Telemedicine journal and e-health : the official journal of the American Telemedicine Association最新文献

{"title":"Teleconsultation Competencies in Undergraduate Medical Education: A Critical Narrative Review and Evidence-Gap Analysis.","authors":"Wojciech Michał Glinkowski, Rafał Doniec, Tomasz Cedro, Bartłomiej Michalak, Aldona Katarzyna Jankowska, Andrzej Śliwczyński","doi":"10.1177/15305627261462600","DOIUrl":"10.1177/15305627261462600","url":null,"abstract":"<p><strong>Background: </strong>The rapid expansion of telemedicine has increased the relevance of teleconsultations in everyday clinical practice. However, the manner in which teleconsultation competencies are conceptualized, taught, and assessed in undergraduate medical education remains unclear.</p><p><strong>Methods: </strong>A narrative review was conducted using a transparent methodology to identify and select studies. Several bibliographic databases were searched using predefined eligibility criteria, focusing on educational interventions that specifically targeted teleconsultation competencies among undergraduate medical students. The selection process emphasized conceptual clarity, curricular intent, and the inclusion of empirically reported educational outcomes. The eligibility criteria were intentionally designed to identify studies that explicitly conceptualized teleconsultation as a distinct undergraduate clinical competency.</p><p><strong>Results: </strong>The search process yielded 199 records. After screening and comprehensive full-text evaluation, only one study explicitly conceptualized teleconsultation as a distinct undergraduate clinical competency and met all predefined eligibility criteria. This study details a structured educational intervention that frames teleconsultation as a distinct clinical competency. The outcomes concerning communication, clinical reasoning in virtual environments, technical aspects of teleconsultation, and components of remote physical examination were reported.</p><p><strong>Conclusions: </strong>The principal finding was the identification of substantial evidence gaps in the conceptualization, assessment, and longitudinal teaching of teleconsultation competencies. Current evidence regarding the instruction of teleconsultation competencies in undergraduate medical education is limited. The prevailing literature addresses telemedicine primarily as a mode of care delivery rather than emphasizing teleconsultation as a distinct clinical skill. These observations highlight a discrepancy between contemporary clinical practice and undergraduate training, emphasizing the need for well-defined educational frameworks that incorporate teleconsultation competencies.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"983-994"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Retrospective Chart Review of Remote Communication for Rural Older Cancer Survivors.","authors":"Allie Herron, Laura Berger, Kennedy Franklin, Bailey Pilson, Priyanka Dadha, Marquita W Lewis","doi":"10.1177/15305627261462598","DOIUrl":"10.1177/15305627261462598","url":null,"abstract":"<p><strong>Background: </strong>Evidence assessing rural older cancer survivors' patient portal use is limited. To this end, we analyzed My Chart messages among this group to reveal key insights into their patient portal use.</p><p><strong>Methods: </strong>We conducted a retrospective qualitative chart review of MyChart messages from cancer patients aged at least 65 years and from rural ZIP codes receiving care at an urban hospital from March 1, 2020, to May 25, 2023.</p><p><strong>Results: </strong>The resulting sample consisted of 860 coded messages from 411 patients. The qualitative analysis yielded 1,295 coded occurrences, from which nine themes emerged. The most frequent coded messages were identified as <i>Ongoing Clinical Care Concerns</i> (<i>n</i> = 464) and <i>Supportive Care (n = 128)</i>. The least frequently coded theme was <i>Requesting telehealth (n = 35)</i>.</p><p><strong>Conclusion: </strong>Our analysis of MyChart messages of rural older cancer survivors demonstrates high engagement with MyChart messaging and has implications for the use of tailored patient portal designs for this uniquely vulnerable patient population.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"1074-1081"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Corrigendum to:</i> Associations Between Sociodemographic Factors and Interest in Remote Patient Monitoring Among Arkansas Residents.","authors":"","doi":"10.1177/15305627261475986","DOIUrl":"10.1177/15305627261475986","url":null,"abstract":"","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"1082"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148682048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entropy, Thermodynamics, and Telemedicine.","authors":"Charles R Doarn","doi":"10.1177/15305627261487069","DOIUrl":"10.1177/15305627261487069","url":null,"abstract":"","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"981-982"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veterans Affairs Clinical Resource Hub Improve Access to Mental Health Services for Rural Veterans.","authors":"Erin Jaske, Chelle L Wheat, Karin Nelson, Idamay Curtis, Lawrence Wahlberg, Bradford Felker","doi":"10.1177/15305627261458161","DOIUrl":"10.1177/15305627261458161","url":null,"abstract":"<p><strong>Background: </strong>Access to high-quality mental health (MH) care in rural communities remains a persistent challenge. In 2019, the Veterans Health Administration (VA) developed 18 regional Clinical Resource Hubs (CRH) to increase Veteran access to clinical services, mainly through telemedicine and telemental health. This study evaluates trends in CRH MH services among Veterans residing in rural areas for the first 5 years of the program.</p><p><strong>Methods: </strong>This retrospective cohort study utilized CRH MH encounter data (i.e., clinical visits or patient contacts) from the VA Corporate Data Warehouse for the first 5 years of the CRH program (Fiscal years [FY] 2020-2024) with a focus on rural and highly rural Veterans. Veteran demographics and clinic characteristics were collected, and measures were aggregated for each FY. Descriptive statistics were calculated using independent <i>t</i>-tests for continuous variables and Fisher's exact or Chi-square tests for categorical variables.</p><p><strong>Results: </strong>Using primarily telemental health services, CRH MH teams completed 627,436 encounters, with 81.9% delivered via telemedicine among Veterans residing in rural or highly rural areas. Care delivery shifted substantially over 5 years, with video visits to a patient's homes increasing from 9.2% to 64.3% while clinic-based video visits declined from 77.5% to 7.1%. Racial and ethnic diversity increased steadily over time, especially among Black and Hispanic Veterans. Between FY20 and FY24, encounters for depressive disorders decreased slightly while encounters for anxiety disorders, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder diagnoses increased.</p><p><strong>Conclusions: </strong>Veterans in rural and highly rural communities often struggle to access MH care, and the CRH MH program was designed to utilize primarily telemental health to fill in these gaps to improve Veteran access. During the first 5 years of the CRH MH program, the amount of MH care provided to rural Veterans more than doubled with expanded site participation and an increasingly diverse patient population over time.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"995-1002"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Person-Centered Telehealth Service Implementation on 30-Day Readmissions and Hospital Reimbursement: A Prospective Comparative Study.","authors":"Mohamad Ezzeldin, Alzahra'a Al Matairi, Mohammad El-Ghanem, Leighann Mealer, Eric Anderson, Rime Ezzeldin, Raquel Washer, Lisa Greco, Zuhair Ali, Yazan J Alderazi","doi":"10.1177/15305627261461865","DOIUrl":"10.1177/15305627261461865","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between implementation of a personalized, postdischarge telehealth support program and 30-day hospital readmission among patients hospitalized with stroke.</p><p><strong>Methods: </strong>This observational pre-post implementation study was conducted within an acute care hospital system and included adult patients (≥18 years) admitted with ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Following discharge, eligible patients were offered enrollment in a person-centered telehealth support program. The primary outcome was all-cause 30-day readmission. Multivariable regression models were used to adjust for baseline clinical characteristics.</p><p><strong>Results: </strong>Among 405 patients, 258 were admitted before telehealth implementation, 31 were enrolled in the telehealth program after implementation, and 116 were postimplementation nonenrollees. Thirty-day readmission occurred in 23 of 258 patients (8.9%) before implementation, in 0 of 31 telehealth enrollees (0%), and in 3 of 116 nonenrollees (2.6%). After adjustment for clinical covariates, postimplementation patients demonstrated a lower estimated risk of 30-day readmission compared with preimplementation patients, with the lowest risk observed among telehealth enrollees. Based on a 6.3% absolute reduction in readmissions and published cost estimates, telehealth implementation corresponded to an annual savings of approximately $112,000-$124,000 in avoided uncompensated care for uninsured patients and $545,000-$602,000 in reduced exposure to denied claims for insured patients per 1,000 strokes. Anticoagulant use was associated with a higher estimated probability of readmission.</p><p><strong>Conclusion: </strong>Implementation of a person-centered postdischarge telehealth service was associated with substantially lower 30-day readmissions among patients hospitalized with stroke and may provide meaningful economic benefits by reducing costly readmissions and financial burden on hospitals.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"1058-1066"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in Telehealth Use in a National Home Test-to-Treat Program for Acute Respiratory Infections.","authors":"Wojciech R Losos, Biqi Wang, Kim Fisher, Laurel O'Connor, Apurv Soni, Ben S Gerber","doi":"10.1177/15305627261462584","DOIUrl":"10.1177/15305627261462584","url":null,"abstract":"<p><strong>Background: </strong>Home test-to-treat (HTTT) programs deliver timely antiviral treatment for acute respiratory infections, including COVID-19 and influenza, through at-home testing and telehealth. Because access is often measured by visit occurrence, variation in how and when care is delivered may be overlooked. We hypothesized that telehealth access follows distinct process-based patterns.</p><p><strong>Methods: </strong>We analyzed de-identified encounters from the national HTTT program (September 2023-July 2024); 6,213 of 8,160 eligible individuals remained after exclusions for missing data. Phenotypes were derived by k-means clustering of standardized variables capturing encounter timing, modality preference, process duration, and sociodemographic and digital access attributes. Ten-day surveys assessed symptom duration and health care utilization.</p><p><strong>Results: </strong>Three phenotypes emerged: Delayed/Disrupted Access (<i>n</i> = 1,537; 24.7%), Digitally Engaged but Socioeconomically Vulnerable (<i>n</i> = 1,460; 23.5%), and Mainstream Access and Efficient Utilization (<i>n</i> = 3,216; 51.8%). Mean process duration differed (15.93 [SD 3.84] vs. 3.69 [3.31] vs. 2.87 [2.41] h; <i>p</i> < 0.001). Synchronous preference was lowest in the Digitally Engaged group (22.9%); antiviral prescribing was high (88.6-91.9%). Among 10-day respondents (<i>n</i> = 1,023), symptom duration did not differ. Emergency department visits were most frequent in the Digitally Engaged group (2.3% vs. 0.0% and 0.5%; <i>p</i> = 0.02) and urgent care in the Delayed/Disrupted group (5.8% vs. 4.1% vs. 2.0%; <i>p</i> = 0.02).</p><p><strong>Conclusions: </strong>Telehealth use in a national HTTT program formed distinct phenotypes defined by timing, modality, and care-process efficiency. Evaluating equity requires attention to how and when care is delivered, not simply whether it occurred.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"1029-1038"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Critical Care for Eastern Ontario-A Cost-Benefit Analysis.","authors":"Cameron Leafloor, Kwadwo Kyerementeng, Dave Neilipovitz, Melanie Lecours, Scott Millington","doi":"10.1177/15305627261465202","DOIUrl":"10.1177/15305627261465202","url":null,"abstract":"<p><strong>Background: </strong>Virtual critical care (VCC) programs provide remote specialist support to community hospitals caring for critically ill patients, yet Canadian evidence regarding their economic impact remains limited. This study aimed to estimate the cost savings associated with a newly implemented VCC program in Eastern Ontario.</p><p><strong>Methods: </strong>A retrospective cost-benefit analysis of the first 19 months of a regional VCC program based at a tertiary academic center supporting 13 community hospitals was conducted. All adult patients with an initiated VCC consultation were included. Cost estimates focused on avoided interfacility transfers, transportation costs, and differences in inpatient costs between academic and community hospital settings. Descriptive statistics were used to compare estimated cost savings with program operating costs.</p><p><strong>Results: </strong>Between April 2023 and October 2024, 473 VCC calls representing 312 unique patient encounters were recorded (298 patients included in analysis). Transfers to larger centers were avoided in 179 cases (60%). Avoided land ambulance transfers were estimated to save $61,101 CAD over the study period. Estimated inpatient cost savings associated with avoided transfers ranged from $687,643 CAD (mean length of stay [LOS]) to $2,681,420 CAD (median LOS), corresponding to monthly savings of $36,191-$141,127 CAD. These savings approached or exceeded the estimated VCC program monthly operating cost.</p><p><strong>Conclusion: </strong>The Eastern Ontario VCC program was associated with substantial estimated cost savings, primarily through avoided transfers and reduced use of high-cost academic intensive care beds. These findings support VCC as a potentially cost-effective health system intervention for supporting critically ill patients in community hospitals.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"1052-1057"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148538093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Determinants of Telehealth Use by Cancer Survivorship: A National Online Survey.","authors":"Michelle Yang, Umayma Abdullatif, Nada Shalaby, Sagar Kamprath, Wei-Chen Lee","doi":"10.1177/15305627261492657","DOIUrl":"https://doi.org/10.1177/15305627261492657","url":null,"abstract":"<p><strong>Introduction: </strong>Since the COVID-19 pandemic, telehealth utilization has increased substantially and remained well above pre-2020 levels. This study sought to determine whether cancer survivorship phase predicts telehealth utilization, perceived barriers, and benefits, informing future strategies to enhance digital care for this immuno-compromised population.</p><p><strong>Methods: </strong>We conducted a national cross-sectional survey to examine telehealth utilization among adults with and without a history of cancer (<i>n</i> = 202). Participants were categorized as no cancer (<i>n</i> = 40), having cancer 1-5 years since diagnosis (<i>n</i> = 79), and having cancer ≥6 years since diagnosis (<i>n</i> = 83). The primary outcome was utilization pattern by cancer history, and the secondary outcomes were determinants (5 perceived benefits and 6 perceived challenges) of telehealth use. Multivariable regression analyses of quantitative data and thematic qualitative analyses of qualitative responses were performed.</p><p><strong>Results: </strong>Adults diagnosed with cancer in 5 years demonstrated higher telehealth utilization followed by those with cancer for 6+ years, while those who never had cancer were least likely to engage (80.3%>62.5%>40.0%, <i>p</i> < 0.001). The most common challenge was poor internet quality (47.4% of the recent-cancer group) although there is no significant difference found. All three groups reported that flexibility was the most important benefit (<i>p</i> = 0.034). Qualitative analysis echoed these findings, highlighting flexibility as major benefits (61.5%).</p><p><strong>Conclusion: </strong>Qualitative responses complemented the quantitative data with a better understanding of eight determinants of telehealth use. Policies promoting broadband reliability, multilingual access, and digital literacy are key to equitable telehealth engagement that meets different needs across cancer histories.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"15305627261492657"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Readiness for Stroke Telemedicine in a Greek Island Network: A Cross-Sectional Study.","authors":"Sevasti Chatzidaki, Konstantinos Anargyros, Theodoros Xanthos","doi":"10.1177/15305627261492660","DOIUrl":"https://doi.org/10.1177/15305627261492660","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke outcome depends on treatment speed, delayed in remote island areas by limited neurological coverage and patient transfer. Telemedicine offers remote support, but implementation depends on staff readiness (knowledge, attitudes, and exposure), undescribed in the Greek island context.</p><p><strong>Methods: </strong>Cross-sectional survey of 135 health professionals (convenience sample) in an island hub-and-spoke network of 12 National Health System facilities; all self-reported. Two cross-culturally adapted instruments were used: the Acute Stroke Management Questionnaire (23-item knowledge score) and an attitude questionnaire based on diffusion of innovations theory. Analysis included reliability, correlation, group comparison, factor, and regression.</p><p><strong>Results: </strong>Stroke knowledge scores were relatively high (mean 3.95), lowest in advanced management, and differed by professional role (<i>p</i> = 0.015). Parallel analysis supported two correlated attitude factors rather than five: perceived value and usability (mean 3.57) and local visibility and workflow fit (mean 2.75), a gap of 0.82 points (<i>p</i> < 0.001). All had heard of telemedicine, but only 63% had seen a system in use. Prior exposure was associated with a more positive attitude bivariately (<i>p</i> = 0.016) but not after adjustment. Knowledge was associated with overall attitude (Spearman's <i>ρ</i> = 0.322; Pearson's <i>r</i> = 0.462; both <i>p</i> < 0.001) and with perceived value and usability (<i>ρ</i> = 0.435), but not with local visibility and workflow fit (<i>ρ</i> = 0.061).</p><p><strong>Conclusions: </strong>In this self-selected sample, knowledge was associated with general appraisal of telemedicine, whereas no clear rank association was detected with perceived local integration. These exploratory findings identify targets for further evaluation without establishing the effects of education or organizational change.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":"15305627261492660"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}