic examination documented. The most common diagnoses were chalazion (18), conjunctivitis (13), corneal abrasion (12), and encounter after corneal foreign body removal (7). After virtual follow-up, 23 patients (23.2%) had subsequent referrals, and no patients re-presented to the ophthalmic ED. Conclusions: Ophthalmic telemedicine may be a safe and feasible modality for providing timely post-acute near-term follow-up care for patients with appropriate ophthalmic diagnoses.

Exploring Patients' Intentions for Usage of Video Telemedicine Follow-Up Services: Cross-Sectional Study.

Background: Data suggest that regarding completion rates and lower readmission rates, video telemedicine follow-up is as efficient as in-person consultations. However, evidence of patients' intention to adopt such service is lacking. The objective of this study was to determine the essential factors influencing Chinese patients' intention to adopt video telemedicine follow-up. Methods: The researchers extended the technology acceptance model (TAM) by incorporating trust, subjective norms (SNs), perceived risk (PR), and perceived disease threat (PDT). A survey was conducted with 793 Chinese patients, and the collected data were analyzed using the partial least-squares approach. Results: The study revealed that trust emerged as the strongest factor influencing patients' behavioral intention (BI) to use video telemedicine follow-up, followed by SNs, perceived ease of use (PEOU), and perceived usefulness (PU). PR and PDT had no significant influence on patients' intention to adopt video telemedicine follow-up. PEOU mediated the relationship between trust, SNs, and BI, and PU mediated the relationship between trust and BI. The study also found that gender, age, and usage experience moderated certain relationships in the model. Conclusions: Our findings support the use of the extended TAM in understanding individual's motivations for using video telemedicine follow-up in China. In addition, this study contributes to the existing literature on telemedicine promotion by identifying significant mediation mechanisms. These findings have practical implications for planning, creating, and implementing improved video telemedicine follow-up services.

Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study.

Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Eligible patients (n= 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p= 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p= 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.

Acceptability of telemedicine for follow up after contraceptive implant initiation at an obstetrics and gynecologic training center

BackgroundDuring the COVID-19 pandemic, telemedicine has become a popular adjunct to in-person visits, including for family planning services. This study determined the proportion of clients participated in telemedicine services and the association between sociodemographic factors and telemedicine participation during the COVID-19 pandemic. The adverse effects within the first seven days post-insertion were also reported.MethodsThis retrospective cohort study considered data from all women initiating contraceptive implantation between June 2020 and August 2021 at King Chulalongkorn Memorial Hospital. Clients were offered the following two options for follow-up visits: in-person or communication via an online LINE® Official Account (LINE® OA), a free chat application widely used among the Thais. Logistic regression analyses were used to assess the association between socio-demographic factors and telehealth usage.ResultsIn total, 574 of 947 (60.6%) clients participated in telemedicine follow-up services during the period considered. A significant association between telemedicine usage and the following were observed: the peak of second wave COVID-19 outbreak in Thailand, using the period preceding the second wave as a reference [adjusted odds ratio (aOR) = 1.47 (95% confidence interval [CI]: 1.12–1.96)]; participants receiving governmental benefits for contraceptive implant payment (aOR: 3.23, 95% CI: 1.86–5.60), and timing of contraceptive implant(s) initiation, using interval insertion as a reference for which aORs of postpartum and immediate postpartum insertions were 0.62 (95% CI: 0.43–0.90) and 0.35 (95% CI: 0.24–0.52), respectively. Significant ecchymosis at the insertion site was observed in 13.1% of participants.ConclusionThis study emphasizes the significance of telemedicine during the COVID-19 epidemic, particularly in facilitating contraceptive implant initiation. Our data show a significant increase in the uptake and utilization of telemedicine during the pandemic’s peak. The data also shows that during the period of Thailand’s second COVID-19 epidemic, government benefits for contraceptive implant payment, and the timing of contraceptive implant initiation, are significantly associated with telemedicine use. This finding supports the continued use of telemedicine in healthcare, particularly for services like family planning, where remote follow-ups can provide safe, efficient, and timely care.