Journal of Telemedicine and Telecare最新文献

{"title":"Agreement between face-to-face and telehealth physical therapy triage decisions in a routine outpatient setting.","authors":"Zafnat Sharvit, Alon Kalron","doi":"10.1177/1357633X261471678","DOIUrl":"https://doi.org/10.1177/1357633X261471678","url":null,"abstract":"<p><p>BackgroundTelehealth has increasingly been integrated into physiotherapy services to improve access and reduce waiting times. However, evidence regarding agreement between telehealth and face-to-face physiotherapy triage decisions remains limited, particularly in routine outpatient settings.MethodsA repeated-measures agreement study was conducted to evaluate the use of telehealth for physiotherapy triage in an outpatient clinic. Adults referred for physiotherapy triage due to chronic musculoskeletal conditions underwent two consecutive triage assessments, face-to-face and telehealth, performed by five independent physiotherapists. Agreement in treatment recommendations and in urgency classification was assessed using percentage agreement and Cohen's kappa or weighted kappa. Patient and physiotherapist satisfaction with telehealth triage was evaluated using visual analog scale questionnaires.ResultsThirty participants completed both triage assessments. Agreement between face-to-face and telehealth triage was moderate for treatment recommendations (70.0%, Kappa = 0.44) and lower for urgency classification (56.7%, weighted Kappa = 0.22), with variability across musculoskeletal conditions. Both patients and physiotherapists reported high levels of satisfaction with telehealth triage.ConclusionsTelehealth physiotherapy triage demonstrated moderate agreement with face-to-face assessments for treatment recommendations but limited agreement for urgency classification. While telehealth appears feasible for supporting treatment allocation, caution is warranted when using it to determine clinical urgency, and further standardization of urgency assessment is needed.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261471678"},"PeriodicalIF":3.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing at a distance: How telemedicine impacts the diagnostic process.","authors":"Traber D Giardina, Umber Shahid, Rosann T Cholankeril, Jan A Lindsay, Hardeep Singh, Daniel R Murphy","doi":"10.1177/1357633X261466000","DOIUrl":"https://doi.org/10.1177/1357633X261466000","url":null,"abstract":"<p><p>BackgroundThe rapid expansion of telemedicine has reshaped healthcare delivery, offering increased accessibility and convenience. However, its impact on the diagnostic process is still undergoing evaluation. This study explored key stakeholder perspectives to enhance understanding of telemedicine's role in the diagnostic process.MethodsWe conducted semistructured interviews with 34 subject-matter experts (SMEs) in telemedicine and practicing clinicians across various healthcare organizations and 10 patients with prior telemedicine experience. Using inductive qualitative content analysis, we identified themes related to facilitators and challenges in the diagnostic process via telemedicine encounters.ResultsSMEs and clinicians noted telemedicine's potential to improve access and enhance continuity of care, but they raised concerns about diagnostic accuracy due to the absence of hands-on physical exams and challenges in managing diagnostic uncertainty. Specifically, clinicians described relying more on additional testing, patient self-reports, and scheduling in-person follow-ups to compensate. Patients emphasized the convenience and accessibility of telemedicine, particularly for those with disabilities, and valued the ability to communicate with clinicians in a familiar environment. However, few patients had received a new diagnosis via telemedicine; and many preferred in-person visits for new or complex concerns. Additionally, barriers related to digital literacy, technology challenges, and incomplete follow-up on diagnostic testing emerged as critical factors influencing telemedicine's effectiveness in diagnostic decision-making.ConclusionsOur qualitative study of stakeholder perspectives underscores certain limitations of telemedicine in the diagnostic process and outlines the need to consider strategies to enhance the effectiveness of diagnostic decision-making in telemedicine.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261466000"},"PeriodicalIF":3.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The out-of-pocket costs of Medicare-reimbursed telepsychiatry consultations since telehealth expansion in Australia: An administrative data linkage analysis.","authors":"Luke Sy-Cherng Woon, Paul Maguire, Rebecca E Reay, Tarun Bastiampillai, Jeffrey Cl Looi, Wai-Man Liu","doi":"10.1177/1357633X251393387","DOIUrl":"10.1177/1357633X251393387","url":null,"abstract":"<p><p>IntroductionTelepsychiatry has been widely adopted following changes to the Medicare Benefits Schedule (MBS) telehealth policy. This study aimed to examine the effect of telehealth policy changes on the out-of-pocket costs of MBS-subsidised psychiatric consultations.MethodsWe extracted records of relevant face-to-face, video, and telephone consultations from linked MBS claims data, Pharmaceutical Benefits Schedule data (2017-2023) and the 2021 Census data. For each consultation mode, we calculated the average monthly bulk-billing rate and average fee gap for non-bulk-billed consultations. Multivariate regression analyses were conducted to examine the determinants of bulk-billing and the fee gap.ResultsIn total, 13,507,907 consultations involving 1,234,328 unique individuals were analysed. The average bulk-billing rate was 50.9%, decreasing over time. Fee gaps increased across all consultation modes. Face-to-face consultations were generally less likely to be bulk-billed and incurred higher fee gaps than other modes. Over successive policy periods, video consultations had an increasingly lower likelihood of bulk-billing and were associated with higher fee gaps. Patients in rural and remote areas were likely to bear greater out-of-pocket costs, including for video consultations. Attention Deficit Hyperactivity Disorder (ADHD) prescription-related consultations were associated with lower bulk-billing rates and higher fee gaps, especially in the video mode.DiscussionWhile the expansion of telepsychiatry increased service availability, it did not consistently reduce the financial burden of psychiatric care, especially for rural and remote Australians. The higher out-of-pocket costs associated with ADHD prescription-related consultations warrant closer policy attention.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"587-600"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global perspectives on telemedicine-enabled medications for opioid use disorder: Practices, priorities, and barriers.","authors":"Joe Schofield, Alexander Mario Baldacchino, Atul Ambekar, Honest Anaba, Jenna L Butner, Nathaniel Day, Hamed Ekhtiari, Fatima Elomari, Marica Ferri, Konstantinos Kokkolis, Christos Kouimtsidis, Jonna Levola, Jiang Long, David Martell, Dario Gigena Parker, Afarin Rahimi-Movaghar, Kristiana Siste, Scott Steiger, Arash Khojasteh Zonoozi, Joseph Tay Wee Teck","doi":"10.1177/1357633X251394442","DOIUrl":"10.1177/1357633X251394442","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"601-611"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tele-triage for pediatric foreign body aspiration: A case report from rural India and its implications.","authors":"Shagun Singh, Richa Gupta, Pallavi L Nadig, Parminder Kaur, Amit Agarwal, Biman Saikia","doi":"10.1177/1357633X251397713","DOIUrl":"10.1177/1357633X251397713","url":null,"abstract":"<p><p>BackgroundForeign body aspiration (FBA) is a potentially fatal pediatric emergency, particularly in children under three years of age. Diagnostic delays are common in rural and resource-limited settings due to limited access to specialists, leading to increased morbidity. Telemedicine can play a critical role in early recognition and timely referral.Case PresentationWe report a 1.5-year-old boy from rural Haryana who developed a cough following almond ingestion. A teleconsultation was initiated via the <i>eSanjeevani</i> platform. On remote assessment, reduced air entry and wheeze on the left side raised suspicion of an airway foreign body. Chest X-ray revealed left lung hyperinflation with mediastinal shift. The child was urgently referred to a tertiary centre, where rigid bronchoscopy confirmed and successfully removed an almond from the left main bronchus. He recovered fully, with subsequent follow-up conducted via teleconsultation.DiscussionThis case highlights the value of telemedicine in early triage of pediatric FBA, especially in rural areas where bronchoscopy facilities are not immediately available. Prompt remote assessment facilitated timely diagnosis, urgent referral, and safe intervention, thereby preventing complications.ConclusionTele-triage through national platforms like <i>eSanjeevani</i> is a viable and effective strategy to bridge critical gaps in pediatric emergency care and improve outcomes in rural and resource-limited settings.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"635-638"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved appropriateness of electronic consultations in primary care with ongoing liver disease education.","authors":"Francisco Javier Pérez Hernández, Yanira González Méndez, Carla Amaral González, Juan Adolfo Ortega Sánchez, Dalia Elena Morales Arráez, Raquel de la Barreda Heuser, Inmaculada Alonso Abreu, Laura Ramos López, Onofre Alarcón Fernández, Marta Carrillo Palau, Manuel Hernández-Guerra","doi":"10.1177/1357633X251392338","DOIUrl":"10.1177/1357633X251392338","url":null,"abstract":"<p><p>IntroductionThis study evaluates the short-term impact of two educational strategies on the appropriateness of electronic consultations (e-consults) submitted by primary care physicians (PCPs) to hepatologists for chronic liver disease (CLD) management. We compared a synchronous education program delivered in-person and online by hepatologists with an asynchronous approach based on e-consult feedback.MethodsWe conducted a 24-month prospective observational cohort study, analyzing e-consults related to the most prevalent CLD submitted by 326 PCPs to 10 hospital-based specialists in the Department of Gastroenterology and Hepatology. E-consults were categorized into three consecutive 8-month periods based on PCPs' training exposure: Group I (no training), Group II (synchronous continuing medical education) and Group III (asynchronous education via e-consult feedback).ResultsA total of 9934 consecutive e-consults were analyzed, which 663 pertained to CLD cases, submitted by 205 (63%) of 326 eligible PCPs, involving 629 patients (median age: 55 years; 61.8% male). Overall, 68% of e-consults were deemed appropriate, with 58.2% resulting in a specialist care appointment. Appropriateness significantly improved following both synchronous and asynchronous training compared to the pre-training period (75.2% vs. 69.1% vs. 60.1%; <i>p</i> < 0.05). E-consults submitted by trained PCPs were significantly more likely to be appropriate (OR = 2.001; 95% CI: 1.360-2.946; <i>p</i> < 0.001).ConclusionBoth synchronous and asynchronous training significantly improved e-consult appropriateness and reduced unnecessary referrals. Asynchronous education via e-consult feedback emerged as a practical and effective alternative. These findings underscore the importance of educational programs in optimizing e-consult utilization, warranting further research on long-term impacts.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"620-628"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying the cost savings of the South Australian Telestroke Service.","authors":"Peter Lee, Andrew Bivard, Craig Kurunawai, Matthew Willcourt, Aaron Tan, Joshua Mahadevan, Michael Waters, Jackson Harvey, Joanne Van Eunen, Karen Dixon, Bianca Piantedosi, Stephen Davis, Geoffery Donnan, Jim Jannes, Timothy Kleinig, Lan Gao","doi":"10.1177/1357633X251389689","DOIUrl":"10.1177/1357633X251389689","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"567-575"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rendezvous transport plus prehospital computed tomography angiography on mobile stroke unit for large vessel occlusion: Achieving 103 min call-to-puncture time in 106 km distance.","authors":"Lu Wang, Xi Wu, Songtao Guo, Jialu Li, Xiao Wu, Fuxia Yang, Xunming Ji, Xiuhai Guo","doi":"10.1177/1357633X251393432","DOIUrl":"10.1177/1357633X251393432","url":null,"abstract":"<p><p>AimInvestigate the role of mobile stroke unit (MSU) and rendezvous transport with emergency medical service (EMS) in timely large vessel occlusion (LVO) identification and direct transfer to the comprehensive stroke center.MethodsThe fifth-generation MSU (5G-MSU) program was first implemented in 2019, directly dispatched through the 120 emergency medical services. The rendezvous transport was initiated in 2020. We report the first case of rendezvous transport plus prehospital computed tomography angiography (CTA) on 5G-MSU for endovascular treatment of LVO.ResultsA 5G-MSU was dispatched for a patient with reported right-sided hemiparesis and reduced consciousness at a primary stroke center, located at a distance of 106 km. The 5G-MSU and EMS coordinated a rendezvous transport to transfer the patient. CTA performed on the 5G-MSU revealed basilar artery occlusion, prompting immediate contact with the main hospital's angiography suite. Upon arrival, the patient was directly transferred to the angiography suite for endovascular therapy, achieving successful recanalization. Consequently, the call-to-puncture time was successfully achieved within 103 min, across a distance of 106 km.DiscussionRendezvous transport combined with prehospital CTA on the 5G-MSU in rural areas is feasible. This approach allows the MSU to extend beyond its conventional treatment coverage, rapidly identify large vessel occlusions, and thereby significantly reduce call-to-treatment time.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"629-634"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of the ECHO^® model™ for patient navigation capacity building in Malaysia.","authors":"Kishwani Hiram Chakraverty, Aisha Adam, Maheswari Jaganathan, Junaidi Bin Awg Isa, Kavitha Muniandy, Hani Zainal, Aini Fatimah Ghazali, Mallika Muniandi, France Olovia Roimin, Yannest Christy Yanam, Stency Merinda Joseph Ngadan, Linda Boten, Jananezwary Kanapathy","doi":"10.1177/1357633X251400034","DOIUrl":"10.1177/1357633X251400034","url":null,"abstract":"<p><p>BackgroundThe patient navigation programme (PNP) is an effective health intervention to address barriers in accessing timely and equitable cancer care. However, its expansion in Malaysia for breast cancer care faces challenges due to limited capacity building among nurses and navigators, particularly nurses who are actively involved in the operation of the PNP centres. The Extension for Community Healthcare Outcomes (ECHO^®) model, a tele-mentoring approach, offers a scalable and sustainable solution for capacity building among the nurses and navigators. This study aims to evaluate the feasibility and impact of using the ECHO model to train nurses and navigators on patient navigation competencies focused on improving breast cancer care delivery.MethodsThe study involved nurses in breast cancer care from Ministry of Health (MOH) state referral hospitals in Malaysia and newly recruited nurses and social workers by Cancer Research Malaysia to subsequently be placed as nurse and community navigator for the upcoming new centres. Participants received an ECHO-based training programme comprising bi-weekly virtual sessions of a six-domain curriculum covering 12 topics on patient navigation competencies. Pre- and post-session assessments were conducted to measure satisfaction, knowledge and confidence in conducting patient navigation.ResultsMost participants were within the age range of 31-35 (n = 38; 40.4% [95% CI, 30.5%-50.3%]) with majority being female (n = 87; 92.6% [95% CI, 87.2%-97.9%]) and MOH nurses (n = 71; 75.5% [95% CI, 66.8%-84.2%]). An average of 28 participants attended each session. Participants expressed high level satisfaction while showing improvements in knowledge and confidence with an average increase in mean score of (1.45 [95% CI, 0.84-2.13]; p < .05) and (0.61 [95% CI, 0.51-0.65]; p < .05) respectively following the intervention.ConclusionThe study demonstrates the feasibility and effectiveness of the ECHO model for patient navigation capacity building among nurses and navigators. Findings support broader implementation of the ECHO model to strengthen breast cancer care delivery.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"612-619"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative performance of spoke centers versus telemedicine service in the emergency activation of ST elevation myocardial infarction network: Insights from the \"detective\" registry.","authors":"Martino Pepe, Rocco Tritto, Carlo D'Agostino, Gianluigi Napoli, Davide Rodio, Maria Ludovica Naccarati, Angela Ivana Bruno, Anna Maria Natola, Salvatore Giordano, Pasquale Caldarola, Vincenzo Pestrichella, Plinio Cirillo, Arturo Giordano, Giuseppe Biondi Zoccai, Marcello De Giosa, Sabino Iliceto, Marco Matteo Ciccone","doi":"10.1177/1357633X251389690","DOIUrl":"10.1177/1357633X251389690","url":null,"abstract":"<p><p>IntroductionTelemedicine has implemented the regional networks between 24/7 catheterization laboratories of \"Hub\" hospitals and the Territorial Emergency Medical Service (TEMS) to reduce time to diagnosis and treatment of ST segment elevation myocardial infarction (STEMI). Telemedicine has been conversely hypothesized to carry an excess of false-positive diagnoses; however, comparisons with a traditional diagnostic process at non-percutaneous coronary intervention capable (\"Spoke\") hospitals are lacking<b>.</b>MethodsThis multicenter case-control study retrospectively included 1001 consecutive patients with an initial diagnosis of STEMI or very high risk (VHR) non-ST elevation acute coronary syndrome who were referred from January 2018 to December 2021 to the Apulian STEMI network after an \"in-presence\" clinical evaluation at a Spoke center or a remote telemedicine-supported assessment. The comparative performance of both approaches has been evaluated by comparing the running diagnosis with the discharge diagnosis.ResultsTEMS and Spoke groups included 470 and 531 patients, respectively. False-positive diagnoses occurred in 21.3% and 35.8% of the TEMS and Spoke patients, respectively (p < 0.001). Spoke group showed a higher number of discharge diagnoses of non-ST elevation myocardial infarction without VHR features (p < 0.001), myocardial infarction with no obstruction of coronary arteries (p = 0.033), and myocarditis (p = 0.007). Overall, the main predictors of false-positive diagnoses were the referral from Spoke center, chronic kidney disease, and ongoing oral anticoagulation.ConclusionsTelemedicine showed lower false-positive rate compared with an on-site clinical cardiological assessment. This apparently paradoxical result questions the hypothesis of overdiagnosis as the main limitation of telemedicine which conversely reduces time-to-diagnosis and healthcare costs.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"576-586"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}