BackgroundOur Neurosurgery Department started inter-hospital medical collaboration using hotline telephones in 2000 and has been sharing images using videophone and smartphones since 2002. Currently, an image sharing system using Synapse (Fujifilm medical) is deployed at 15 hospitals in and outside of Yamaguchi Prefecture, and about 300 Doctor to Doctor (D2D) consultations are conducted annually. The consultations conducted so far have been D2D telephone consultations for acute diseases, mainly stroke and head trauma.ProblemWhile it is difficult to maintain advanced medical care of brain tumor in depopulated areas, a system is needed to enable consultation on treatment plans and advanced medical care at hospitals in depopulated areas in order to minimize the burden of patient travel. To achieve this, a system that (1) enables easy communication, (2) makes images available to all hospitals, and (3) is low-cost is needed.MethodsTo solve these problems, we established MEDIMONY, the first start-up company from our department, and have been developing the system. The system is based on a zero-touch system that allows hospitals in underpopulated areas to communicate with each other without having to operate the system. The zero-touch system is operated with ordinary tablets and uses LTE for communication, so Wi-Fi is not required for hospitals in depopulated areas. Doctor to Patient (D2P) with D has been in operation since May 2025, using this system to provide chemotherapy at hospitals in underpopulated areas.FutureThe company is also developing a system to share monitor images from electronic medical records without the need for an image sharing system, aiming to enable consultations at all hospitals. The company will continue to develop D2D and D2P with D for brain tumor patients in Yamaguchi Prefecture, aiming to create a model project that will enable equalization of medical care in depopulated areas.

Objective: This study evaluates telehealth utilization in a multidisciplinary pediatric vascular anomalies center, examining its impact on access to care and factors associated with use. Findings will inform strategies to enhance care delivery and patient outcomes. Study Design: A retrospective review of patients seen via telehealth between 2019 and 2023 was conducted. Visit-level data were extracted from the electronic health record, and diagnoses were verified through manual chart review. Inclusion criteria encompassed all completed telehealth visits; incomplete visits were excluded. Variables included demographics, diagnosis, visit reason, and socioeconomic data via the Area Deprivation Index. Chi-square and Wilcoxon rank sum tests assessed factors associated with telehealth utilization. Results: Telehealth patients were older (median 6 vs 5 years, P = .002), more often female (66% vs 55%, P < .001), and white non-Hispanic (65.7% vs 54.9%, P < .001). Telehealth visits increased annually, plateauing at 200 per year by 2022. New patient visits were the most common (42–53% annually), while general visits declined. Telehealth patients had higher Area Deprivation Index scores ( P < .001) and lived farther from the center (median 95.9 miles). Conclusions: Telehealth improved access to multidisciplinary vascular anomalies care, reducing travel burdens and accommodating various visit types. However, disparities persist, with minority and non-English-speaking patients more likely to seek in-person care despite economic hardships. Addressing structural barriers through culturally tailored education, improved technology access, and strategic provider utilization is essential to ensuring equitable, sustainable multidisciplinary care. Quality of Evidence: Level 4.

Geographic access to prostate cancer care may influence outcomes but is often measured using straight-line distance, which may not accurately capture the travel burden experienced by patients. To evaluate the association between estimated travel time from patients' residence to treatment facilities and all-cause and prostate cancer-specific mortality. This retrospective cohort study used data from the Multilevel Epidemiologic Tumor Registry for Oncology, a nationally representative, investigator-initiated, population-based cancer registry that integrates geomasked residential and treatment facility information from multiple US state cancer registries. The study included patients aged 40 to 99 years from Hawaii, Louisiana, Massachusetts, New Jersey, Ohio, Utah, and Washington (Seattle and Puget Sound areas) with prostate cancer diagnosed between January 1, 2000, and December 31, 2015, and follow-up through January 1, 2018. Patients with missing follow-up, diagnosis at autopsy, and missing residential or treatment facility data were excluded. The data were analyzed from May 1, 2024, to March 15, 2025. Travel time from residence to treatment facility, categorized as less than 30 minutes vs 30 minutes or longer, was estimated based on masked geocodes and road network data. The primary outcomes were all-cause and prostate cancer-specific mortality measured using Cox proportional hazards regression models. The study included 159 943 men (mean [SD] age, 66.3 [9.5] years; median [IQR] follow-up, 101.2 [57.3-120.0] months), of whom 44.1% were estimated to have a less than 30-minute travel time and 55.9% to have a 30-minute or longer travel time. Those with a long travel time had a lower risk of death from any cause (adjusted hazard ratio, 0.91 [95% CI, 0.89-0.93]) and from prostate cancer (adjusted hazard ratio, 0.90 [95% CI, 0.86-0.95]). This cohort study found that longer travel time to treatment facilities was associated with lower all-cause and prostate cancer-specific mortality, possibly reflecting better quality through care centralization at specialized centers. While consistent across most subgroups, the findings should be interpreted with consideration of access barriers, such as transportation, that may contribute to missed or delayed diagnoses.

Specialty care access remains a significant challenge, particularly for patients in rural and underserved areas. This study evaluates the implementation and impact of an electronic consultation (eConsult) program aimed at improving access to rheumatology care within the University of Colorado Hospital network. This mixed methods evaluation of a rheumatology eConsult program used electronic health record and Medicaid claims data to describe patient, provider, and referral characteristics, care process and utilization outcomes, and interviews to gain provider insights about the program. The analysis included 10,433 traditional referrals and 670 internal and external eConsults placed between April 2018 - June 2022. Most internal eConsults (445/595, 75%) were completed electronically without the need to convert to an in-person consultation, and 73% (325/445) were completed within 3 days. The eConsults that were converted to traditional face-to-face referrals had a higher 180-day completion rate (36%) compared to traditional referrals (19%, p< 0.001). Overall, eConsults and traditional referrals had comparable rates of pharmacotherapy initiation for referrals related to suspected rheumatoid arthritis (RA) (57.1% vs 31.4%, p=0.082). Most eConsults came from primary care providers internal to the network (596/670, 89%). Interviews with team members highlighted successes such as improved efficiency and reduced patient travel burdens, while also identifying challenges, notably the need for increased provider familiarity and usage of the eConsult platform. Overall, the eConsult program represents a promising strategy to enhance specialty care delivery, particularly for underserved and distant populations, though ongoing education and system integration efforts are crucial for maximizing its impact.

This study aimed to identify how telehealth supports access to Voluntary Assisted Dying (VAD) globally and explore potential risks and benefits of telehealth for VAD consultations. A systematic review of peer-reviewed articles on telehealth and VAD examining global use of telehealth to support access to VAD, global restrictions to telehealth-enabled VAD, and practical and clinical implications of using telehealth in supporting VAD was performed. PubMed, Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and Scopus were searched and supplemented by handsearching relevant articles. Study quality was assessed using the SQUIRE (The Standard for Quality Improvement Reporting Excellence) guidelines. Two hundred and thirty articles were identified and then screened by two reviewers. Data were extracted from 26 included articles. Guided by Braun and Clarke's thematic analysis methodology, manual open coding was undertaken, and peer debriefing meetings resulted in the final key themes. Overall, findings indicate that telehealth can facilitate VAD services, enhance patient and provider experiences, and mitigate access inequities. The analysis highlighted that telehealth could further improve VAD access, especially in rural and remote areas. Until then, there are ongoing legal ambiguities for providers in Australia. Telehealth can improve access to VAD, particularly in remote areas, reducing travel burdens for terminally ill patients. Global evidence from VAD and other sensitive medical fields supports the conclusion that telehealth's benefits outweigh its risks. Legislative clarity in Australia is necessary to resolve conflicts between federal and state laws and to provide clarity for healthcare providers and improve access for eligible patients. Future research should include more robust measures of the efficacy of telehealth.

Abstract Background Health is a fundamental driver of sustainable development. In Assam, informal workers, who make up a significant portion of the labour force, face substantial barriers to accessing healthcare services. These challenges include physical distance, high costs, time constraints, and limited health awareness. Methods This study adopts a mixed-method approach using primary survey data from 600 informal workers across rural and urban areas of Assam. Healthcare accessibility is examined through four dimensions: distance, travel time, cost, and awareness. An Awareness Index is constructed based on participants’ exposure to health-related media (such as radio, television, and newspapers) and their involvement in public health programmes. Chi-square tests are used to explore the association between access indicators and socio-economic variables, including age, gender, education, caste, and income. Results The findings reveal notable disparities in healthcare access across the districts of Dhubri, Sonitpur, and Dhemaji. Travel-related difficulties and low awareness levels are significant barriers. The Awareness Index scores are particularly low among older individuals, those with lower education levels, and economically disadvantaged groups. Statistically significant associations are observed between healthcare access and socio-economic factors. Conclusion The study emphasises the need to improve local healthcare infrastructure, reduce travel burdens, and enhance health awareness through community-based interventions. Policy efforts must focus on inclusive and equitable healthcare delivery to address the needs of informal workers in Assam.

Background. Commuting poses a considerable burden and costs for patients with rare rheumatic diseases such as systemic sclerosis (SSc), who require care from tertiary medical centres. In a universal healthcare system, the selection of healthcare services is possibly influenced by geographical distribution, referral networks from primary care, and patient preferences. This study aims to evaluate whether longer commuting distances are associated with clinical variables and differences in medication access among Italian SSc patients receiving follow-up care at tertiary centres. Materials and Methods. The driving distance from the city of residence to the care centre was calculated using the Google Maps Distance Matrix API for anonymized patients with SSc from the Systemic Sclerosis Progression INvestiGation (SPRING) Italian registry. This distance was then correlated with clinical and drug history in an ordinal logistic regression analysis. Results. The characteristics of 1,782 patients were obtained from 38 centres across the country (Figure 1 and Table 1): 74.2% were categorized as short-distance commuters (traveling less than 100 km), 20.1% as intermediate-distance commuters (traveling 100-500 km), and 5.6% as long-distance commuters (traveling more than 500 km). Notably, 24.6% of the patients received care outside their residential administrative region. Patients with interstitial lung disease (ILD), pulmonary arterial hypertension, lower Forced Vital Capacity (FVC), reduced Diffusion Capacity for Carbon Monoxide (DLCO), anti-Scl70 positivity, and anti-centromere negativity had higher probability of traveling longer distances. Similarly, access to multiple immunosuppressants (cyclophosphamide, azathioprine, methotrexate, tocilizumab) and vasoactive/vasodilator drugs (Endothelin Receptor Antagonists (ERA), Phosphodiesterase Type 5 Inhibitors (PDE5i), iloprost) was associated with increased probability of long travel distances (Table 1). No significant differences were correlated to demographics or comorbidity burden. Conclusions. SSc patients with pulmonary complications are more likely to undertake longer commuting distances and have a higher likelihood of receiving advanced treatments. Public health strategies should aim to enhance accessibility to specialized care and advanced therapies for these patients, recognizing the impact of travel burden on healthcare access.

Transgender and gender diverse individuals often face challenges with social aspects of transition despite access to conventional gender-affirming medical and surgical treatments. Gender Expression Care (GEC) addresses this by offering practical and immediate support led by interdisciplinary professionals in a small-group workshop series. Participants receive guidance in voice and movement, communication strategies, wardrobe styling, and cosmetic techniques in order to more safely and confidently align their outward presentation with their gender identity. During the COVID-19 pandemic, GEC was rapidly adapted from an in-person to a virtual format. This study aims to describe that transition, using descriptive statistics and a qualitative thematic approach to explore the experience of 261 participants. Telemedicine improved access to GEC, expanding from 24 unique zip codes concentrated in one major urban area for workshops held in-person, to 158 zip codes spanning a wide geographic region for workshops held virtually. Satisfaction was high, with 89% of participants reporting a good, very good, or excellent experience virtually. In addition, this format eliminated the financial burden of travel, facilitating participation by members from various socioeconomic backgrounds. Telemedicine is a suitable format to help transitioning individuals develop their own authentic gender expression while building social connection beyond traditional geographic boundaries.

IntroductionMild cognitive impairment (MCI) is an intermediate stage between normal aging and mild dementia. Patients with MCI and dementia usually experience impairment in cognitive functions such as memory, executive function, and processing speed. They may also develop neuropsychiatric symptoms, such as depression, anxiety, and agitation. While previous studies suggest that mindfulness meditation may benefit this population, the feasibility of delivering such interventions online remains unclear. Therefore, this study aims to investigate the feasibility and acceptability of an eight-week, online-delivered mindfulness program for people with MCI and mild dementia.MethodsThis study will recruit 32 participants over 60 years old with MCI or mild dementia in the UK. Participants will attend a weekly live online mindfulness meditation session, led by an experienced mindfulness teacher for eight weeks. Each session lasts 2.5 hours. In addition, participants will be encouraged to do daily home practice.The primary outcomes are feasibility and acceptability of an online program, assessed through participation records and semi-structured interviews. Secondary outcomes include participants' changes in cognitive function, mood, sleep, quality of life, mindfulness, and resilience.DiscussionMindfulness meditation delivered online could help reduce travel burdens and overall costs. This study aims to assess the usability and potential effects of online-delivered programs for this population, providing evidence to support the use of remote interventions in the care of older adults with cognitive impairments.Study registrationClinicalTrials.gov Identifier: NCT06768450.

Telemedicine has emerged as a transformative tool in modern health care, facilitating remote communication between physicians and patients while improving access, operational efficiency, and cost-effectiveness. Its role has been extensively studied in adult primary care and surgery. However, its application in Pediatric Plastic Surgery remains unexplored. This study evaluates the impact of telehealth at a high-volume Pediatric Plastic Surgery center, assessing its efficacy in expanding access and optimizing patient care pathways. An IRB-approved retrospective analysis using Salesforce Data Analytics (Salesforce Inc., San Francisco, CA) was conducted on all patients referred to the plastic surgery department at a tertiary pediatric hospital between January 2020 and December 2024. Data collected included referring location, primary diagnosis, and home state. Key outcomes analyzed included referral-to-visit conversion rates, surgical conversion rates, and time to surgery. Comparative analyses were performed between telehealth and in-person consultations, as well as between in-state and out-of-state referrals. A total of 6369 patients were referred during the study period. The majority (82.5%) resided within 80 miles of the hospital, with 57.3% being in-state and 42.7% out-of-state referrals. The overall referral-to-visit conversion rate was 71%. Among those who underwent consultation, 52.9% proceeded with surgery. Notably, telehealth consultations were associated with a significantly higher surgical conversion rate compared with in-person visits (60.5% versus 47.6%; P<0.001). While consultation rates were comparable between in-state (65.0%) and out-of-state (70.0%) referrals (P=0.72), out-of-state patients using telehealth had markedly higher surgical conversion rates than those seen in person (70.1% versus 36.9%; P<0.001). In-state patients using telehealth also had significantly higher surgical conversion rates compared with those seen in-person (59.8% versus 36.0%; P<0.001). There was no significant difference in time-to-surgery between the telehealth and the in-person cohorts (167 versus 165d; P>0.05). This study underscores the critical role of telehealth in Pediatric Plastic Surgery, particularly in enhancing access for geographically distant patients. Telehealth consultations were associated with higher surgical conversion rates, particularly among out-of-state patients, suggesting that virtual consultations may facilitate more streamlined surgical planning and reduce unnecessary travel burdens. These findings support the broader integration of telehealth into Pediatric Plastic Surgery practice to improve patient access, optimize resource utilization, and expand care delivery for underserved populations.

Proton beam therapy (PBT) offers dosimetric advantages in pediatric radiotherapy by reducing radiation exposure to healthy tissues. However, broad implementation raises important ethical, logistical, and equity considerations, especially in settings with limited access to advanced technologies. This position paper by the Paediatric Radiation Oncology Society (PROS) reviews the clinical rationale for selecting radiotherapy modalities in children, with a specific focus on ethical utilization of PBT. The document synthesizes evidence on the benefits and limitations of modern photon and proton therapies, explores disparities in access, outlines the role of local pediatric radiation oncologists, and addresses the impact of industry-driven messaging on family decision-making. While PBT offers clinical benefit in selecting pediatric cancers, high-quality photon-based treatments such as IMRT and VMAT remain effective and widely accessible alternatives. The referral and evaluation process for PBT is complex and may introduce treatment delays. Travel and financial burdens can exacerbate disparities. PROS underscores the critical role of local pediatric radiation oncologists in counseling families, and calls for balanced, evidence-based communication from providers and industry stakeholders. PROS advocates for an ethical, equitable, and evidence-informed approach to radiotherapy modality selection in children, reflecting holistic considerations beyond dosimetry. Proton therapy should be pursued when clinically indicated and accessible without compromising timely care. Investment in a comprehensive radiation therapy infrastructure, including professional education, collaborative research, and responsible public messaging, is essential to optimize pediatric cancer outcomes globally.

Orthopaedic injuries often require timely management. This is challenging in remote regions, such as Far North Queensland, where patients must travel long distances. A Virtual Fracture Clinic (VFC) model offers a promising alternative, allowing remote management of select cases, and reducing travel burdens and healthcare costs. This prospective cohort study assessed the implementation of a VFC at Cairns Base Hospital. An orthopaedic registrar triaged patients to the VFC based on predefined criteria over a 5-week period. Primary outcomes included patient satisfaction, travel distance savings and cost savings. Secondary outcomes included the clinical outcomes of the VFC and the traditional clinic. Out of 514 referrals, 36.4% were managed through the VFC. Compared with the traditional clinic, VFC patients had shorter wait times, and 91.4% of those seen in the VFC could be discharged without further review. VFC patients were highly satisfied, with 75.2% indicating a willingness to undergo the same treatment again. The VFC also resulted in significant travel distance and cost savings. No patients in the VFC required surgery during the follow-up period. This study provides the first prospective evidence that registrar-led VFCs in regional Australia can safely deliver orthopaedic care with substantial logistical and economic benefits. With high patient satisfaction and no compromise in safety, this model could redefine how fracture care is delivered across Australia's vast rural landscape, helping close the gap in access for remote and Indigenous populations.

Purpose: This systematic review addresses the clinical question how do sociodemographic factors influence diabetic retinopathy (DR) screening adherence among individuals with diabetes. The review examines individuals with diabetes as the target population, focusing on the impact of various sociodemographic exposures on DR screening uptake. Methods: A comprehensive systematic search was conducted across Ovid MEDLINE, Embase, and the Cochrane Library from inception to November 2024. The primary outcome was the overall rate of DR screening among individuals, while the secondary outcomes included the odds ratios (ORs) or proportions of individuals screened for DR, stratified by sociodemographic factors. Results: Thirty-three studies were included, spanning over 100,000 participants. Older age, higher education, higher income, and private insurance were consistently associated with higher screening adherence. Employed individuals, particularly those in manual labor or with rigid schedules, had lower participation. Women generally showed higher adherence, though findings varied. Ethnic disparities were observed, with Black and Hispanic populations demonstrating lower screening rates. Geographic distance and travel burden were frequently reported barriers. Conclusion: This review demonstrates that sociodemographic factors significantly affect DR screening adherence. Strengths include the broad geographic scope and diversity of populations studied. Limitations involve study heterogeneity and occasional reliance on self-reported data.

Home delivery of medications is an emerging service that can enhance treatment continuity, reduce travel burdens, and improve public health outcomes in low-resource settings like Yemen. However, community pharmacists’ perceptions in Sana’a remain unclear. To assess community pharmacists’ perceptions of home medication delivery services in terms of their advantages, disadvantages, and the factors influencing their acceptance. A cross-sectional survey was conducted among 375 community pharmacies in Sana’a from April to July 2023. Logistic regression identified factors affecting service acceptance. Of 390 pharmacies approached, 375 (96.2%) participated. The majority were male (85.9%), and 49.3% held a Bachelor of Pharmacy degree. More than two-thirds (68.3%) were aware of the service, 47.2% were willing to adopt it, and 31.7% currently offered it. The main disadvantages identified were dispensing errors (69.1%), verification limitations (71.5%), and challenges in marketing over-the-counter items (70.7%). In contrast, the primary advantages included facilitating treatment during pandemics (83.2%), aiding vulnerable populations (84.5%), providing convenience for parents (80.8%), and potentially reducing congestion in health facilities (72.0%). In multivariable analysis, willingness to adopt home delivery was higher among pharmacists currently providing it (AOR = 9.10), partially involved (AOR = 4.05), and those aware of it (AOR = 4.95; all p < 0.001). Most community pharmacists in Sana’a are aware of home medication delivery, and nearly half express a willingness to adopt it for its continuity of care, reduced facility congestion, and convenience. However, Concerns about medication errors remain, and acceptance is strongly influenced by awareness and involvement.

PurposeTelemedicine can help specialists in providing efficient care to patients from a distance and it has been growing steadily in healthcare. This study aims to provide an operational perspective by investigating the effect of telemedicine on patients’ choices, healthcare providers’ service decisions, service quality and total social welfare.MethodsWe propose an optimization model that incorporates patients’ choices and physicians’ actions under two scenarios: full coverage and partial coverage. We analyze the model and conduct numerical experiments to explore the impact of telemedicine in a referral-based healthcare system with heterogeneous patients.ResultsThe findings show that telemedicine can induce greater collaboration between generalists and the specialist, which would result in the specialist spending less time on each patient. Interestingly, we find that after the introduction of telemedicine, the average quality cost decreases under full coverage but increases under partial coverage. Moreover, the introduction of telemedicine could lead to higher social welfare as it improves the accessibility of services to patients, especially in rural areas. Finally, this study also demonstrates that the referral-based healthcare system may benefit more from telemedicine when there is a heavier travel burden for patients or a higher financial incentive for generalists.ConclusionThe introduction of telemedicine mainly contributes to the patients’ service accessibility, particularly for patients in remote areas, and can foster closer collaboration between generalists and specialists. However, in hospitals where medical resources are already strained, it may worsen specialist overuse and lead to lower service quality. These findings highlight that telemedicine is not universally beneficial. The policymaker should consider regional coverage conditions and use targeted financial incentives to improve its effectiveness within referral-based healthcare systems.

Global housing demand has increased sharply due to rapid population growth and displacement driven by climate change and natural disasters, prompting many countries, including Bangladesh, to adopt public housing initiatives. The Ashrayan Project, launched by the Government of Bangladesh, is a flagship initiative aimed at alleviating homelessness and poverty by providing secure shelter and livelihood opportunities for landless and disaster-affected families. This study evaluates beneficiaries’ perceptions to extract lessons for improving the selection, design, and implementation of future housing initiatives. It examines how effectively the project is achieving its objectives, with a focus on access to livelihoods and essential services. Information from 404 beneficiaries across 40 upazilas was collected through a telephone survey. The findings show improvements in living conditions, particularly access to electricity, drinking water, and sanitation. However, shortcomings include distant locations, limited livelihood opportunities, and inadequate access to amenities such as healthcare and growth centers, which increase travel burdens and affect income stability. These challenges have led to dissatisfaction with basic services and, in some cases, partial abandonment of settlements or relocation to urban areas. Overall, the study highlights the need for better site selection, greater beneficiary participation, and integrated amenities to strengthen the sustainability of such housing programs.

Efficient access to blood banks is critical for patient care in regions experiencing persistent shortages of blood supply. This study applies the Traveling Salesman Problem (TSP) framework to optimize travel routes among eight major blood banks in Tacloban City, Philippines. Using data on distance, time, and fare collected through field observations, Google Maps, and local fare matrices, weighted graphs were constructed to represent inter-hospital connectivity. The Greedy Algorithm was employed to generate heuristic solutions for minimizing total travel burdens from multiple starting points. Results showed that optimal paths varied depending on the choice of starting facility, with centrally located hospitals such as Mother of Mercy Hospital and Divine Word Hospital producing shorter routes in terms of both time and cost. By contrast, the Eastern Visayas Medical Center, being geographically isolated, consistently resulted in higher travel distances. Findings demonstrate that heuristic approaches can effectively support healthcare logistics by reducing cost and time for patients’ families during emergencies. This research contributes to the growing body of work integrating combinatorial optimization into public health logistics, offering insights for planners, administrators, and policymakers.

Abstract Pituitary adenomas often require urgent surgical intervention to prevent irreversible visual or hormonal dysfunction. Yet, access to experienced pituitary surgeons remains highly centralized. We analyzed national patterns in provider distribution and travel burden, identifying geographic and sociodemographic factors that limit timely access to specialized surgical care. We performed a cross-sectional geospatial and sociodemographic analysis across 40 U.S. County catchment areas. Pituitary surgeons were identified from CMS billing data as providers who submitted ≥10 annual claims for CPT codes 62165, 61546, or 61548 over five years. Provider locations were geocoded to define access points. County-level demographic and health data were obtained from the UCSF Health Atlas. Two primary outcomes were calculated: mean Euclidean distance to the nearest pituitary surgeon and surgeon density per 100,000 population. Multivariate linear regression models identified predictors of both outcomes. Among 83 identified pituitary surgeons, access varied markedly across regions. Travel distances ranged from 5.9 to over 150 miles. A multivariate model (adjusted R² = 0.706, p &amp;lt; 0.001) revealed that higher proportions of Native American residents predicted significantly longer travel distances (β = +18.2 miles per 1%, p &amp;lt; 0.00001), alongside cognitive disability prevalence, depression, lack of vehicle access, and poor internet infrastructure (p &amp;lt; 0.05). Surgeon density was positively associated with population density, income, education, and vehicle access. Latino-majority regions had significantly fewer providers per capita (β = -0.059, p &amp;lt; 0.01). Substantial disparities exist in access to pituitary surgery, driven by overlapping social, economic, and geographic barriers. Native American and socioeconomically disadvantaged populations face the longest travel distances, while wealthier urban areas benefit from greater provider density. Interventions such as telehealth, transportation support, and workforce redistribution are needed to address these inequities.

BackgroundVirtual health care models that incorporate registered nurse triage with rapid access to same-day virtual visits with clinicians represent a growing innovation in health care delivery. While traditional telephone advice lines focus primarily on registered nurse–led triage and care navigation, systems such as the Department of Veterans Affairs (VA) are beginning to embed physicians and advanced practice providers directly into these platforms. This hybrid model has the potential to enhance clinical responsiveness, reduce unnecessary emergency department and urgent care visits, and increase patient satisfaction by providing timely care from home.ObjectiveThis study aimed to explore Veterans’ experiences and perceptions of the VA’s integrated virtual triage and urgent care model, specifically through the VA Health Connect platform. We sought to understand how Veterans learned about and interacted with these services and to gather their insights on aspects to preserve or improve.MethodsWe conducted in-depth qualitative interviews with 24 Veterans from various geographical regions served by 6 VA health care systems. Interviews were carried out between June 18 and August 8, 2024. Data were analyzed using a qualitative descriptive approach with constant comparison to identify emergent themes and representative quotes.ResultsParticipants reported high satisfaction with VA Health Connect’s nurse triage and virtual clinical visit services. Key benefits included timeliness of care, personal time savings, efficient service organization, and positive interactions with nurses and providers. Veterans appreciated the convenience of resolving health issues quickly and remotely, often citing significant travel burdens avoided. They also highlighted the knowledgeable and personalized clinical advice received. However, several areas for improvement were identified. Some Veterans expressed frustration about being routed to nurse triage instead of directly scheduling with their primary care providers. Moreover, many were initially unaware of the full range of services available through VA Health Connect and suggested enhanced outreach and communication strategies.ConclusionsVeterans are highly satisfied with the VA Health Connect model, valuing its timeliness, convenience, and the professionalism of clinical staff. Effective promotion and clear communication about the capabilities and limitations of the service could further enhance user experience and uptake. As this integrated care model continues to evolve, its success will depend on effectively integrating virtual services into routine care and ensuring Veterans are well-informed and confident in using these resources.

ABSTRACTIntroductionTimely treatment initiation is critical to clinical outcomes in breast cancer (BC). While social determinants of health are established drivers of disparities in the timeliness of care (ToC), the impact of travel burden remains less defined. This study evaluates associations between travel burden, ToC, and overall survival (OS) in a nationally representative BC cohort.MethodsWe analyzed 283,166 bc patients from the National Cancer Database (2004–2021) with documented great circle distance (GCD), categorized as ≤ 10, 10.1–20.0, and > 20 miles. Associations between GCD and ToC—defined as time from diagnosis to first treatment and categorized as < 8, 8–12, and > 12 weeks—were assessed using negative binomial models, and associations with OS were evaluated using Cox models.ResultsCompared to patients with GCD < 10 miles, patients with GCD > 20 miles experienced delays in ToC when diagnosed with early‐stage disease, especially when undergoing surgery as first treatment (RR: 1.05, 95% CI: 1.04–1.06). Compared to treatment within 8 weeks of diagnosis, treatment initiation > 12 weeks had 24% higher mortality (HR: 1.24, 95% CI: 1.14–1.35), especially among patients receiving surgery (HR: 1.31, 95% CI: 1.19–1.43) and chemotherapy (HR: 1.30, 95% CI: 1.18–1.43). Even surgery within 8–12 weeks carried an elevated risk (HR: 1.09, 95% CI: 1.02–1.16). Metropolitan patients with GCD > 20 miles had a 12% lower mortality (HR: 0.88, 95% CI: 0.81–0.96) than those ≤ 10 miles away; no such differences were observed in urban or rural groups.ConclusionTravel burden influences BC ToC and OS through geographic, clinical, and facility factors, underscoring the need for tailored interventions that address local care capacity, patient demographics, and disease profiles.