Search

Study Design: A primary, observational, cross-sectional, analytical study., Objective: The development of a framework for systematic telemedicine (TM) for orthopedic physicians in frequent clinical care may increase agreement in diagnosis and satisfaction among users of TM. Therefore, this study aimed to estimate the agreement in the diagnosis of low back pain (LBP) between TM, systematized by a self-completed digital questionnaire, and face-to-face (FF) care in patients with LBP., Methods: This study included adults up to 75 years of age with LBP for more than 6 weeks. They were evaluated at 2 independent time points (TM and FF) by different orthopedists with 3 different levels of expertise. Professionals evaluated the sample without prior knowledge of the diagnosis, and each orthopedist provided a diagnosis. Diagnostic agreement was the primary outcome. Secondary outcomes were the duration of the visit and satisfaction among healthcare professionals., Results: A total of 168 participants were eligible, of whom 126 sought care through TM and 122 sought FF care (mean age, 47 years [range, 18-75 years]; 66.4% women). The agreement among professionals regarding the diagnosis was moderate (kappa = .585, P = .001). TM was faster than FF (11.9 minutes (standard deviation = 4.1) vs 18.6 (SD = 6.9), P < .001). Professional satisfaction was higher among spine specialists than among orthopedic residents and orthopedists who were not specialists in spine surgery., Conclusion: Agreement in diagnosis was moderate for TM, with a 30% shorter visit duration than FF. Satisfaction varied by professional expertise and was higher among spine specialists than among professionals with other expertise., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Unlabelled: This study examines the trends, patterns, and potential health disparities in health care utilization among children with medical complexity, before and during COVID pandemic through a retrospective chart review. Our findings show significant differences in the average number of visits per patient over the years and support the adoption of telehealth consultations, while highlighting concerns about demographic disparities., (© Onur Asan, Ilse Super, Stephen Percy, Katharine N Clouser. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org).)

Anxiety challenges co-occur at a high rate in autistic children and youth (~ 50-79%), often with significant interference with daily functioning. Evidence-based interventions (e.g., cognitive behavioral therapy (CBT)-based approaches) are effective in treating anxiety disorders across populations. Facing your fears (FYF), a group-based CBT program modified for youth with ASD, yields positive outcomes in controlled research settings and community implementation, but access is constrained by limited system capacity and families' distance from specialized centers. COVID-19 spurred innovations in virtual delivery of care, generating possibilities for increased scalability of evidence-based treatments. This study investigated the feasibility, acceptability, and effectiveness of FYF when delivered virtually through a tertiary care hospital in Ontario. Data were collected over one year (N = 100 autistic children/youth aged 8-13 years and their caregivers). Significant improvements emerged in caregiver- and self-reported anxiety symptoms, and caregivers reported increased self-efficacy in supporting their child with their anxiety. Significant predictors of treatment response included youth baseline anxiety, level of adaptive functioning, ASD symptoms, and caregiver self-efficacy. Three COVID-related factors were small but significant contributors to the model. Virtual delivery of FYF is feasible and effective for treating elevated anxiety in autistic children/youth and may improve access.ClinicalTrials.gov identifier: NCT04666493., Competing Interests: Declarations. Competing interests: EA reports the following potential conflicts: Grants from industry (Roche, SynpDx, Maplight, Anavex; Sanofi Aventis), consultations (ROChe, Ono, Impel, Cell-EI, Quadrant) and in-kind supports (AMO pharma, CRA), editorial honoraria/ book royalties (Wiley, APPI, Springer), and a patent (Anxiety Meter). All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be perceived as a potential or actual conflicts of interest. Ethics statement: This study involving human participants was approved by the Research Ethics Board at Holland Bloorview Kids Rehabilitation Hospital. The study was conducted in accordance with local legislation and institutional requirements. Participants provided written informed consent as described in the manuscript., (© 2025. The Author(s).)

Background: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users., Objective: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services., Methods: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers., Results: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care-related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents' collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs., Conclusions: This analysis provides an exploratory look at the data to highlight barriers that may impact a user's ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents' use of telehealth., (©Zachary Junkins, Nusrath Zahan, David Neyens. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 26.02.2025.)

Background: The exponential growth in the use of telehealth during the pandemic underscored the need to quantify how telehealth impacts overall health care costs. While the pandemic inhibited access to in-person care for all Americans, access to care will remain challenging for some populations. Objective: We sought to assess the cost-benefit of telehealth by reviewing a data set of 1.4 million telehealth encounters across the United States performed between February and September 2020. Methods: A retrospective analysis used data from six large health systems and one state Medicaid agency. The economic model considered both direct and indirect costs. Results: Building upon a report published in 2021 by the Centers for Telehealth and eHealth Law, this article presents an analysis of the six states with the highest telehealth encounters within the data set. The study revealed significant cost savings. Telehealth was associated with a reduction in costs ranging from $445,000 to $33 million for Medicare and $155,000-$181 million for Medicaid, except for one metropolitan area. Cost savings were based on the most frequent diagnoses: behavioral health, cancer, heart disease, pulmonary conditions, and endocrine disorders. Limitations: The use of encounter data prohibited the analysis of a patient's longitudinal use of telehealth. Each encounter was treated as a unique observation. While the data set represented telehealth use across the nation, some states were over-represented while others were under-represented, based on available data. Finally, for the six health systems, data was restricted to the regions covered by the health system. As such, in some states, most encounters take place in metropolitan areas. Conclusion: Telehealth can generate significant cost savings, particularly within the Medicaid program, by increasing access to health care452244 services, especially for conditions directly impacted by provider shortages within geographic proximity to the patient.

Background: The COVID-19 pandemic has escalated the utilization of virtual care platforms in pediatric diabetes mellitus. The impact of these interventions on the health-related quality of life (HRQOL) is unclear., Objective: This systematic review evaluated the impact of virtual care, including eHealth and mHealth modalities, when compared to in-person care, on HRQOL in children with diabetes., Methods: MEDLINE, EMBASE, EMCare, PsycInfo, and Web of Science, ProQuest Dissertations and Theses A&I, and ClinicalTrials.gov databases and registries were searched from database inception to October 2 nd , 2023. Randomized and non-randomized comparative studies were eligible for inclusion., Results: Thirteen studies were identified (12 randomized controlled trials, 1 cross-sectional study) involving 1566 children with type 1 diabetes mellitus (T1DM). The supplemental virtual care interventions utilized either web- or mobile-based platforms for intervention implementation. No interventions were detrimental to HRQOL, and a few improved the short-term HRQOL. No interventions worsened glycemic control. Patients and family's satisfaction with virtual care was high, perceiving it to be equal to or better than in-person care. There was no evidence for the use of virtual care and its effect on HRQOL in pediatric type 2 diabetes mellitus patients., Conclusion: Virtual care is associated with a stable or improved HRQOL and patient and family satisfaction in pediatric T1DM. Decision makers need to consider expanding virtual access to pediatric diabetes care that can improve equitable access to quality care across healthcare systems globally., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Rajan et al.)

Background: Patients inevitably incur some cost for accessing health care, even in universal systems such as Canada. The COVID-19 pandemic dramatically shifted health care delivery from in-person to telehealth services, also shifting the proportion of costs offset by patients and their families by reducing the need to travel to in-person appointments., Objective: This study aimed to develop a method for estimating the costs patients and their families incur and CO 2 emissions attributed to travel needed for emergency department (ED) visits, hospitalizations, and physician appointments., Methods: We present a method to evaluate the costs associated with in-person and telehealth care appointments from the perspective of patients, their families, and the environment. We used ED locations, road distances, and duration of appointment to account for costs paid by patients (ie, lost productivity, informal caregiving, and out-of-pocket expenses) attributed to travel to receive medical care. Costs to the environment were evaluated by calculating the amount of CO 2 emitted per medical visit. Using our costs calculated per visit, we apply our method to calculate total patient costs for a simulated population over 1 year., Results: Our method estimates that patients in British Columbia pay up to $300 (2023 CAD, CAD $1=US $0.86) on average to attend an in-person ED visit, depending on where they live; $166 may be attributed to lost productivity, $83 to informal caregiving, and $50 to out-of-pocket expenses. These estimates are higher than most observed cost estimates. In addition, avoiding in-person care diverts up to 13 kg of CO 2 per medical visit, depending on the distance and frequency of travel to appointments. This translates to up to $0.70 in carbon costs per visit, or cumulatively $44,120 per year in British Columbia, conventionally not included in patient cost estimates., Conclusions: We present a novel method for estimating patient-incurred costs and CO 2 emissions from accessing health care and apply it to estimate that every year, patients in British Columbia pay upwards of 30 million dollars to access health care services, primarily for medical travel. Our method adds to the economic evaluation literature by providing a more comprehensive and context-modifiable calculation of patient costs that will allow for more informed decision-making regarding health care services., (©Graham Mainer-Pearson, Kurtis Stewart, Kim Williams, John Pawlovich, Scott Graham, Linda Riches, Sonya Cressman, Kendall Ho. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.02.2025.)

Objective: Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQIA + community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing and receiving care through virtual models. The objective of this qualitative study was to describe physician perspectives on their experiences providing care to patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada., Methods: We interviewed 14 Virtual ED physicians from different sites across the Greater Toronto Area. Semi-structured interviews were conducted to explore ED physicians' experiences with treating patients from equity-deserving populations who used the Virtual ED. Inductive thematic analysis was used to identify themes from the interview data., Results: Three themes were identified, which included: (1) Considerations for Virtual ED Inclusivity; (2) Beliefs about Compassionate Virtual ED Care Practices; and (3) Proposed Innovations for Advancing Equity through Virtual ED Care. An overarching and connecting theme was accessibility. Across these themes, providers highlighted factors that influenced Virtual ED accessibility for many equity-deserving populations., Conclusions: The Virtual ED holds many promising applications for the delivery of equitable and compassionate care for equity-deserving populations. There are several patient, provider and system level issues that need to be considered to ensure its inclusivity and accessibility. One suggestion for innovation includes creating community hubs offering access to the Virtual ED to make it easier for equity-deserving populations who may face barriers to using it or need a safe space to do so., Competing Interests: Declarations. Conflict of interest: J. Hall is the Virtual Emergency Department Medical Director at Sunnybrook Health Sciences Centre and S. Mehta and A. Ackery were physicians providing services for the Virtual Emergency Department at Unity Health Toronto. The other authors have no conflicts of interest to declare., (© 2025. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

Objective: Endometriosis is a chronic and inflammatory condition that affects approximately 10% of the reproductive-age population. During the COVID-19 pandemic, there was a shift towards virtual care for endometriosis. Our aim was to evaluate the diagnostic and treatment outcomes of virtual-only care, compared to those who had both virtual and in-person visits., Design: Retrospective descriptive analysis of registry data., Setting: This study was conducted in British Columbia, Canada, at a tertiary referral center for endometriosis and pelvic pain., Participants: In this cohort (n=389), we examined patients who received an initial virtual assessment followed by virtual care alone (Virtual Only group, n=203) and those who had an initial virtual assessment followed by an in-person physical exam (Physical Exam group, n=186)., Interventions: Virtual care at the center during the Covid-19 pandemic., Results: The Physical Exam group was more likely to have surgery compared to the Virtual Only group (45.7% vs. 16%, p<.001). At the time of surgery, the groups did not differ based on type of surgery (e.g. excision of endometriosis and/or hysterectomy), endometriosis anatomic findings (e.g. stage and anatomic subtype), surgical complexity or surgical complications. At baseline, the two groups did not differ in their pain, mental health or quality of life scores. At one-year follow-up, the two groups did not differ in these outcome measures., Conclusion: There was a lower rate of surgery, but no differences in surgical findings or complications, nor in one-year outcomes, after virtual only care for endometriosis compared to patients that had a virtual visit and then underwent a physical exam. These results support a hybrid model, where a virtual visit is the first contact and serves as a triage tool to determine whether a patient is appropriate for virtual only care or would benefit from a physical exam. Future research could incorporate population-based administrative data or qualitative approaches to understanding patient experiences and physician perspectives on virtual care for the treatment of endometriosis., Competing Interests: Conflict of Interest Hannah Rojas reported a research award from the University of British Columbia Faculty of Medicine. Caroline Lee reported receiving personal fees from Pfizer. Mohamed Bedaiwy reported receiving personal fees from AbbVie Advisory Board, Ferring, Pfizer, Canadian Institutes Health Research (CIHR), and Baxter Advisory Board outside the submitted work. Catherine Allaire reported receiving personal fees from AbbVie and Pfizer and has leadership roles at Canadian Society for the Advancement of Gynecologic Excellence (CanSAGE), EndoAct Canada, and International Pelvic Pain Society (IPPS) outside the submitted work. Paul Yong reported CIHR funding, personal funding and grants from Canada Research Chair Program, Michael Health BC, Women's Health Research Institute, University of British Columbia, International Society for the Study of Women's Sexual Health (ISSWSH), Canadian Foundation of Innovation (CFI), CanSAGE, IPPS, World Endometriosis Society (WES), Society for the Study of Reproduction (SSR), Vulvodynia Sumit. The other authors report no disclosures., (Copyright © 2025. Published by Elsevier Inc.)

Background: Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known., Objective: This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period., Methods: This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks., Results: Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ≥10), 36% (120/342) reported anxiety (GAD-7 ≥8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (-2.4, 95% CI -3.0 to -1.8) and GAD-7 scores (-1.5, 95% CI -2.0 to -1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up., Conclusions: This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care., (©Jae Downing Corman, Jaclyn M W Hughto, Theresa I Shireman, Kellan Baker, Kate Steinle, Michelle Forcier. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.02.2025.)

Background: The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care., Objective: This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions., Methods: We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size., Results: A total of 13,667 articles were screened, and 219 (1.6%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5%) were primary studies, and 28 (16.5%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4%), medical assessment and treatment of particular conditions (63/170, 37.1%), rehabilitation (17/170, 10%), and counseling (74/170, 43.5%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes., Conclusions: Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care., (©Payal Agarwal, Glenn George Fletcher, Karishini Ramamoorthi, Xiaomei Yao, Onil Bhattacharyya. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.02.2025.)

Background: The COVID-19 pandemic led to a rapid transition to telehealth, particularly in general practice where continuous care for chronic conditions, such as musculoskeletal (MSK), is provided., Aim: To determine the appropriateness of telehealth for MSK conditions by identifying whether in-person tasks can be supported remotely via telehealth., Design & Setting: This study is a secondary analysis of the Harnessing Resources from the Internet (HaRI) dataset. This dataset comprises of 281 videos of recorded GP consultations. The dataset includes 10 GPs, across eight separate clinics, and was collected during 2017 in the UK., Method: Content analysis was conducted to identify the clinical tasks, physical examinations, and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth., Results: Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations, and 12 physical artefacts were observed. Of clinical tasks, 17% ( n = 2/12) were deemed to be 'easily translatable over telehealth' and 50% ( n = 6/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% ( n = 2/12) of tasks were rated 'moderately translatable over telehealth', and 17% ( n = 2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10., Conclusion: Most clinical tasks observed during in-person GP consultations with patients with MSK conditions are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK conditions in primary care., (Copyright © 2025, The Authors.)

(1) Background: Veterinary virtual care holds the potential to alleviate some barriers to accessing care, yet concerns within the profession exist. Understanding veterinarians' perspectives and identifying the potential opportunities and challenges that virtual care poses for access to veterinary care are thus needed. (2) Methods: Semi-structured interviews were conducted virtually with 22 companion-animal veterinarians practicing across Canada and the United States. Interviews were accompanied by an electronic survey, with which a Net Promoter Score (NPS) was calculated for each participant. Using their NPS, participants were categorized as a "promoter" or "detractor", with respect to their perspective on veterinary virtual care. A thematic analysis was conducted on verbatim transcripts of the interviews. (3) Results: A total of 11 detractors and 11 promoters were interviewed. Four subthemes were identified, including the following: (1) there are limitations to virtual care, (2) virtual care plays a role in access to care, (3) "virtual care is better than no care" and (4) virtual care offers specific value in supplementing in-person care. (4) Conclusion: When no other option for care delivery exists, virtual care was viewed as a way to increase access to veterinary care.

Background: Current telemedicine technologies are not fully optimized for conducting physical examinations. The Virtual Remote Tele-Physical Examination (VIRTEPEX) system, a novel proprietary technology platform using a Microsoft Kinect-based augmented reality game system to track motion and estimate force, has the potential to assist with conducting asynchronous, remote musculoskeletal examinations., Objective: This pilot study evaluated the feasibility of the VIRTEPEX system as a supplement to telehealth musculoskeletal strength assessments., Methods: In this cross-sectional pilot study, 12 study participants with upper extremity pain and/or weakness underwent strength evaluations for four upper extremity movements using in-person, telehealth, VIRTEPEX, and composite (telehealth plus VIRTEPEX) assessments. The evaluators were blinded to each other's assessments. The primary outcome was feasibility, as determined by participant recruitment, study completion, and safety. The secondary outcome was preliminary evaluation of inter-rater agreement between in-person, telehealth, and VIRTEPEX strength assessments, including κ statistics., Results: This pilot study had an 80% recruitment rate, a 100% completion rate, and reported no adverse events. In-person and telehealth evaluations achieved highest overall agreement (85.71%), followed by agreements between in-person and composite (75%), in-person and VIRTEPEX (62.5%), and telehealth and VIRTEPEX (62.5%) evaluations. However, for shoulder flexion, agreement between in-person and VIRTEPEX evaluations (78.57%; κ=0.571, 95% CI 0.183 to 0.960) and in-person and composite evaluations (78.57%; κ=0.571, 95% CI 0.183 to 0.960) was higher than that between in-person and telehealth evaluations (71.43%; κ=0.429, 95% CI -0.025 to 0.882)., Conclusions: This study demonstrates the feasibility of asynchronous VIRTEPEX examinations and supports the potential for VIRTEPEX to supplement and add value to standard telehealth platforms. Further studies with an additional development of VIRTEPEX and larger sample sizes for adequate power are warranted., (© Richard Wu, Keerthana Chakka, Sara Belko, Ninad Khargonkar, Kevin Desai, Balakrishnan Prabhakaran, Thiru Annaswamy. Originally published in JMIR Serious Games (https://games.jmir.org).)

Background: Little is known about antibiotic prescribing for respiratory tract infections (RTIs) in virtual versus in-person urgent care., Methods: In this retrospective study, we used electronic health record data from Cleveland Clinic Health System. We identified RTI patients via International Classification of Diseases, Tenth Revision, Clinical Modification, codes and assessed whether the visit resulted in an antibiotic. We described differences in diagnoses and prescribing by setting (virtual versus in-person). We used mixed effects logistic regression to model the odds of antibiotic receipt by urgent care setting. We applied the model first to all physicians and second only to those who saw patients in both settings., Results: There were 69 189 in-person and 19 003 virtual visits. Fifty-eight percent of virtual visits resulted in an antibiotic compared with 43% of in-person visits. Sinusitis diagnoses were more than twice as common in virtual versus in-person care (36% vs 14%) and were associated with high rates of prescribing in both settings (95% in-person, 91% virtual). Compared with in-person care, virtual urgent care was positively associated with a prescription (odds ratio, 1.64; 95% confidence interval [CI]: 1.53-1.75). Among visits conducted by 39 physicians who saw patients in both settings, odds of antibiotic prescription in virtual care were 1.71 times higher than in in-person care (95% CI: 1.53-1.90)., Conclusions: Antibiotic prescriptions were more common in virtual versus in-person urgent care, including among physicians who provided care in both platforms. This appears to be related to the high rate of sinusitis diagnosis in virtual urgent care., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Remote Patient Monitoring (RPM) has driven significant advancements in Canadian healthcare, especially during the transformative period from 2018 to 2023. This perspective article explores the state of play and examines the current landscape of RPM platforms adopted across Canada, detailing their functionalities and measurable impacts on healthcare outcomes, particularly in chronic disease management and hospital readmission reduction. We explore the regulatory, technical, and operational challenges that RPM faces, including critical issues around data privacy, security, and interoperability, factors essential for sustainable integration. Additionally, this article provides a balanced analysis of RPM's potential for continued growth within Canadian healthcare, highlighting its strengths and limitations in the post-2023 context and offering strategic recommendations to guide its future development. Keywords: Remote Patient Monitoring, Digital Health, Virtual Care, Canadian Healthcare, Healthcare Technology, AI, Perspectives., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2025 Bouabida, Chaves, Anane and Jagram.)

Objective: To explore whether utilisation of a Virtual Emergency Department (VVED) differs according to socioeconomic status (SES)., Methods: A retrospective analysis was undertaken of data from the VVED - a telehealth service that provides care for patients across Victoria, Australia with non-life-threatening emergencies. The study included all individuals who presented to the VVED between July 2022 and June 2023 through the two most common referral pathways (self-referral and ambulance referral). Area-level SES was ascertained by matching residential postcodes to the corresponding Australian Bureau of Statistics (ABS) Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) decile. IRSAD scores were divided into quintiles (1 = lowest SES, 5 = highest SES) and multivariable logistic regression modelling was used to analyse associations between the SES quintile and referral pathway, presented as odds ratios (ORs) with 95% confidence intervals (CIs)., Results: There were 68 598 participants included in the analyses (mean age: 36.6 years; 58.4% female). Compared to SES quintile 3, higher odds of self-referral to the VVED were observed in the two most advantaged SES groups (Quintile 4; adjusted OR [aOR] = 1.16; 95% CI: 1.06-1.26; P = 0.001) (Quintile 5; aOR = 1.38; 95% CI: 1.25-1.52; P < 0.001). Conversely, lower odds of self-referral were observed in the most disadvantaged SES group (Quintile 1; aOR = 0.82; 95% CI: 0.75-0.90; P < 0.001)., Conclusions: The present study demonstrated a relatively even utilisation of the VVED service across SES population groups. The use of healthcare provider pathways, such as ambulance paramedics, may increase equitable access to telehealth. Clinical attention should be directed toward specific social groups in the emergency care setting., (© 2025 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Background: Over recent years there has been a shift in clinical practice to support care delivery via telemedicine. This study aims to highlight the patient and provider experience of telemedicine over 2.5 years within a Canadian Pediatric Neurology clinic., Method: A REDCap survey was sent to all patients/parents and providers with a telemedicine appointment between March 2020 and September 2022., Results: Seven providers and 272 patients responded. Ninety-one percent of patients and 100% of providers were satisfied with telemedicine. Ninety percent of patients and 100% of providers found telemedicine more convenient. Eighty-seven percent of patients and 100% of providers were interested in future telemedicine appointments. Main challenges were with performing a physical examination and technological issues., Conclusion: Our survey shows that the majority of patients and providers had highly positive experiences with telemedicine and were interested in continuing care via telemedicine. This study supports incorporating telemedicine into future pediatric neurology practice., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To understand the impact of the transition to telehealth during COVID-19 on psychotherapy visits for patients with dementia. Method: Retrospective study of older adults with dementia who had at least one psychotherapy visit in the 9 months before and after the onset of COVID-19 at 3 U.S. health systems. Care disruptions were gaps of 45+ days. Descriptive statistics and logistic mixed-effects models examined factors associated with care disruption. Results: 4953 patients with dementia made 19,902 psychotherapy visits. Gaps in psychotherapy were less frequent during COVID-19 (29.4%) than before (48.9%), with the odds of a patient experiencing a care disruption during COVID-19 0.54 times the odds prior to COVID-19 (95% CI: 0.50-0.59). Almost all patient subgroups had lower adjusted odds of care disruption during COVID-19. Discussion: There were fewer disruptions in psychotherapy care following the rapid shift to virtual care. Telehealth may be a viable option for patients with dementia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Apply the Sustainability in Quality Improvement framework to virtual care for Otolaryngology-Head and Neck Surgery (OHNS) patients to understand the economic, environmental, and social impacts., Methods: This project consisted of retrospective analysis of anonymized data from all appointments that took place in three academic ambulatory OHNS clinics (pediatrics, head and neck, and otology/neurotology) from fiscal years of 2021 to 2023. Data were obtained from our institution's Virtual Care Dashboard. The following metrics were calculated: travel costs avoided with virtual appointments (economic value), fuel and carbon emissions avoided with virtual appointments (environmental value), and differences in Ontario Marginalization (ON-Marg) Index scores between patients seen virtually versus in-person (social value)., Results: A total of 41,343 visits occurred over the 2-year period (18.1% virtual). Nearly all virtual visits were by telephone (99.6%). The average cost savings per virtual care visit was $87.50, and total cost savings across all 3 clinics was $640,300. Total environmental savings were 82,500 L of fuel and 246.6 metric tons of carbon emissions. There were no statistical differences in monthly average marginalization (ON-Marg) indices in patients seen virtually compared to in-person., Discussion: Virtual care demonstrated financial and environmental savings for OHNS patients that can accumulate over multiple appointments. No difference in ON-Marg indices between patients assessed virtually versus in-person suggests that virtual care was accessible for patients regardless of social background., Implications for Practice: Our data suggests that virtual care may be a viable complement for delivering OHNS care that leads to fiscal and environmental savings for patients and ensures equitable access to care., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Background: Rural provider-to-provider telehealth is growing globally. It is used to both facilitate equitable access to specialist healthcare services for those living in rural and remote areas and provide support to place-based providers. There is limited research on the implementation of these services, especially in an emergency or inpatient hospital setting. The Western Australia Country Health Service (WACHS) Command Centre is one such example. First implemented in 2012, the Command Centre services a geographical area covering 2.55 million square kilometres, a population of approximately 550,000, and provides five clinical streams including Emergency, Mental Health Emergency, Midwifery and Obstetrics Emergency, Inpatient, and Palliative Care Afterhours Telehealth Services., Objectives: This study aimed to evaluate the implementation and access of rural provider-to-provider telehealth in country Western Australia, for the years 2012 to 2023., Methods: A retrospective observational analysis was conducted of all patient contacts managed by clinical telehealth streams of the Command Centre, between 31 August 2012 and 31 December 2023. Utilising descriptive statistics, analyses was informed by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework and Implementation Outcomes Framework (IOF) definitions., Results: Over the near 12-year period, a total of 215,965 service contacts were analysed from the five Command Centre clinical streams. There was large variation in the reach and adoption of services across regions, sites, and health facility types, however service scope and activity has increased steadily over time (maintenance). 95 of the 103 WACHS-managed sites had utilised Command Centre clinical telehealth services. The Command Centre has seen an increase in the proportion of clinical telehealth services provided to the most disadvantaged populations, demonstrating improved equity of access (effectiveness) over time., Conclusion: There is a steady expansion in the availability of provider-to-provider clinical telehealth services delivered by the WACHS Command Centre across country WA, but with wide variability of usage depending on region, site, and health facility type. The results of this study show there is a need to understand the contextual factors influencing the adoption, implementation, and sustainability of the service., Competing Interests: Declarations. Ethics approval and consent to participate: This research has ethics and governance approval from WA Country Health Service Human Research Ethics Committee (RGS6417), and reciprocal approval from Curtin University (79445). A waiver of consent for use of administrative service data has been approved by the WA Country Health Service Human Research Ethics Committee in accordance with the Australian National Statement on the Ethical Conduct in Human Research, 2023, Sect. 2.3.10. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: In March 2020, the Renfrew County Virtual Triage and Assessment Centre (VTAC) was launched as a large-scale, innovative, hybrid healthcare program. VTAC aims to alleviate pressure on emergency departments by providing additional and more equitable access to family physicians and allied health professionals. This study's objective was to evaluate patients' experiences with VTAC., Methods: In this mixed-methods study, we distributed 3,026 surveys, receiving 383 responses that met our inclusion criteria (13%), and conducted 10 semi-structured interviews with Renfrew County residents aged 18 and above who had utilized VTAC at least once since 2023. Survey data were analyzed through descriptive statistics, chi-squared tests, and a multivariate binary logistic regression, while semi-structured interviews were coded and analyzed using reflexive thematic analysis., Results: The majority of survey respondents were aged over 55 (58%), identified as Caucasian (91%) and women (70%), with 76% having college or university-level education. Additionally, 81% were either unattached, or attached to a doctor who was not easily accessible. Our findings demonstrate overall satisfaction with VTAC, with 86% patients reporting that they were satisfied or very satisfied with the program. This was irrespective of demographic characteristics, health status, or appointment modality. In our interviews, four main themes emerged: "Healthcare in Renfrew County", "Accessing VTAC", "VTAC Clinical Care", and "Improving VTAC". These themes underscore major difficulties residents encounter in accessing healthcare in Renfrew County and illustrate that services from VTAC align with a genuine population-level need, contributing to mitigating some of these challenges., Conclusion: Renfrew County, like many other underserved regions, is grappling with a crisis of access to healthcare. VTAC addresses this gap by providing timely access to a family doctor. Our findings demonstrate patient acceptability and satisfaction with VTAC, offering insights that could guide the design of similar healthcare programs. This model may also serve as a scalable solution for improving healthcare access in underserved regions facing similar challenges., Competing Interests: Declarations. Ethics approval and consent to participate: All research conducted in this study adhered to the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2). Formal ethical approval for the study was obtained from the Montfort Hospital Research Ethics Board (REB). Informed consent to participate was obtained from all of the participants in the study. Prior to completing the survey, participants provided online informed consent. For interviews, verbal informed consent was obtained prior to the commencement of each interview. All data were securely stored. Survey responses were collected anonymously. Interview recordings were anonymized to maintain confidentiality. Consent for publication: Not applicable. Competing interests: JF is the medical lead of VTAC; however, he was not involved in data collection. AS and CP hold salaried positions at the Institut du Savoir Montfort, partially funded by allocations for VTAC evaluation. Patient partners (DBP, KM, and MH) received an honorarium from VTAC for their involvement in the project. There are no other competing interest to declare., (© 2025. The Author(s).)

Background: Telehomecare monitoring (TM) in patients with cancer is a complex intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management, and practice transformation. Further investigation into these variations factors will improve implementation processes and produce effective outcomes., Objective: This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for patients receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to (a) site characteristics, (b) team characteristics, and (c) characteristics of patients receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) according to the site, implementation process, and patient characteristics; (3) describe the acceptability and feasibility of TM from the perspectives of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of provincewide implementation., Methods: This type II hybrid effectiveness-implementation study uses a concurrent mixed methods design. Evaluability assessment is integrated into an emerging practice in 3 participating sites to enable the evaluation of implementation strategies on TM clinical outcomes. Quantitative data for ePROMs and ePREMs will be collected using validated oncology questionnaire. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses will be undertaken alongside interpretive descriptive coding of qualitative data. Qualitative data will be gathered from key informants guided by the RE-AIM (reach, efficacy, adoption, implementation, maintenance) framework and its extension, PRISM (practical robust implementation and sustainability model). The concurrent approach allows results at multiple stages of this study to be integrated iteratively. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice, and transferable to other settings., Results: Questionnaires were pretested and the technological platform was codeveloped with members of the cancer care team and patients. Preparatory work was carried out to configure the TM platform and activate coordinating mechanisms between members of the cancer care team, patients, information technology experts, and the research team. A steering committee with 3 working groups was established to oversee the technological, clinical, and evaluation aspects of this study. Recruitment of patients for ePROMs started in February 2024, and data collection is expected to continue until March 2025. Interviews with members of the cancer care team began in November 2024. Full analysis should be completed by September 2025., Conclusions: This study will clarify how, why, for whom, and under what conditions TM can complement current care models. Our evaluability assessment will help to address implementation complexities and better understand intervention-to-practice operationalization so that implementation might be adapted to contextual factors without potentially harmful or inequitable impacts on patients., International Registered Report Identifier (irrid): DERR1-10.2196/63099., (©Dominique Tremblay, Thomas Joly-Mischlich, Annick Dufour, Marie-Claude Battista, Djamal Berbiche, José Côté, Marco Décelles, Catherine Forget, Brigitte Guérin, Manon Larivière, Frédéric Lemay, Manon Lemonde, Éric Maillet, Nathalie Moreau, Michel Pavic, Sara Soldera, Catherine Wilhelmy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 20.01.2025.)

Background: Professionals in caring disciplines have been pivotal in advancing virtual care, which leverages remote technologies to deliver effective support and services from a distance. Educators in these caring professions are required to teach students the skills and competencies needed to provide high-quality and effective care. As virtual care becomes more integral, educators must equip students in these fields with both interpersonal and technological skills, bridging traditional hands-on learning with digital literacy. However, there is a gap in evidence exploring educators' perceptions and experiences of teaching caring profession students about virtual caring skills within online environments., Objective: This study aims to better understand caring profession educators' online teaching experiences to foster student development of virtual caring skills and competencies., Methods: We used a sequential explanatory mixed methods approach that integrated a cross-sectional survey and individual interviews with educators from caring professions to better understand caring professional educators' online teaching experiences to foster student development of virtual caring skills and competencies. The survey's primary objectives were to examine the various elements of existing e-learning opportunities, delve into educators' perspectives and encounters with these opportunities, and identify the factors that either facilitated or hindered online teaching practices to support students in developing virtual caring skills and competencies. The individual interview guides were based on survey findings and a systematic review of the evidence to gain deeper insights into educators' experiences and perspectives., Results: A total of 82 survey participants and 8 interview participants were drawn from educators in the fields of education, medicine, nursing, and social work. Various instructional methods were used to help students develop virtual caring skills, including reflections on learning, online modules, online discussion boards, demonstrations of remote care, and consultation with clients. There was a statistically significant difference between educators' level of experience teaching online and their satisfaction with online teaching and learning technologies (P<.001) and between educators' faculties (departments) and their satisfaction with online teaching and learning technologies (P=.001). Participants identified barriers (time constraints, underdeveloped curriculum, decreased student engagement, and limited access to virtual caring equipment and technology), facilitators (clearly defined learning objectives, technology software and support, teaching support, stakeholder engagement, and flexibility), and principles of teaching virtual caring skills in online environments (connection, interaction, compassion, empathy, care, and vulnerability)., Conclusions: Our study identifies the barriers, facilitators, and principles in teaching virtual caring skills, offering practical strategies for educators in caring professions. This study contributes to the growing body of educational research on virtual caring skills by offering educator insights and suggestions for improved teaching and learning strategies in caring professions' programs. As educational practices evolve, future research should explore how traditionally in-person educators can effectively teach virtual caring skills across diverse contexts., (©Lorelli Nowell, Sonja Johnston, Sara Dolan, Michele Jacobsen, Diane L Lorenzetti, Elizabeth Oddone Paolucci. Originally published in JMIR Nursing (https://nursing.jmir.org), 15.01.2025.)

Background: Virtual care (VC) for dementia in primary care settings is an important aspect of healthcare delivery in Canada. However, the evidence informing optimal and sustainable provision of VC for persons living with dementia (PLWD) and their care partners is scarce. The objectives of this study were to (1) describe the frequency of VC use, (2) identify characteristics of PLWD, care partners, and family physicians (FPs) that are associated with the use of VC, and (3) explore FPs' perceptions of barriers and facilitators to provide VC for PLWD and their care partners., Methods: The Alzheimer Society of Canada and College of Family Physicians of Canada conducted three nationwide cross-sectional surveys between October 2020 and April 2021: (1) One with PLWD, (2) one with care partners of PLWD, and (3) one with FPs. Virtual care was defined as two-way synchronous communication by telephone and/or a web camera. The prevalence of VC use among FPs, PLWD, and care partners was described. Logistic regression models were used to determine characteristics of participants (sociodemographic, urbanicity, frequency and availability of support for connecting with FPs, and FPs' practice characteristics) associated with any VC use (phone and/or video). Inductive thematic analysis of open-ended questions explored FPs' perceptions., Results: 131 PLWD, 341 care partners, and 125 FPs participated. 61.2% of PLWD, 59.5% of care partners, and 77.4% of FPs reported using VC. The models for PLWD (included age and ethnicity) and care partners (included gender/sex, urbanicity, and receiving support from a family member/friend to connect with FP) were inconclusive. FPs with > 20 years in practice were less likely to provide VC (OR = 0.23, 95%CI: 0.08-0.62, p < 0.01). FPs perceived that preferences regarding virtual vs. in-person care, office/family support, technology and family presence, and remuneration for FPs influenced VC use., Conclusions: Virtual primary dementia care uptake in Canada is substantial and mainly performed via telephone. According to FPs, physician-patient-caregiver partnerships and infrastructure for VC play key roles in using VC. Virtual care could facilitate access to primary care and minimize potential disruptions to in-person care for PLWD. Outcomes of virtual primary care for dementia need further investigation., Competing Interests: Declarations. Ethics approval and consent to participate: The project was approved by the Baycrest Research Ethics Board and McGill Institutional Review Board. All methods were performed in accordance with relevant guidelines and regulations. The online surveys for PLWD and care partners included a section for the informed consent before the questions. For the case of PLWD, an informed consent form accessible in simple language was developed; if they could not consent, the substitute decision-maker (e.g., caregiver) consented on behalf of the PLWD. Physicians were emailed a description of the study that included a link to the survey. By clicking on the survey link and completing the survey, consent was implied. The physician cohort are competent and not a vulnerable population. The survey was anonymous and there were no ways to identify physicians. Consent for publication: Not applicable. Competing interests: Dr. Allan Grill declares that he gets paid a salary for his role as Physician Advisor for the College of Family Physicians of Canada. The rest of the authors declare that they have no conflicts of interest., (© 2025. The Author(s).)

The COVID-19 pandemic triggered a global pivot to virtual care (VC) technologies. While there has been considerable academic work exploring the "how" of VC, few studies have explored the impact of this pivot, its unintended consequences, and its governing rationales. This study addresses this gap in relation to care, professional identity and the evolving requirements for health professions education. Collected over three years, data for this study included evaluation surveys (134), interviews (59), publicly-available documents (240), and academic articles (217). Interviews and surveys were conducted in the Toronto Academic Health Science Network (TAHSN) and in a European academic medical centre (Maastricht UMC). Criteria for academic literature were that they addressed the shift to VC and were published between 2019 and 2023. Foucault's work, The Birth of the Clinic, his methodologies of Critical Discourse Analysis and his concept of spatiality, guided the analysis. Patients, clinicians and institutional leaders were appreciative of VC and the perceived improvements brought to care logistics, patient experience and efficiencies. Two discourses governed these sentiments-VC as a tool for both "service" and "managerialism." Assessing changes in clinical practice, experience and professional identity, our analysis suggested that a new virtual clinical space was being produced, one in which rules and experiences were different from that of a classical clinic. We named this new space the "Mediverse"-a space of undiscovered complexity with material and unintended consequences on user experience. This study identifies a new framework in which to study and assess this new clinical space., Competing Interests: Declarations. Conflict of interests: The authors declare no competing interests. Ethical approval: Ethics approval was obtained from the Research Ethics Boards of University Health Network (REB# 20–6063.4), the Hospital for Sick Children (REB#: 1000073889) and the University of Toronto (REB# 40940). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all individual participants included in the study., (© 2025. The Author(s), under exclusive licence to Springer Nature B.V.)

Background/Objectives : Caregivers of children with chronic illnesses, including chronic pain, experience high levels of distress, which impacts their own mental and physical health as well as child outcomes. Virtual care solutions offer opportunities to provide accessible support, yet most overlook caregivers' needs. We conducted a scoping review to create an interactive Evidence and Gap Map (EGM) of virtual care solutions across a stepped care continuum (i.e., from self-directed to specialized care) for caregivers of youth with chronic illnesses. Methods : The review methodology was co-designed with four caregivers. Data sources were the peer-reviewed scientific literature and a call for innovations. Records were independently coded and assessed for quality. Results : Overall, 73 studies were included. Most virtual care solutions targeted caregivers of children with cancer, neurological disorders, and complex chronic illnesses. Over half were noted at lower levels of stepped care (i.e., self-guided apps and websites), with psychological strategies being predominant (84%). However, very few addressed caregivers' physical health (15%) or provided family counseling (19%) or practical support (1%). Significant gaps were noted in interventions for managing caregiver chronic pain, despite its high prevalence and impact on child outcomes. Conclusions : Evidence and Gap Maps are innovative visual tools for knowledge synthesis, facilitating rapid, evidence-informed decision-making for patients, families, health professionals, and policymakers. This EGM highlighted high-quality virtual care solutions ready for immediate scaling and identified critical evidence gaps requiring prioritization. To address the complexities of pediatric chronic illnesses, including chronic pain, virtual care initiatives must prioritize family-centered, accessible, and equitable approaches. Engaging caregivers as partners is critical to ensure interventions align with their needs and priorities.

Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients' perspectives on virtual mental health care quality will be critical to informing future policies and practices., Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care., Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient., Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001)., Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances., (©Allison Crawford, Anne Kirvan, Marcos Sanches, Amanda Gambin, Denise Canso, Eva Serhal. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.01.2025.)

Introduction: Access to antenatal ultrasound is limited in low-income countries such as Ethiopia. Virtual care platforms that facilitate supervision and mentoring for ultrasound scanning may improve patient access by facilitating task-sharing of antenatal ultrasound with midlevel providers. The purpose of this study was to assess the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on antenatal care (ANC) and patient access, and its sustainability as it transitioned from a pilot project to a continuing clinical program. Methods: Health care providers at two health centers in the North Shoa Zone, Ethiopia, performed antenatal tele-ultrasound exams with remote guidance from obstetricians located in urban areas. Data regarding ANC and ultrasound utilization, participant travel, ultrasound findings, specialist referrals, and participant experience were collected through a mobile app. Results: Between November 2020 and December 2023, 7,297 tele-ultrasound exams were performed. Of these, 489 tele-ultrasound exams were performed during the period of data collection from October to December 2022. The availability of tele-ultrasound at the two health centers significantly reduced participant travel distance (4.2 km vs. 10.2 km; p < 0.01; one-way distance). Most participants (99.2%) indicated the tele-ultrasound service was very important or important, with high levels of satisfaction. Clinically significant findings were identified in 26 cases (5.3%), leading to necessary referrals. Conclusion: This study demonstrated the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on improving the quality of ANC, and its sustainability. These findings lay a foundation upon which low-income countries can develop tele-ultrasound programs to improve antenatal ultrasound access.

Purpose: Increased mental health (MH) needs during the COVID-19 pandemic led to the implementation of a novel pediatric Emergency Department Virtual Care (EDVC) service. Our study aimed to describe the pediatric MH patient population that used EDVC by comparing patient-specific factors of those who obtained services virtually to those seen in-person. Method: This retrospective chart review was conducted at a pediatric hospital in Eastern Ontario. Children and youth (aged 3-17) who received virtual or in-person emergency MH services from May to December 2020 were included. Patient demographics, clinical presentation details and disposition were compared between the virtual and in-person groups. Data was analyzed using descriptive statistics. Results: 1104 youth (96.1%) utilized the in-person ED for MH concerns; 45 (3.9%) used EDVC. In-person youth had a higher level of perceived risk (78.9% vs. 41.9%) and were more likely to present with concerns of depression, suicidal ideation, self-harm, or laceration (46.1% vs. 35.6%). Anxiety/situational crises or behavioural issues were more likely to present virtually. Eight patients (17.8%) were redirected to the ED from EDVC. Conclusions: Several patient-specific factors varied between youth seen in-person or virtually for MH concern. Study results can assist with the design and implementation of virtual MH care platforms., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The COVID-19 pandemic prompted an unprecedented surge in virtual services, necessitating a rapid shift to digital healthcare approaches. This review focuses on evaluating the evidence of virtual care (VC) in delivering HIV care, considering the complex nature of HIV and the need for tailored-approaches, especially for marginalized populations., Methods: A mixed-methods systematic review was performed with searches on five databases, covering studies from January 1946 to May 2022. Inclusion criteria involved two-way virtual consultations between healthcare workers and people living with HIV (PLHIV), with detailed descriptions and outcomes. Qualitative and quantitative studies were included, and the risk of bias was assessed using the Newcastle-Ottawa score and Stenfors' framework., Results: Among 4143 identified records, 26 studies met the criteria, with various models of care described. The majority of studies were observational, and videoconferencing was the primary mode of virtual consultation employed. Quantitative analysis revealed PLHIV generally accept VC, with high attendance rates (87%). Mean acceptability and satisfaction rates were 80% and 85%, respectively, while 87% achieved HIV viral suppression. The setting and models of VC implementation varied, with some introduced in response to COVID-19 while others were as part of trials., Conclusions: VC for PLHIV is deemed an acceptable and effective approach and is associated with good virological outcomes. Data on other health outcomes is lacking. The review underscores the importance of diverse models of care, patient choice and comprehensive training initiatives for both staff and patients. Establishing a 'gold standard' for VC models is crucial for ensuring appropriate and effective reviews of PLHIV in virtual settings., (© 2024 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

Background: The COVID-19 pandemic precipitated a rapid roll-out of virtual health care services to people with intellectual disabilities. Limited evidence is available for clinicians to guide virtual care delivery., Method: Twenty-three studies were identified through systematic searching of 16 databases. Extracted data were mapped to the NSW Virtual Health Strategy., Results: Evidence exists to support the use of virtual care for screening, diagnosis, assessment, and review of people with intellectual disabilities, with benefits for clients, carers, and clinicians. Evidence mapped well to the priority areas of the NSW Virtual Health Strategy, highlighting the need for clinician training and specific supports and adaptations to ensure accessibility for people with intellectual disabilities., Conclusions: The use of virtual care to assess the health needs of people with intellectual disabilities across the lifespan is nascent. An opportunity exists for co-design with people with intellectual disabilities to reduce barriers to accessing and engaging in virtual care., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: A significant shift toward virtual care has occurred for many patients with inflammatory bowel disease (IBD). To date, there are no prospective studies assessing patients visits across different styles of appointments., Methods: We randomized IBD patients' appointments to in-person, video-assisted virtual, or telephone and subsequent appointments to the alternate style of visit in a single-center study in Victoria, Canada. Participants completed surveys after each appointment. Demographic data were collected and average scores were analyzed for potential associations., Results: Forty-one patients were randomized to appointments, and 86 post-appointment surveys were completed, 30 in-person, 29 telephone, and 27 telehealth. The average age was 46.5 ± 18 years and 59% were female. The overall patient score (out of ten) by appointment type was 9.1 ± 1.0 for in-person, 7.8 ± 2.1 for telephone, and 8.0 ± 2.6 for telehealth without a statistically significant difference. While there was only a near statistically significant preference for in-person appointments compared with telehealth p = 0.055, it was statistically significant when comparing with phone appointments p = 0.014. The highest rated factors for preference of an in-person appointment were optimal communication and interaction with care provider (86%). For patients who preferred telehealth or telephone appointments, the highest rated factors were time and cost savings (71%, 43% and 58%, 33%, respectively). In-person appointments were associated with a significantly higher cost (p < 0.01), and longer time commitment., Conclusions: Despite the increased cost and time commitment, in-person appointments were highly rated particularly in comparison to phone appointments. Based on this research, providers can be better informed on factors contributing to patients' preferred appointment style., Competing Interests: Declarations. Conflict of interest: No authors have any conflicts of interest to declare. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. This study received Ethics Approval via the Human Research Ethics Board of Vancouver Island Health Authority on February 2nd, 2021 and included an additional COVID-19 Safety Appendix (Study Number H20-01498). Informed consent: Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: This study describes the proportion of Ontario adults with and without intellectual and developmental disabilities (IDD) who used community- and hospital-based healthcare in the first 2 years of the pandemic compared with the year pre-COVID-19., Methods: Linked health administrative databases identified 87 341 adults with IDD and also adults without IDD living in Ontario, Canada. For each cohort, counts and proportions of adults who used different types of healthcare services were reported for the pre-COVID-19 year (16 March 2019 to 14 March 2020) and the first two COVID-19 years (15 March 2020 to 14 March 2021 and 15 March 2021 to 14 March 2022)., Results: Compared with the year prior to COVID-19, the proportion of adults with and without IDD who used health services was lower during the first COVID-19 year, but the likelihood of all types of visits increased during the second year. The likelihood of using homecare and of being hospitalized nearly returned to pre-pandemic levels. Virtual physician visits increased in each COVID-19 year from 5.2% prior to the pandemic to 13.0% in year 1 and 58.7% in year 2. For all years, the proportion of adults who used each service type was higher for those with IDD than without IDD., Conclusions: For adults with and without IDD in Ontario, Canada, during the first two COVID-19 years healthcare use decreased for all service types, except for virtual physician visits. In the second year, healthcare use increased but did not reach pre-COVID-19 levels. In all years, adults with IDD were more likely to use services than other adults., (© 2025 The Author(s). Journal of Intellectual Disability Research published by MENCAP and John Wiley & Sons Ltd.)

The rapid evolution of digital health technologies has significantly transformed health care delivery, particularly in the realm of virtual care. This article synthesizes insights from the Annual Virtual Care Symposium entitled "Virtual Care: Embedding Virtual Care into Post-Pandemic Healthcare Delivery" held on March 13, 2024, hosted by Yale School of Medicine, Emory University, University of Washington, and Mayo Clinic Arizona. By examining the initiatives presented by faculty from Yale, Houston Methodist, and Emory in this session, we explore the integration of advanced technologies in virtual care, the challenges faced, and the potential for improving patient outcomes and health care efficiency as these novel practices become systematized and sustainable. The session focused on artificial intelligence and technology-enabled clinical workflow redesign., (© The Author(s) 2024. Published by Mary Ann Liebert, Inc., publishers.)

Background: During the COVID-19 pandemic, virtual care was used to deliver primary care services. Nurses contributed to primary care teams' capacity to deliver care virtually. This study explored nurses' roles in virtual care delivery in primary care and the barriers and facilitators that influenced their contributions., Methods: We employed a qualitative descriptive approach and conducted semi-structured interviews with nurses representing each regulatory designation (i.e., Nurse Practitioners, Registered Nurses, Licensed/Registered Practical Nurses) working in primary care in four Canadian provinces (i.e., British Columbia, Ontario, Nova Scotia, and Newfoundland and Labrador). We performed thematic analysis on data related to the delivery of virtual care., Results: We interviewed seventy-six nurses and identified three key themes and various sub-themes related to virtual nursing practice during the COVID-19 pandemic: (1) variable adoption of virtual care among nurses, (2) facilitators and barriers to virtual nursing practice, and (3) impacts of virtual delivery on care provision by nurses. Nurses' involvement in virtual care varied across designations and nurses recalled various facilitators and impediments that influenced their virtual care experience, such as guidance documents, funding models, and the availability of equipment. Virtual care influenced nurses' workflow, their ability to deliver patient-centred care, and their ability to bridge the care gap., Conclusions: Primary care teams are increasingly relying upon nurses to support virtual care delivery, emphasizing the need to understand nursing roles in virtual care. Primary care funding models should be leveraged to support nurses in virtual care delivery; and standardized learning opportunities and guidance documents focused on virtual care should be available to support primary care nurses and strengthen their contributions in future primary care teams that involve virtual nursing care., Competing Interests: Declarations. Ethics approval and consent to participate: We obtained ethics approval from each of the regional research ethics boards: Simon Fraser University and the University of British Columbia (File: H20-02998); Western University Research Ethics Board (File: 120519); the Nova Scotia Health Authority Research Ethics Board (File: 1027959); and the Health Research Ethics Board of Newfoundland and Labrador (File: 20222815). Prior to initiating any interviews, we shared an information and consent form with all participants which outlined the voluntary nature of their involvement in the study, the risks and benefits associated with their involvement, and the confidentiality of information collected. As per approval from the above ethics review boards, we obtained verbal informed consent from all participants prior to initiating interviews. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

This retrospective, descriptive study, conducted in 2024, analysed Virtual Care Survey (2020-2022) data of patients' self-reported reflections on use and experiences to investigate relationships between demographics, the number of chronic conditions, and virtual care use among older rural patients (≥65 years with at least one chronic condition) living in New South Wales, and their satisfaction with virtual care. Associations between categorical variables were assessed using chi-squared tests, and Kruskal-Wallis tests were used for continuous variables. Qualitative feedback was analysed thematically. The study included 264 patients (median age 74 years; 51.1% women). Most virtual care appointments (65.3%) were for consultations, check-ups, or review of test results. Over one-third (38.3%) of the patients had multimorbidity and were 1.8 times more likely to have five or more virtual care appointments compared to the patients with one chronic condition. The oldest age group (≥80 years) preferred telephone over online mediums (Skype or Zoom) ( p < 0.05). Patient satisfaction was high (65.8%), with 60.9% finding virtual care comparable to in-person consultations. Technological issues correlated with more negative experiences ( p < 0.05). Key themes were enhanced accessibility and convenience, quality and safety of virtual care, and recommendations for equitable access. Despite positive responses, addressing technological complexities is important for optimising virtual care models for older rural Australians with chronic conditions.

Background: Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underused, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve usage rates. However, data supporting the efficacy and cost-effectiveness of VCR are limited. In the present study, we compared the outcomes and cost of a VCR versus traditional CBCR program., Methods and Results: In a retrospective cohort study comparing VCR versus CBCR, CBCR data were collected from a period of January 2018 to September 2023. VCR data were collected from program initiation in July 2021 to September 2023. Primary health outcomes measured were 1-year mortality rates, recurrent myocardial infarction, all-cause hospital readmission, and emergency department visits. Primary cost outcomes were analyzed as cost ratios related to VCR versus CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post-CR enrollment. VCR was associated with a significant reduction in 1-year all-cause hospital readmission (incident rate ratio [IRR], 0.616 [95% CI, 0.489-0.777], P <0.001) and ED admission (IRR, 0.557 [95% CI, 0.452-0.687], P <0.001) at 1 year. The IRR of myocardial infarction and all-cause mortality did not significantly differ between VCR and CBCR. In addition, VCR was associated with significant reductions in medically related (cost ratio, 0.814 [95% CI, 0.690-0.960], P =0.0144) and total costs allowed (cost ratio, 0.838 [95% CI, 0.725-0.970], P =0.0176)., Conclusions: VCR is a viable alternative to CBCR with at least comparable efficacy and cost, and as such, represents a key mechanism for improving access to and participation in CR for eligible patients.

The United States faces a growing scarcity of primary care resources within an already overstressed and poorly accessible health care system. Many health care organizations are evaluating novel models of care and adoption of digital technologies to improve primary care access and efficiency of health care delivery. This article describes a virtual primary care (VPC) model that expands access and increases the efficiency of the traditional primary care team by utilizing on-demand and asynchronous digital tools. In the first year of operations, this service line provided >21,000 on-demand telemedicine visits and >4,000 asynchronous eVisits. The VPC service line improved access to primary care services in a financially successful and sustainable model., (© The Author(s) 2024. Published by Mary Ann Liebert, Inc., publishers.)

Introduction: The COVID-19 pandemic forced a rapid shift toward virtual modalities for the treatment of depression in primary care., Methods: Participants were adults 18 years and older with a new episode of depression diagnosed in primary care between March 1, 2020, and May 21, 2021, and moderate-to-severe symptoms of depression at the time of diagnosis (N = 9619). Outcomes were 1) antidepressant medications prescribed and dispensed (referred to as received), as well as adherence to those medications; 2) referrals made to depression-related services and the receipt of those services; and 3) a follow-up visit completed with the diagnosing practitioner regardless of treatment actions., Results: Patients were 42.4 ± 17.8 years old, and 77.6% had moderate-to-severe symptoms at diagnosis. Most patients were women (70.4%), 48.2% were Hispanic, and 8.4% were Black. Telephone visits were associated with 64% increased odds of having an antidepressant prescribed when compared to in-person visits. However, patients prescribed an antidepressant during a telephone visit were 52% less likely to receive this prescription when compared to patients who were prescribed an antidepressant during an in-person visit. Telephone and video visits were associated with 48% and 37% decreased odds, respectively, of having a follow-up visit with the prescribing practitioner when compared to an in-person visit., Conclusion: Telemedicine for depression in adult primary care may result in greater antidepressant prescribing than in-person care, but these medications are less likely to be received. This study's findings suggest that health systems should adjust electronic decision support tools (such as mail-order pharmacies) to ensure virtual care decisions are implemented.

Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV., Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care., Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes., Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access., Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities., (© Kristina M Kokorelias, Dean Valentine, Erica M Dove, Paige Brown, Stuart McKinlay, Christine L Sheppard, Hardeep Singh, Andrew D Eaton, Laura Jamieson, Marina B Wasilewski, Alice Zhabokritsky, Ashley Flanagan, Reham Abdelhalim, Rahel Zewude, Rabea Parpia, Sharon Walmsley, Luxey Sirisegaram. Originally published in JMIR Aging (https://aging.jmir.org).)

Background: There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored., Objective: This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies., Methods: We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research., Results: Our search identified 1474 studies. We removed 36.36% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3% (28/938) of the studies for extraction. Only 14% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39%) or impede (7/28, 25%) the provision of care virtually. In addition, clinicians' perceptions of patient stability (5/28, 18%) and the heightened risks associated with virtual care (10/28, 36%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43%)., Conclusions: The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities., (©Shawna Narayan, Ellie Gooderham, Sarah Spencer, Rita K McCracken, Lindsay Hedden. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.12.2024.)

Telerehabilitation is proposed as a promising avenue to enhance service accessibility for Indigenous communities, yet its application for Indigenous children remains relatively unexplored. This scoping review followed the PRISMA-ScR framework to explore current knowledge on the use of telerehabilitation for Indigenous children. Ten scholarly databases, seven grey literature databases, reference searches, and expert consultations were utilised to identify relevant studies. Included articles discussed the use of telerehabilitation provided by rehabilitation professionals (e.g. occupational therapist (OT), physical therapist (PT), speech and language pathologist (SLP) to Indigenous children and/or caregivers. Seven studies were included. Telerehabilitation was explored in different ways, the most common being real-time videoconferencing by SLPs. While some studies explicitly acknowledged cultural responsiveness within both the research process and the intervention, most were not designed for Indigenous children and their caregivers; rather, these participants were included with non-Indigenous participants. Successful implementation and sustainability of telerehabilitation services requires addressing technological limitations, understanding, and respecting diverse worldviews, and co-developing services to meet the unique needs of Indigenous families. Telerehabilitation has been rarely used with Indigenous children and when it was, little attention was given to cultural considerations. These findings emphasise that future telerehabilitation interventions should be truly community-led to ensure cultural relevance.

The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Five themes emerged from the data: (1) Lack of emotional intimacy when receiving virtual care, (2) Inadequacy of virtual platforms, (3) Saving time with virtual care, (4) Virtual care facilitated accessibility, and (5) Loss of connections with patients and colleagues. Given that virtual care continues to be implemented, and in some instances touted as an optimal option for the delivery of cardiac rehabilitation, it is critical to address the needs of older adults living with cardiovascular disease and their healthcare providers. This is particularly crucial related to issues accessing and using technology, as well as older adults' need to build trust and emotional connection with their providers.

Purpose: To evaluate the effectiveness of telerehabilitation for promoting return-to-work (RTW) among injured workers., Methods: We conducted a pragmatic, quasi-experimental study comparing telerehabilitation, in-person, or hybrid services. Descriptive statistics analyzed demographics, occupational factors, and patient-reported outcome measures (PROMs). Kruskal-Wallis tests investigated differences between mode of delivery and changes in PROM scores. Logistic and Cox-proportional hazard regression examined associations between mode of delivery and RTW status or days receiving wage replacement benefits in the first-year post-discharge, respectively, while controlling for potential confounders., Results: A slightly higher percentage of the 3,708 worker sample were male (52.8%). Mean (standard deviation (SD)) age across all delivery formats was 45.5 (12.5) years. Edmonton zone had the highest amount of telerehabilitation delivery (53.5%). The majority of workers had their program delivered in a hybrid format (54.1%) and returned to work (74.4%) at discharge. All PROMs showed improvement although differences across delivery formats were not clinically meaningful. Delivery via telerehabilitation had significantly lower odds of RTW at discharge (Odds Ratio: 0.82, 95% Confidence Interval: 0.70-0.97) and a significantly lower risk of experiencing suspension of wage replacement benefits in the first year following discharge (Hazard Ratio: 0.92, 95% Confidence Interval: 0.84-0.99). Associations were no longer significant when confounders were controlled for., Conclusion: RTW outcomes were not statistically different across delivery formats, suggesting that telerehabilitation is a novel strategy that may improve equitable access and earlier engagement in occupational rehabilitation. Factors such as gender and geographic location should be considered when deciding on service delivery format., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments., Methods: We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders., Results: 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003)., Conclusions: Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: The use of tele-mental health care increased rapidly in 2020 as a critical response to the COVID-19 pandemic, serving as an effective contact-free alternative to treatment. Today, tele-mental health care remains a viable option for individuals with geographic and physical barriers to treatment. However, there are several potential therapeutic disadvantages to tele-mental health care (ie, missing nonverbal signals, handling crises, confidentiality, weakened social connection in group therapy) that should be evaluated. While published literature has explored client satisfaction within teletherapy and the effect of using technology for tele-mental health care demands, there is a need for published surveys that evaluate the therapeutic experience in teletherapy and in-person mediums of care., Objective: The authors of this study sought to develop and validate a survey that could evaluate the comparative impact of teletherapy and in-person care from a therapeutic perspective across key factors (ie, therapeutic alliance, engagement, rapport, and confidentiality)., Methods: Participants were clients who experienced both tele-mental health care and in-person therapy at an intensive outpatient mental health treatment program for young adults from April 2020 through June 2022. Generated items on the survey were formulated based on input from experts in the field and existing validated scales. All individuals completed the survey on the internet, following informed consent (n=89). An exploratory factor analysis was conducted to understand factor structure, and Cronbach α was used to determine internal consistency. Incremental validity was demonstrated through a hierarchical linear regression., Results: The exploratory factor analysis revealed a 14-item, 3-factor structure. All 14 items correlated at a minimum of 0.30 with at least one other item. Kaiser-Meyer-Olkin measure of sampling adequacy was 0.75 and Bartlett's test of sphericity was significant (χ291=528.41, P<.001). In total, 3 factors accounted for 61% of the variance, and the preliminary Cronbach α (α=0.71) indicates a satisfactory level of internal consistency. The Zoom Exhaustion and Fatigue Scale (ZEF) and Client Satisfaction Questionnaire (CSQ; -0.29) were significantly correlated, as well as the ZEF and Therapy Mode Preference Scale (TMPS; -0.31), and CSQ and TMPS (0.50; P<.001). Hierarchical linear regression revealed that the CSQ significantly accounted for additional variance in the TMPS (P<.001). With the ZEF entered into the model, no further variance was accounted for (P=.06)., Conclusions: Continual research is warranted to expand the current findings by validating this standardized tool for assessing the therapeutic impact of teletherapy versus in-person care in a generalizable population., (© Brianna Cerrito, Jamie Xiao, Amanda Fialk, Frank D Buono. Originally published in JMIR Formative Research (https://formative.jmir.org).)

Background: Geographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time-the time required for patients to travel from their residences to health facilities-remain understudied compared with others., Objective: This study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital., Methods: We sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients' travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups., Results: Our summary statistics show that, on average, 22.08% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients' drive time to the hospital increases. Specifically, the coefficient for drive time is -0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases., Conclusions: Our findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth's role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth., (©Youyou Tao, Ace Vo, Dezhi Wu, Junyuan Lin, Kala Seal, Abhay Mishra, Arindam Brahma. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.11.2024.)

Introduction: The rapid evolution and implementation of virtual care technologies for clinical use often exceeds the development of standardized implementation protocols, leading to gaps in the equitable and sustainable adoption of virtual care services, particularly in rural and remote areas. This paper introduces a comprehensive evaluation tool designed to assess community capacity and readiness for virtual care., Methods: The development of the tool was informed by experiences from the Virtual Care and Robotics Program at the University of Saskatchewan. It involved a collaborative, multi-stakeholder approach that engaged healthcare leaders, IT experts and community healthcare workers. This iterative process included defining evaluation categories, mapping evaluative domains and refining the tool into a user-friendly checklist manual., Results: The tool identifies three key domains for assessing readiness: clinical needs, technology infrastructure and human resources/workflows. It was piloted in the remote community of Fond du Lac, Saskatchewan, where it successfully qualified the community for implementing telerobotic ultrasound services. The tool facilitated local engagement and highlighted the community's specific needs and readiness, enhancing the implementation process., Conclusion: This evaluation tool contributes to bridging the gap between the rapid deployment of virtual care technologies and the need for comprehensive, standardized implementation protocols. It offers a structured, practical approach to assessing and enhancing community readiness for virtual care while promoting successful clinical implementation and equitable access to healthcare., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.