Telehealth Services Research Articles

Health Care Facility Characteristics Associated With Providing Telehealth HIV Care Services During the COVID-19 Pandemic

Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility’s own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. ( Am J Public Health. Published online ahead of print January 16, 2025:e1–e5. https://doi.org/10.2105/AJPH.2024.307908 )

FACTORSINFLUENCINGEFFECTIVETELEHEALTHMANAGEMENT: PERSPECTIVES OF QUALITY COMPETENCY AND ORGANIZATIONAL CHANGE

This study investigates key factors influencing effective telehealth management in healthcare organizations in Saudi Arabia, particularly within primary health centers in Riyadh Saudi Arabia. Present study focuses on five primary areas: technology infrastructure, provider training and competency,patientengagement,regulatorycomplianceandqualityassurance,andorganizational culture and change management. A comprehensive survey questionnaire was conducted among healthcare staff, including directors, physicians, head nurses, and administrative personnel, to assess these factors' impact on telehealth effectiveness. SPSS was utilized for data analysis. Analysis of data revealed significant positive relationships between all suggested constructs which leads consequently to effective telehealth management. Specifically, technology infrastructure and organizational culture emerged as the strongest predictors. Further, findings emphasize the necessity of investing in robust technology systems, enhancingprovidertraining,,ensuringregulatorycompliance,promotingpatientengagement,and fostering a supportive organizational culture for the successful implementation of telehealth services. Study further provides practical implications for healthcare organizations and policymakers, offeringinsightsintooptimizingtelehealthservicestoimprovehealthcaredeliveryinSaudiArabia.

Trauma-focused evidence-based psychotherapy for post-traumatic stress disorder delivered via video telehealth in the Veterans Health Administration.

Trauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for post-traumatic stress disorder (PTSD). During and after the COVID-19 pandemic, veterans began to initiate general mental health services delivered via video telehealth at high rates. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via video telehealth versus in-person. Using data from the VA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP between April 2022 and April 2023 (n = 24,447). We used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of their EBP care via video telehealth. In our sample, 74.4% of veterans who received PTSD EBP used video telehealth for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by video telehealth. Female veterans, younger veterans, and veterans with fewer mental health comorbidities were more likely to have received their PTSD EBP via video telehealth. Additional strong interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans. Video telehealth delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, female veterans, and particularly female, racial/ethnic minority veterans were more likely to receive PTSD EBP via video telehealth. Future research designed to contextualize the observed differences in video telehealth delivery of PTSD EBPs should consider the role of social determinants of health.

Impact of COVID-19 on Substance Use Disorder Treatment: Examining the Influence of In-Person and Telehealth Intervention on Outcomes Using Real-World Data.

Background: The COVID-19 health crisis challenged healthcare systems around the world, leading to restrictions in access to face-to-face healthcare services, and forcing rapid adaptation to telehealth services. At present, there is a gap in the functioning of this adaptation in drug-dependence centres. The present study analyses, over four years, care indicators on the care modality (face-to-face vs. hybrid), the patient profile and the impact on retention in treatment. Methods: Retrospective observational study with data collected between 14 March 2019 and 21 June 2023. The electronic health records of 44,930 patients were analysed according to different moments and selected based on the different health measures imposed by the COVID-19 pandemic. Patients were classified according to whether they received an in-person or hybrid intervention. Bivariate statistics and logistic regression analysis were applied. Results: The trend over time shows an increase in the number of patients seen in addiction centres. However, no notable changes within the in-person care modality and a modest increase in telehealth services are observed. Telehealth is primarily used among patients with opiate addiction, as well as with those with comorbid mental disorders. Logistic regression analysis shows that patients in a hybrid modality are more likely to remain in treatment. Conclusions: Results show that hybrid care is associated with higher patient retention rates. Despite this, different profiles are mostly treated with in-person interventions rather than hybrid modalities. Future studies should explore how to generalise personalised hybrid care among SUD patients considering factors such as patients' educational level, employment status or accessibility to mental health services.

Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research

Background Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh’s Non-Communicable Disease Control program initiated “Wellbeing Centers,” telemental health services in selected public hospitals. Objective This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization’s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results Almost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers’ services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings.

Perceived Telehealth Usability for Personalized Healthcare Among the Adult Population in Saudi Arabia: A Cross-Sectional Study in the Post-COVID-19 Era.

Background: Due to technological advancements, the demand for easily accessible and convenient healthcare services is rising globally. Thus, telehealth is gaining momentum that was previously unheard of. The Kingdom of Saudi Arabia (KSA) actively embraces digital innovation in the healthcare industry through its ambitious Vision 2030 initiative. This study aimed to assess the perceived usability of telehealth for personalized healthcare among the KSA adult population in the post-COVID-19 era. Methods: This cross-sectional study used a convenience sample of 975 adults from the general population in KSA. A digital survey was used for data collection through Survey Monkey software. It contained two sections: personal and health data and the Telehealth Usability Questionnaire (TUQ). The data was collected over three months (July-September 2024) and investigated using the multinomial logistic regression analysis. Results: This study showed that 59.8% of the participants have initiated telehealth service use before the COVID-19 pandemic, and the most frequently used services are the issuance of sick leave (30.6%), tele-prescription (29.0%), virtual consultation (20.0%), tele-mental health services (19.4%), telemonitoring (18.6), and tele-referral (18.2%). A high total telehealth usability score was observed among 60.4% of the participants: 72.7% perceive telehealth as highly useful, 76.4% perceive it as easy to use, 60.1% have high satisfaction and intention for future use, 57.4% perceive high interface quality, and 51.8% perceive a high interaction quality. Conversely, 45.8% perceive low reliability of the telehealth system. Multinomial logistic regression showed that low education (AOR = 2.04; 95% CI = 1.16-4.85) and using virtual consultation (AOR = 0.98; 95% CI = 0.38-0.99) were predictors of low telehealth usability. However, being female (AOR = 1.67; 95% CI = 1.27-2.55), being in higher education (AOR = 1.47; 95% CI = 1.02-2.34), and living in the central KSA region (AOR = 1.37; 95% CI = 1.10-2.23) were predictors of high telehealth usability. Working status, income, and presence of chronic disease were not statistically significant predictors. Conclusions: Telehealth services have been highly usable in KSA even before the COVID-19 pandemic, with commonly used asynchronous services. Many social, technological, and system-related factors could affect the user experience and system reliability. Hence, telehealth developments are recommended to overcome such barriers, with future initiatives focusing on the flexibility and convenience of telehealth systems.

Health Care Utilisation and Unmet Needs in Survivors ofHead and Neck Cancer in Regional Australia: A Cross-Sectional Survey.

The post-treatment survivorship period marks the transition away from acute care and poses distinct challenges for individuals with head and neck cancer (HNC). This can be especially challenging for people in regional areas who travel long distances to access care and experience unique challenges in accessing health services. To investigate unmet needs and healthcare utilisation of survivors of HNC in regional areas. Invitations were sent to 619 survivors of HNC living in rural New South Wales, Australia, who were 1-15years post-treatment. Participants self-reported unmet survivorship needs and the strength of these needs using the Cancer Survivors' Unmet Needs Measure. Health care utilisation over the preceding 12months was collected using an investigator-designed questionnaire. One hundred and seventeen responses were received (19% response rate). Participants were predominantly male (65%), had oropharynx cancer (52%), with mean age of 70.2years. Some 54% of participants reported at least one unmet need, and 40% rated these unmet needs as 'strong'. Top unmet needs included concern about recurrence (24%), access to local services (15%), and financial support (15%). 94% of participants reported seeing their GP, while 62% visited a dental clinic; only 10% sought professional psychosocial support despite prevalent unmet needs. Rural survivors of HNC in Australia have substantial unmet psychosocial needs yet demonstrate low utilisation of professional psychosocial support. This may reflect the limited availability or accessibility of services for this population, which could be addressed with shared models of care utilising both GP-led and telehealth services.

Disparities in telehealth utilization between US rural and urban areas during the COVID-19 pandemic.

During the COVID-19 pandemic, telehealth services were expanded across the United States to meet the increased demand and safety requirements of care. This observational study aims to understand rural-urban differences in telehealth utilization during the early part of the COVID-19 pandemic. Individual-level data from the National Health Interview Survey 2020-2021 (age ≥18) were analyzed for this study. The Propensity Score Matching method with multivariable Ordinary Least Square was used to analyze 2 outcome variables-(1) having a medical appointment by video or phone in the past 12 months and (2) having a virtual one for reasons related to the pandemic. Event study models were analyzed to understand the trend of telehealth utilization throughout 6 quarters of the pandemic. Subgroup analysis by health insurance, age, sex, race, citizenship, and disability status was performed to identify underlying disparities between rural and urban residents. Analysis reveals that rural respondents (N = 6,984) were 8.7 percentage points (P<.001) less likely than urban respondents (N = 40,207) to have a medical appointment by video or phone. Rural residents were 8.1 percentage points (P<.001) less likely to have had a virtual medical appointment because of reasons related to the COVID-19 pandemic than urban users. The event study showed that rural-urban telehealth utilization disparities persisted throughout the pandemic. Subgroup analysis revealed significant rural-urban disparities in telehealth utilization by demographic characteristics. Results demonstrate that rural residents were less likely than urban residents to utilize telehealth services during the COVID-19 pandemic, highlighting concerns about access to care for rural residents.

Occupational health professionals' and HR specialists' perceptions of telemental health services in occupational health care settings: A qualitative study.

The rise in mental health-related work disability pensions highlights the need for more research on how occupational health care (OHC) can support mental health, including the use of telehealth (TH) services in mental health care. The research, employing a descriptive qualitative approach through interviews (n = 42), focused on experiences of professionals from a private OHC service provider in Finland and human resource representatives (HRRs) of OHC client companies. Inductive content analysis was used to analyze the data. Our research suggests that TH services provided by OHC can enhance access to care and expedite the initiation of work ability support, particularly in mental health cases. However, potential challenges include a perceived sense of distance, superficiality in interactions, and difficulty in forming a comprehensive understanding due to few non-verbal cues. A combined approach of TH and face-to-face services is suggested to provide flexible, and individualized support. Further studies on remote low-threshold discussion mental health services and studies comparing TH and face-to-face services are advised.

Assessing the Efficacy of Telehealth Services in Rural Areas

Assessing the Efficacy of Telehealth Services in Rural Areas

GENERATING VIDEO VISITS FOR RURAL OLDER VETERANS IN TELE-GERIATRIC MENTAL HEALTH SERVICES

Abstract Telehealth services increase access to specialty mental health services for rural older adults. Within the Veterans Health Administration (VHA), older Veterans are more likely to receive audio-only mental telehealth services compared with younger Veterans. Using a mixed methods approach, we examined the use of video telehealth services by geriatric mental health (GMH) providers in four regional VHA telehealth hubs. Between October 2022 and September 2023, 351 rural Veterans with a mean age of 75.1 years (SD = 8.8) received services from one or more GMH provider. Patients were mostly white (88.6%), males (95.4%) with high care needs (CAN = 81.6 out of 100, indicating highest need). Of the 1,440 encounters delivered, 49% were video to home, 27% were video to clinic, 19% were telephone, and 5% were e-consultation services. Through interviews with GMH providers, we identified technology-related barriers and solutions used to help rural Veterans be seen via video. Findings suggested that barriers to video services included lack of home internet and/or devices, poor connection, and audio or video issues. Solutions included using VHA resources to obtain iPads for patients who lacked connectivity/devices and prioritizing getting patients into local clinic when needed for video visits. Providers described utilizing the telehealth clinical technician to help overcome patient barriers and discomfort with digital technology through teaching patients and caregivers to use home telehealth software. With troubleshooting, use of resources and training, high quality video telehealth services can be delivered successfully to older rural Veterans and increase access to GMH care.

Revisiting Diabetes with a Focus on Complications, Innovations, and Care Strategies

Diabetes mellitus (DM) is a chronic endocrine health issue characterized by persistent hyperglycemia resulting from impaired insulin excretion, insulin impact, or both. This condition poses significant challenges due to its associated complications, including macrovascular conditions like heart disease and stroke, as well as microvascular complications such as diabetic neuropathy, retinopathy, nephropathy, and cardiomyopathy. Specialist nurses are integral to comprehensive diabetes care, offering expertise that spans multiple domains. Their contributions include improving inpatient management by reducing hospital stays and enhancing clinical outcomes, providing outpatient support to foster self-management and monitor disease progression, and delivering specialized care in pediatric diabetes, diabetic foot ulcer prevention, and gestational diabetes management. Additionally, nurse-led interventions, including education programs, telehealth services, and telephone support, empower patients to better manage their condition (table 1). This paper also highlights the challenges specialist nurses face, such as limited scope of practice, inadequate remuneration, and the need for greater interprofessional collaboration. By addressing these barriers and leveraging the expertise of specialist nurses, healthcare systems can significantly enhance diabetes management, reduce complications, and improve the overall quality of life (QOL) for individuals with diabetes. The findings underscore the critical role of specialist nurses in addressing the global diabetes epidemic and the importance of supporting their continued involvement in patient-centered care.

Ambivalent and heavy burdened wanderers on a road less travelled: a meta-ethnography on end-of-life care experiences among family caregivers in rural areas

BackgroundAs the population ages, more people will be diagnosed with cancer, and they will live longer due to receiving better treatment and optimized palliative care. Family members will be expected to take on more responsibilities related to providing palliative care at home. Several countries have expressed their vision of making home death an option, but such a vision can be more challenging in rural areas. There is a lack of synthesized research providing an in-depth understanding of rural family caregiving for people with cancer at the end of life. Thus, the purpose of this study was to synthesize and reinterpret the findings from qualitative research on rural family caregivers of adult cancer patients at the end of life.MethodsWe conducted a meta-ethnography following Noblit and Hare’s approach. A systematic literature search of four databases and extensive manual searches were completed in April 2022. The final sample included twelve studies from six different countries published in 2011–2022.ResultsBased on the translation and synthesis of the included studies, four themes were developed (1) providing family care at the end of life in rural areas—a challenging endeavour; (2) the heavy responsibility of rural caregiving—a lonesome experience; (3) working on and behind the scenes; and (4) the strong and weak spots of community connectedness in rural areas. An overarching metaphor, namely, “ambivalent and heavy burdened wanderers on a road less travelled”, provides a deeper understanding of the meaning of rural family caregiving at the end of life.ConclusionsThis study provides valuable insights into end-of-life cancer care for rural families on four continents. It is crucial to prepare family caregivers for the demanding role of palliative caregiving in rural areas. To address the long distances and poor access related to specialized health care services, outpatient palliative teams tailored to the families’ individual needs should be provided. In addition, more telehealth services, palliative units, or beds in local nursing facilities may reduce the number of exhausting trips that need to be made by caregivers and patients. Healthcare workers in rural areas need further education in palliative care.Trial registrationThe study was registered in PROSPERO.

Telepsychiatry implementation in Qatar: A three-year analysis of no-show rates and its impact on mental health service delivery

Background: The COVID-19 pandemic triggered a rapid shift to telehealth and reshaped healthcare delivery worldwide. In Qatar, telehealth has emerged as a critical tool for ensuring uninterrupted care while minimizing the spread of viruses. However, its long-term efficacy, particularly in mental health services, is still poorly understood. The aim of this study was to address this gap by evaluating the post-pandemic impact of telehealth on the accessibility of mental health services in Qatar. Methods: We conducted a comparative analysis of no-show rates over a four-month period before the initiation of telepsychiatry and telepsychology (March to June 2019) and corresponding periods in 2020, 2021, and 2022. The analysis considered visit types (new visit and follow-up visit) in various psychiatric (child and adolescent, adult, geriatric, forensic, and intellectual disability) and psychological outpatient clinics before and after the implementation of telehealth services. Results: Among both new and follow-up cases, there was a significant reduction (p &lt; 0.0001) in the collective proportion of no-show rates following the introduction of telehealth compared to the rates recorded before the implementation. Exceptions to this trend were appointments in child and adolescent mental health service psychology and forensic psychiatric services. Conclusion: Telehealth has proven instrumental in improving access to mental health services in Qatar post-pandemic. Its integration shows the potential for reducing no-show rates and enhancing continuity of care. These findings are important for healthcare policy-making and practice in Qatar and provide valuable insights into the global discourse on the evolving role of telehealth.

Transitioning From Crisis to Continuity Post-COVID-19 Pandemic: Adoption of Telehealth by Sehat Kahani Healthcare Providers, Karachi, Pakistan

Objective: To evaluate the usability and effectiveness of telehealth services among healthcare providers in Karachi, Pakistan post-COVID-19 pandemic, focusing on the Sehat Kahani platform. Methods: A cross-sectional study was conducted with 388 healthcare professionals utilising the Telehealth Usability Questionnaire (TUQ). Sociodemographic information, encompassing age, gender, speciality, and experience, was also gathered.Results: The predominant demographic of participants was female (89.9%), with ages ranging from 25 to 46 (90%). A majority of participants (86%) were of Pakistani origin. The average TUQ score was 5.73 (± 0.4), reflecting a favourable view of telehealth. Identified key challenges encompassed inadequate internet access (92%), limited financial resources (54%), legal issues (49%), and limitations in the treatment of specific diseases (78%).Conclusion: Telehealth possesses considerable potential to enhance healthcare accessibility and quality in Pakistan. Addressing problems like as infrastructure, budgetary limitations, and legal obstacles is essential for its extensive implementation. Future investigations should examine the enduring effects of telemedicine on patient outcomes and the efficiency of healthcare systems. Keywords: mHealth, Telemedicine, TUQ (Telehealth Usability Questionnaire), Sehat Kahani, Covid-19, Pandemic

An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia.

Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults. We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions. A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions. Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.

Perceived Experiences and Needs of Digital Resources Among Postpartum Women in the United Arab Emirates: Qualitative Focus Group Study.

The postpartum period is a critical phase in a woman's life, marked by various physical, psychological, and social challenges. In light of the rapid proliferation and uptake of digital technologies, particularly in the United Arab Emirates (UAE), mothers increasingly seek informational and emotional support from digital resources. No previous study has thoroughly explored the usage of various digital resources beyond telehealth services in the UAE. This literature gap is particularly relevant for the postpartum period, which remains largely understudied in the UAE. This study aims to delve into the digital experiences of postpartum women in the UAE by exploring the types of resources they navigate and the purposes those resources serve. In addition, it seeks to identify their perspectives and needs regarding digital resources that support their postpartum journey. Four focus groups were conducted synchronously on the web, involving a total of 27 multicultural mothers (mean age 32.47, SD 4.56 years), between 2 and 12 months post partum and living in the UAE. Descriptive interpretive thematic analysis was used to analyze the data. Sixteen out of 27 women exhibited severe depressive symptoms at the time of the discussions (Edinburgh Postnatal Depression Scale score of >12). Two main themes were generated from the analysis: (1) Mothers' Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes.

'It Cuts Both Ways': A Qualitative Analysis of Stakeholders' Views on the Emerging and Potential Unintended Consequences of Telehealth in Rural Australia.

Telehealth has been consistently viewed as a viable solution for addressing healthcare inaccessibility and mitigating the impact of health workforce shortages in rural areas. However, despite high utilisation in rural areas, little is known about the unintended consequences of telehealth in terms of unexpected benefits and drawbacks. This study aimed to investigate the unintended consequences of telehealth in rural Australia. A qualitative exploratory design was employed. Semi-structured interviews were conducted to examine the views of various stakeholders across Australia. Twenty participants were interviewed across Australia, including six telehealth consumers, six providers, six state government representatives and two primary health network representatives. Findings on the unintended consequences of telehealth fell under three overarching themes with both reported unexpected benefits and drawbacks across each theme: (1) person-centred healthcare, (2) safety and quality of healthcare and (3) sustainability of rural healthcare. Under these themes, nine sub-themes were identified. This study provides insights into the unintended consequences of telehealth. While telehealth has improved certain aspects of healthcare in rural areas such as the improved support for rural clinicians and the reduced disruption to patients' daily routines, it has also introduced unforeseen challenges such as the transfer of medicolegal burden to local clinicians in rural emergency care facilities to compensate for the absence of physical examinations. These findings feed into decision-making useful for informing and improving telehealth implementation in rural Australia to maximise unexpected benefits, minimise risks, and ensure the long-term viability of telehealth services.

Telehealth Challenges, Opportunities, and Policy Recommendations for Rural Older Adults Living with HIV in the United States

ABSTRACT Over one million people in the United States (U.S.) are living with HIV. People living with HIV in the rural South experience delayed HIV treatment and increased mortality risks. Access challenges and HIV stigma exacerbate care disengagement for rural people living with HIV (PLH). This study examines the applicability and feasibility of telehealth to provide HIV care for older adults in the rural U.S. South. Semi-structured interviews were conducted with 27 key informants with expertise in HIV care and community engagement in high rural HIV burden states. Results indicate that telehealth challenges exist for older rural PLH to receive HIV care, such as lack of internet access and low technology literacy. Phone calls can be a simple and effective telehealth option for older rural PLH, as they align with their care preferences, mitigate care barriers, and show promise increasing care engagement. When warranted, complex telehealth options for older rural PLH require tailored approaches, such as portable medical instruments allowing real-time data sharing during home visits or tablet distribution from the clinic. Findings suggest that policy makers and providers support the reimbursement and use of audio-only telehealth services, expand broadband infrastructure and affordability in rural areas, and implement tailored telehealth interventions.

The evolution of telehealth in early-onset scoliosis care throughout the COVID-19 pandemic.

To investigate the adoption and sustained use of telehealth for managing early-onset scoliosis (EOS) during and after the COVID-19 pandemic. A 35-question anonymous survey was emailed to 191 physician members of an international pediatric spine research group. Ninety seven clinicians completed the survey (51%). Of the 78% who reported that they currently use telehealth for EOS patients, 44% do so rarely; 21% do not use telehealth at all for EOS patients. Pre-pandemic, 37% used telehealth, increasing to 93% during the pandemic, with 40% using telehealth for most visits and 33% for a quarter of visits (p<0.001). Post-pandemic usage was significantly higher than pre-pandemic levels (p<0.001). Bracing was the favored treatment to monitor via telehealth (61% of respondents). Minor curves and initial post-op visits were ranked as the most suitable for remote care (77% of respondents). Geography and transport issues were the most cited drivers of telehealth (71% and 57% of respondents, respectively). No specific subset of EOS was particularly suitable for telehealth. The most common exam techniques used via telehealth included back inspection (88%), observing gait/posture (58%), and Adams test (46%). The COVID-19 pandemic saw a significant increase in telehealth services for EOS patients (p<0.001). While most patients returned to in-person visits post-pandemic, a significant number continued to use telehealth, especially when compared to pre-pandemic (p<0.001). This persistent use, particularly for patients treated with bracing and to monitor minor curves, highlights the opportunity to optimize EOS care by strategically blending telemedicine with conventional clinic visits.