BackgroundGeographic disparities limit access to pediatric cardiology care in rural and underserved communities, contributing to delayed diagnosis, increased transfers, higher costs, and preventable morbidity. Telecardiology has emerged as a scalable strategy to address subspecialty workforce shortages. This review evaluates the effectiveness of telecardiology versus standard in-person care in improving diagnostic timeliness, access to specialist care, and clinical outcomes; its diagnostic accuracy relative to in-person evaluation; and barriers to implementation, in pediatric populations with congenital or acquired heart disease in rural or underserved communities.MethodsPubMed, Medline, Scopus, and Google Scholar were searched, identifying 1200 articles; 182 underwent full-text review. After exclusions, 74 studies were quality appraised using the Joanna Briggs Institute checklist, and 49 high-quality studies were included, evaluating synchronous tele echocardiography, asynchronous store and forward transmission, or remote physiologic monitoring in pediatric patients in rural or resource limited settings.ResultsAcross the 49 included studies, tele echocardiography demonstrated diagnostic concordance ≥98% versus in person evaluation, and fetal telecardiology achieved 100% sensitivity and specificity for complex congenital heart disease in select programs. In the included studies, telecardiology reduced time to diagnosis (100 vs. 147 min, P < .001), interfacility transport by up to 58%, and emergency department utilization (0.4-0.0 visits per patient month in one interstage monitoring program, P = 0.0004). Hospital survival improved from 29.8% to 54.1% (P = 0.002) in one ECMO program, and post Stage II palliation complications decreased from 34.1% to 18.4% (P = 0.02). Cost analyses showed net savings across settings. Barriers included broadband limitations, reimbursement constraints, and regulatory challenges.ConclusionsTelecardiology is a high-impact, evidence-based strategy that can improve diagnostic efficiency, reduce interfacility transfers, lower healthcare utilization, and expand access to pediatric cardiology care without compromising outcomes when implemented with adequate sonographer training and infrastructure investment; consistent with clinical experience, these requirements have limited adoption of store-and-forward fetal echocardiography at some centers. Addressing reimbursement and regulatory barriers is essential for equitable, sustainable implementation.

IntroductionThis study aimed to examine the effect of individuals' anxiety toward AI-based health technologies on their attitudes toward the use of telemedicine services and to determine the mediating role of online privacy perception in this relationship.MethodsDesigned within a quantitative research approach, the study employed a cross-sectional design. Data were collected through an online survey from 404 participants aged 18 years and older living in Istanbul, selected using convenience sampling. The Artificial Intelligence Anxiety Scale, the Telemedicine Service Attitude Scale, and the Online Privacy Perception Scale were used as data collection instruments. The reliability levels of the scales were found to be satisfactory.ResultsThe findings showed that AI anxiety had a direct negative effect on attitudes toward telemedicine services, while also increasing online privacy perception. Online privacy perception negatively affected attitudes toward the use of telemedicine services. Mediation analysis indicated that online privacy perception had a significant and partial mediating role in the effect of AI anxiety on telemedicine use (β = -0.651; p < 0.001).DiscussionThe findings suggest that individuals' psychological concerns and privacy-related perceptions are important determinants of the adoption of digital health services. Accordingly, reducing AI-related anxiety and strengthening privacy assurance may support more positive attitudes toward telemedicine services.

IntroductionTelepharmacy enables pharmacists to deliver clinical and medication-related services remotely, and its use has expanded rapidly in response to evolving patient needs and shifting models of care. While telepharmacy has demonstrated benefits across patient, provider, and system levels, its impact on hospital emergency care utilisation remains unclear, with studies report mixed findings.ObjectiveTo evaluate the impact of pharmacist-delivered telepharmacy interventions on utilisation of emergency department (ED) presentations and hospital readmissions.MethodsA systematic search for randomised controlled trials (RCTs) assessing the effectiveness of telepharmacy services was conducted in November 2025. The primary outcome was the effect of telepharmacy interventions on rates of hospital admission and/or ED presentation. A meta-analysis was completed for studies that reported 30-day hospital readmissions and ED presentations.ResultsSeventeen RCTs involving 9692 patients were included. Three studies reported a significant reduction in 30-day ED presentations, and three studies reported a significant reduction in 30-day hospital readmissions. Seven studies (n = 1859 patients) were eligible for meta-analysis. Telepharmacy interventions were associated with a 6% absolute reduction in 30-day ED presentations (risk difference=0.06, 95% CI: 0.02-0.10, p =0.005). A non-significant reduction was observed in 30-day hospital readmission rates.ConclusionAcross a small number of heterogeneous RCTs, telepharmacy interventions were associated with a significant reduction in 30-day ED presentations but did not significantly reduce 30-day unplanned hospital readmissions. These findings highlight the potential value of telepharmacy in reducing emergency care utilisation.

IntroductionTelerehabilitation has emerged as a promising strategy for improving access to neurological rehabilitation while addressing increasing healthcare demands and resource constraints. Although evidence supporting its clinical effectiveness has expanded considerably, information regarding its economic implications and potential relevance for reimbursement policy and healthcare planning remains limited. This study aimed to compare the costs of a multidisciplinary telerehabilitation programme with those of conventional facility-based neurological rehabilitation and to estimate the potential budgetary consequences of large-scale implementation.MethodsA retrospective comparative cost analysis and budget impact assessment was conducted using prospectively collected programme data and hospital accounting records. The study included 243 individuals receiving telerehabilitation for stroke-related hemiplegia (n = 90), Parkinson's disease (n = 61), aphasia (n = 60), and cerebral palsy (n = 32). Conventional rehabilitation consisted of routine face-to-face multidisciplinary neurological rehabilitation delivered within the same healthcare system using comparable treatment intensity, and costs were derived from real-world institutional expenditure records. Costs were analysed from the health system/provider perspective and standardized to a 30-session rehabilitation episode. Cost outcomes included cost per session, cost per patient, absolute cost difference, relative cost reduction, and cost ratio. A simplified budget impact projection was performed to estimate projected expenditures and savings for hypothetical patient populations ranging from 1000 to 50,000 individuals.ResultsThe mean cost per rehabilitation session was United States Dollars (USD) 365.91 for conventional rehabilitation and USD 164.66 for telerehabilitation. The corresponding cost per patient for a standardized 30-session rehabilitation episode was USD 10,977.43 and USD 4939.84, respectively. Telerehabilitation reduced provider-level costs by USD 6037.59 per patient, corresponding to a relative cost reduction of 55.0%, meaning that telerehabilitation required only 45.0% of the provider cost of an equivalent episode of conventional rehabilitation. Budget impact projections demonstrated potential savings of approximately USD 6.0 million for 1000 patients, increasing to USD 301.9 million for 50,000 patients.ConclusionsIn this real-world provider-level economic analysis, multidisciplinary telerehabilitation was associated with substantially lower provider-level costs than conventional facility-based neurological rehabilitation. The observed cost reduction was primarily attributable to differences in infrastructure and operational resource utilization between service delivery models. If comparable clinical outcomes can be maintained, telerehabilitation may represent a financially sustainable strategy for expanding rehabilitation capacity while supporting efficient resource allocation. However, because comparative clinical effectiveness was not evaluated, the findings should be interpreted as evidence of potential cost savings rather than cost-effectiveness. These findings may provide valuable evidence for reimbursement policy development, healthcare planning, and long-term resource allocation.

IntroductionThis study examined the association between the frequency of MoodSensing smartphone application (MS app) use and psychiatric readmissions and emergency department visits among patients with bipolar disorder.MethodsA 6-month prospective observational pilot study was conducted among 183 patients with bipolar disorder recruited from the psychiatric outpatient department of a medical center in Taiwan. Participants were followed for 6 months and categorized into usage groups based on MS app usage frequency (unused, low-usage, and active users; ≥20% usage defined as active use). Outcomes included psychiatric readmissions and emergency department visits within 6 months, obtained from medical records. Associations between application use and outcomes were analyzed using Firth's logistic regression to account for rare events, adjusting for demographic characteristics and clinical covariates.ResultsParticipants had a mean age of 36.6 years, 57.4% were female, and the mean duration of bipolar disorder was 14.5 years. Overall, 157 participants (85.8%) used the MS app at least once during the 6-month follow-up. Compared with the unused group, active users had significantly lower adjusted odds of psychiatric readmissions (adjusted odds ratio = 0.13, 95% confidence interval = 0.02-0.87) and emergency department visits (adjusted odds ratio = 0.28, 95% confidence interval = 0.08-0.98).DiscussionActive MS app use was associated with lower odds of psychiatric readmissions and emergency department visits. Given the uncontrolled observational pilot design, these findings should be considered preliminary.

IntroductionAlthough telehealth interventions have produced weight-management outcomes comparable with in-person care in several settings, 12-month randomized evidence from public tertiary services in middle-income countries remains limited. This study compared remote and in-person consultations for obesity treatment in a Brazilian public tertiary-care center, focusing on continuity of care, weight loss, and exploratory metabolic outcomes.MethodsThis 12-month, matched-pair randomized, prospective, single-center, open-label pilot trial included 32 adults in a multidisciplinary weight-management program. Participants were allocated to telehealth video consultations or standard in-person care. The primary outcomes were appointment attendance and treatment adherence, defined a priori as the proportion of missed appointments that were rescheduled and subsequently attended. Secondary outcomes included percentage change in body weight, the proportion of participants achieving ≥5% weight loss, anthropometric measures, and metabolic parameters.ResultsThe overall absence rate did not differ significantly between the telehealth and in-person groups (12.5% vs. 17.1%; p = .413). All 10 missed telehealth appointments were rescheduled and attended, compared with 8 of 14 missed in-person appointments (100% vs. 57.1%; p = .024). Mean 12-month percentage weight change was -4.8% ± 4.7% in the telehealth group and -5.5% ± 3.8% in the in-person group, and 56.3% and 62.5% of participants, respectively, achieved ≥5% weight loss. Both groups had significant within-group reductions in waist and hip circumferences. HbA1c decreased within the telehealth group (6.39% ± 1.08% to 5.98% ± 0.46%; p = .005), but no between-group difference in HbA1c change was demonstrated.DiscussionIn this pilot trial, telehealth produced weight and anthropometric outcomes similar to those observed with in-person care and were associated with a higher proportion of missed appointments being rescheduled. The HbA1c finding was exploratory and does not establish metabolic superiority. Larger multicenter trials are needed to confirm these findings and assess long-term effectiveness, implementation, and cost-effectiveness.Trial registrationBrazilian Registry of Clinical Trials (ReBEC), RBR-7wt6hzm; UTN U1111-1318-5411. Registered on 7 April 2025, retrospectively.

BackgroundVitamin K antagonist (VKA) therapy requires frequent monitoring. Although telemedicine has expanded, evidence on its effectiveness in public health systems of developing countries remains limited. We evaluated the safety, quality of anticoagulation control, and cost-effectiveness of telemedicine-based versus in-person follow-up in a Brazilian tertiary public center.MethodsThis retrospective observational study at a Brazilian tertiary university hospital compared an in-person phase with the telemedicine phase initiated in April 2020. Outcomes were time in therapeutic range (TTR), all-cause and anticoagulation-related mortality, and direct healthcare costs. TTR was compared within patients (n = 661 followed regularly in both phases); mortality was compared as phase-specific annualized rates among all patients followed in each phase (1313 in-person; 1086 telemedicine).ResultsMedian TTR did not differ between the in-person and telemedicine phases (58% vs. 60%; p = .35). Annualized all-cause mortality (69 vs. 77 deaths per 1000 person-years; p = .43) and anticoagulation-related mortality (13 vs. 11 per 1000 person-years; p = .61) were also comparable. Cost-minimization analysis showed that telemedicine reduced annual direct expenditures by 10% (USD 4473; 95% CI: 2904-6030).DiscussionTelemedicine-based monitoring for patients on VKAs is as safe and clinically effective as traditional in-person care. Furthermore, telemedicine offers lower direct costs, proving to be a viable alternative to optimize resource allocation and enhance efficiency within the public health system.

Decentralized clinical trial (DCT) methods have evolved globally to improve access to clinical trials for rural, regional, and other underserved populations. Several countries, including Australia, have implemented DCT approaches with variable success.In Australia, the Australian Teletrial Model was developed and adopted as a national policy initiative to improve equitable access to clinical trials. The Australian Teletrial Program, funded by the Commonwealth Government, supported implementation across jurisdictions and health services.The program achieved several important outcomes, including the development of harmonized templates and processes, standard operating procedures, and education and training programs. It also improved patient access to trials and strengthened workforce capability across participating sites.Despite these achievements, several barriers continue to limit broader implementation and sustainability. These include workforce turnover, cumbersome approval processes, variable uptake across different levels of the health system and sponsors, and inconsistent leadership engagement and ownership. Such challenges have constrained scale and productivity.To fully realize the benefits of DCT models and support health equity objectives, a whole-of-system approach is required. Streamlined policies and processes, aligned governance, and sustained leadership commitment are needed to embed decentralized clinical trial models into routine healthcare delivery and ensure long-term sustainability, productivity, and equitable access to clinical research.

IntroductionRural provider-to-provider telehealth (RPPT) is an emerging model of care that uses digital technologies to support collaborative patient care between place-based and virtual providers. Since 2012, the WA Country Health Service Command Centre has delivered an RPPT model of care across country Western Australia. This study explored the contextual factors influencing the implementation and use of RPPT services.MethodsSemi-structured interviews were conducted with 28 nurses, doctors and midwives from across country WA. Interviews were guided by the Practical Implementation Sustainability Model (PRISM) framework. Data were analysed independently by two researchers using reflexive thematic analysis to generate inductive insights, which were then mapped to PRISM domains.ResultsTwelve themes were identified and mapped to PRISM domains, reflecting key contextual influences on RPPT implementation. Themes identified service strengths, interpersonal dynamics, shifting paradigms, perceived patient perspectives, local capacity and capability, organisational systems and practice, situational awareness, patient characteristics, implementation and infrastructure, gaps and growth, external service integration and resourcing.ConclusionThis study identified a range of contextual factors influencing RPPT implementation and use in country WA. Beyond established factors such as resource availability and access to knowledge, the findings highlight the importance of complex system integration, situational awareness, communication and shared understanding and shifting roles and responsibilities. These findings contribute to a broader understanding of RPPT implementation and provide insights for optimising telehealth-enabled models of care in geographically dispersed health systems.

IntroductionWhile there has been a rapid uptake of virtual care in recent years, understanding of its impact on the quality of cancer care remains fragmented due to the heterogeneity of evaluation measures used to date and the lack of a framework to guide the work. We aimed to develop a comprehensive evaluation framework for virtual care in routine oncology practice.MethodsWe conducted separate nominal consensus groups with key informants (knowledge users, policy makers, clinicians, patients, and caregivers) to generate and prioritize lists of potential virtual cancer care measures. To identify measures from the health equity perspective, we undertook a structured consultation with an established health equity expert patient and caregiver panel. Findings were thematically grouped through a cognitive mapping exercise using a virtual whiteboard. Virtual cancer care-specific initial construct definitions were derived first from a systematic review of the literature, then refined through iterative consensus discussions and voting.ResultsMeasurement priorities varied by key informant group, underscoring the need to consider the impacts of virtual cancer care from multiple key informant perspectives. The final framework included 17 constructs with definitions and operationalization considerations distributed across five domains: implementation, service, and client outcomes, with equity and cost as separate, overarching domains.DiscussionOur findings highlight the need to consider the impacts of virtual care from multiple key informant perspectives. Our final, comprehensive virtual cancer care evaluation framework can help guide and standardize future evaluations to improve comparability, inform policy, and guide practice optimization.

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.

IntroductionThis study aimed to evaluate the additional effects of the ENBORTH-TR intervention on pain, kinesiophobia, occupational performance, and satisfaction in individuals with neck and/or back pain (NBP).MethodA total of 136 participants were included in the study. The participants were divided into two groups: the intervention group (n = 67) and the control group (n = 69). A client-centered (CC) intervention was administered to both groups for 4 weeks (3 sessions per week). During this period, the intervention group also received the ENBORTH-TR intervention, which included basic pain education, ergonomic and environmental adaptations, as well as sleep and psychosocial management. All interventions in the study were delivered via telerehabilitation. Occupational performance (Canadian Occupational Performance Measure) and kinesiophobia (Tampa Kinesiophobia Scale) were defined as primary outcomes. Pain intensity (Visual Analog Scale-assessed during activity, rest, and sleep) was used as a secondary outcome.ResultsFollowing the intervention, the intervention group showed statistically significant improvement in all parameters compared to the control group (p < 0.05). The addition of the ENBORTH-TR intervention had a high effect on the primary outcome of occupational performance and satisfaction (η[2]=0.196-0.303; 95% CI for performance:-1.84 to -0.22; satisfaction: -1.62 to -2.36) and a moderate effect on kinesiophobia scores (η[2]=0.061-0.136; 95% CI: 1.60 to 8.79). Regarding the secondary outcomes, significant reductions were observed in pain intensity, particularly during activity (95% CI: 0.57 to 1.75).DiscussionThe integration of ENBORTH-TR into standard CC treatment provides significant short-term additional benefits in terms of improving occupational performance and reducing kinesiophobia in patients with NBP.