Journal of Telemedicine and Telecare最新文献

IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, web-based survey (July to November 2024) of clinicians and clinical leaders via the International Society of Addiction Medicine, World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine facilitated medication for opioid use disorder (TMOUD) practices, priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.ResultsSixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), more often in high-income than LMIC settings (58% vs 11%). Barriers to prescribing were identified, and few settings reimbursed video and telephone consultations equally. Improving treatment retention (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.DiscussionTMOUD remains uneven and concentrated in high-income countries. Updated clinical guidance, digital connectivity investment and interoperable e-health systems, and targeted workforce development, particularly in LMICs, are needed to realise TM's potential for equitable and effective treatment of opioid use disorder. This global survey fills a critical knowledge gap by documenting expert perspectives across income settings, offering cross-national evidence to inform equitable expansion of TMOUD worldwide.

ObjectivesRemote patient monitoring (RPM), combining home blood pressure measurements with telehealth services, effectively manages hypertension. Successful implementation of RPM programs at scale requires understanding program costs and financial sustainability. We evaluated the financial performance of an RPM program.MethodsConducted from March to June 2024 in the Cardiology Division at New York University Langone Health, the study used field observation, surveys, and micro-costing methods. A costing tool was developed to quantify program costs in 2024 US dollars, including personnel, equipment, and supplies. RPM-related services reimbursement rates were estimated using Medicare billing information. The return-on-investment (ROI) ratio was calculated by dividing net return (profit) by the RPM program costs. Sensitivity analyses assessed the impact of varying parameters on the ROI of RPM.ResultsThe average RPM program cost was estimated at $330 per patient (range: $208-$452). Major expenses included data review by staff ($172 per patient), blood pressure devices ($48 per patient), and phone communications ($36 per patient). ROI varied based on patient compliance with home blood pressure monitoring (≥16 days per month), with an average estimate of 22.2% (range: -11.1%-93.3%) per patient at a 55% compliance rate. The ROI was most sensitive to changes in data-review costs, insurance reimbursement rates, patient compliance, device setup, and communication costs.ConclusionsThe RPM program achieved a positive ROI from the perspective of a clinical division in a large healthcare system. Successful implementation and financial sustainability of RPM require efforts to reduce human resource costs and enhance patient engagement.

ObjectiveTo quantify the impact of technology-enabled rehabilitation nursing on patient-reported function after lower-limb arthroplasty and to explore effect modification by surgical procedure and by technological modality.MethodsTen databases were searched from inception to 2 May 2025. Randomised controlled trials (RCTs) comparing an innovative digital or electromechanical rehabilitation intervention with usual postoperative care and reporting WOMAC, KOOS or HOOS outcomes were eligible. Risk of bias was assessed with Cochrane RoB 2.0. Standardised mean differences (Hedges g) were pooled using a Hartung-Knapp REML random-effects model; heterogeneity was quantified with I². Sub-group analyses were prespecified for surgery type (TKA vs THA) and technology class (virtual reality VR, web/app telerehabilitation WB, robot/sensor RB). Publication bias was evaluated with funnel-plot inspection and Egger's regression. The certainty of evidence was assessed with the GRADE framework.ResultsFifteen RCTs (1012 experimental, 954 control participants; 11 TKA, 3 THA, 1 mixed) met the criteria and were all rated overall "low risk" by RoB 2.0. Across trials, technology-enabled care conferred a small but significant improvement in patient-reported function (g = 0.28; 95% CI 0.00 to 0.56; p = 0.049; I² = 86%). VR produced the largest point estimate (g = 0.62; 95% CI -0.18 to 1.41; 4 trials); WB yielded a modest, non-significant benefit (g = 0.18; 95% CI -0.24 to 0.59; 8 trials); RB showed a comparable, non-significant effect (g = 0.14; 95% CI -0.23 to 0.50; 3 trials). The χ² test for subgroup differences was not significant (p = 0.16). Egger's test revealed no evidence of small-study effects (p = 0.73). Leave-one-out and influence analyses confirmed robustness of the pooled estimate. The certainty of evidence was rated as moderate (GRADE).ConclusionsNext-generation digital and electromechanical rehabilitation programmes achieve at least non-inferior- and potentially clinically relevant-improvements in self-reported function after lower-limb arthroplasty while reducing in-person therapist time. Virtual-reality platforms appear most promising, but heterogeneity suggests that dose, feedback fidelity and sensor precision are key effect drivers. Large, standardised multicentre trials with cost-utility endpoints are needed to clarify which technological components add value for which patients.

ObjectiveInability to attend in-person care is a common barrier to accessing exercise therapy and education programs for knee osteoarthritis. The primary aim of this randomised clinical trial (RCT) was to determine if telehealth was non-inferior to 'in-person' delivery of a group-based exercise therapy and education program (GLA:D^®) for knee-related burden at 3 (primary timepoint), 12 and 24 months in people with knee osteoarthritis.DesignThis pre-registered (ACTRN12619000235101) two-arm (in-person v telehealth) non-inferiority limited-disclosure RCT commenced in April 2019, with a planned sample of 110. Knee-related burden was evaluated at baseline, 3- (primary timepoint), 12- and 24-month following intervention commencement by summating four Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄: pain, symptoms, activities of daily living, quality of life [QoL]). Secondary outcomes included health-related QoL, pain severity, physical activity, functional performance, patient satisfaction and global rating of change.ResultsRecruitment ceased in March 2020 due to COVID-19 restrictions. Forty-four participants enrolled at baseline (22 per group). Forty-three (98%), 40 (91%) and 29 (66%) participants provided 3-, 12- and 24-month follow-up data, respectively. The lower limit of the 95% confidence interval (CI) was above the non-inferiority threshold (i.e. -10 points) for KOOS₄ at 3 (mean difference, 95%CI = 6, -2 to 15) and 12 months (0, -9 to 9). Compared to in-person, mean reduction in worst pain was greater for telehealth delivery at 3 months (16.5, 95%CI 0.8 to 32.2). No other secondary outcomes were different between groups.ConclusionKnee-related burden outcomes following telehealth-delivered group-based exercise therapy and education in people with knee osteoarthritis might not be different to in-person delivery.

BackgroundFew studies have explored the cost and clinical impacts of enhanced telehealth interventions for stroke in contemporaneous practice. As such, we sought to compare the cost-effectiveness of a clinical service supported by a purpose built platform for stroke telehealth in South Australia.MethodsMarkov decision analytic models were constructed to model the implementation of an enhanced telehealth programme versus historical controls with limited referral support. The models were profiled on a minimum dataset of 470 patients with stroke symptoms presenting across eight regional/rural hospitals in South Australia. Clinical outcomes and costs were derived from published sources. Incremental cost-effectiveness ratios were used to estimate the cost-effectiveness of the telehealth platform over a lifetime time horizon, from the perspective of the Australian healthcare system compared with a historical control.ResultsImplementation of the South Australia Telestroke programme was associated with a gain of 0.10 quality-adjusted life years and a cost saving of $3873 per patient. That is, over a 5-year period, the introduction of technology-enabled telehealth resulted in a total projected cost saving of $8.7 million (M). This was driven by a reduction in the costs attributed to management (per patient -$2676; total projected: -$6.0 M), nursing home care (per patient: -$3268; total projected: -$7.3 M), non-medical costs (per patient: -$510; total projected: -$1.1 M) and futile transfers (per patient: -$111; total projected: -$250,248), which offset higher intervention costs (per patient: $2674; total projected: $6.0 M) and hospital costs (per patient: $18; total projected: $41,092). Sensitivity analyses confirmed the robustness of these findings.ConclusionThe implementation of an enhanced telehealth programme improves patient outcomes and is cost-saving relative to a telestroke programme with limited referral support. Our findings support ongoing implementation of the enhanced telehealth programme across South Australian hospitals.

ObjectivesTo compare the effects of physical therapy via telerehabilitation on the improvement in cardiopulmonary function, physical factors and psychological factors in patients with coronavirus disease 2019 (COVID-19).MethodsThirty-two patients with COVID-19 were randomly assigned to intervention and control groups. Both groups received online guidance and a leaflet on cardiopulmonary rehabilitation. Additionally, participants in the intervention group received physical therapy training via video call, which included pulmonary training and various exercises. Cardiopulmonary exercise testing, quality of life, functional capacity, cognitive function, lower body strength and endurance and psychological aspects (anxiety, depression and insomnia) were assessed.ResultsThe physical therapy programme delivered via telerehabilitation significantly improved cardiopulmonary function in patients with COVID-19 at the 3-month follow-up compared with the control group. Additionally, the physical therapy programme had beneficial effects on functional capacity, depression symptoms and quality of life.ConclusionA physical therapy programme via telerehabilitation can be delivered to patients with COVID-19 in their own homes to improve cardiopulmonary function after 3 months of follow-up.

IntroductionMental health issues disproportionately affect rural and low-income populations, where access to prevention and treatment is limited. Implementing telemental health services (TMHS) in Federally Qualified Health Centers (FQHCs) could improve accessibility to mental healthcare. This study assessed the effect of TMHS on mental health services utilization in FQHCs, comparing centers with and without TMHS and examined differences in TMHS effect between FQHCs that adopted TMHS before and during the pandemic.MethodsThe study utilized FQHC-level data from Uniform Data Systems annual performance reports (N = 9540 FQHC-year) and county-level demographic, health status, and provider characteristic data from 2016 to 2022. A two-way fixed effects model was applied to examine the effect of TMHS on mental health visit rates, supplemented by the Sun and Abraham difference-in-differences estimator. The analysis included both pre-COVID and during-COVID TMHS adopters.ResultsFQHCs offering TMHS showed 1.04 times increase in overall mental health visit rates compared to those without TMHS. Centers serving higher proportions of Medicaid-insured (1.07 times) and low-income (below 200% FPL; 1.05 times) populations showed even higher visit rates. During-COVID TMHS adopters showed a significant increase (1.05 times), particularly in urban areas, whereas rural adopters did not see significant changes.ConclusionFQHCs offering TMHS showed increased mental health visit rates, especially among low-income and Medicaid-insured populations. FQHCs that adopted TMHS during the pandemic experienced a marked rise in mental health visits, but rural-urban disparities persist, highlighting the ongoing challenges in expanding access to mental healthcare in rural settings.

IntroductionThe COVID-19 pandemic exacerbated existing challenges in treating substance use disorders. This study explores the impact of telehealth on addiction consult services (ACS) medication initiation in hospitalized patients with alcohol and opioid use disorders (AUD and OUD).MethodsWe retrospectively analyzed data from adult patients who received their first ACS consultation in-person (pre-pandemic) and telehealth ACS consultation (during the pandemic). We compared medication initiation rates for AUD and OUD before and after ACS consultation.ResultsThe ACS completed 398 in-person consults and 473 telehealth consults. In-person ACS consultation increased the medication initiation rates from 3.41% for AUD in hospitalized patients without an ACS consult, to 45.45% for AUD after an ACS consult. For OUD pharmacotherapy initiation, an ACS consultation increased medication rates from 6.94% to 41.67% for OUD. Telehealth ACS consultation increased medication initiation rates from 5.16% to 66.20% for AUD and from 7.53% to 67.74% for OUD. Buprenorphine and naltrexone were the most commonly initiated medications for OUD and AUD, respectively.DiscussionThe adoption of telehealth by the hospital ACS during the pandemic effectively increased medication initiation rates for AUD and OUD, consistent with pre-pandemic, demonstrating its potential to expand access to addiction services. This approach could address the current shortage of addiction providers and serve underserved populations.

In this case report, we describe the performance of procedural sedation and emergent joint reduction via remote telehealth leadership for a patient with an acutely limb-threatening injury. The patient was a 33-year-old man who presented to a small rural hospital with a fracture dislocation of his ankle complicated by severe pain refractory to opiate analgesia and neurovascular compromise, including absent peripheral pulses and sensory changes. Due to aviation and resource limitation factors, immediate retrieval was not possible. While it was clear he needed urgent treatment, local staff expressed that they did not possess the training or requisite experience to undertake a procedural sedation and joint reduction. Following extensive discussions between the telehealth specialist and the local team, the telehealth doctor assumed clinical governance for the case, serving as team leader and coaching the local team through a ketamine procedural sedation and emergent joint reduction. Ultimately, these procedures were successful, with immediate improvement in limb neurovascular status. This case, along with prior work, demonstrates that High-Acuity Low-Occurrence (HALO) procedures can be facilitated by telehealth. Key learning points from the case include the choice of anaesthetic agent given limited local experience, delegating a separate telehealth clinician to monitor patient vital signs to cognitively offload local staff, and the importance of detailed pre-procedure discussions prior to completing HALO tasks.