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This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.

Introduction: We highlight the utility of telemedicine and telementoring for the management of orthopaedic emergencies using a case of forearm compartment syndrome following a penetrating trauma in a northern Inuit community in Nunavik, Quebec, Canada., Methods & Results: As in many cases of compartment syndrome in rural settings, the patient was at a high risk of developing irreversible complications. A prompt diagnosis followed by an emergency decompressive fasciotomy was warranted. Using telemedicine and telementoring guidance, the diagnosis of compartment syndrome was made, and the patient's volar compartment was successfully decompressed by a local emergency physician in a timely manner. Subsequently, the patient was able to be safely transferred to a level 1 trauma centre for further surgical management. This included a second-look operative exploration, irrigation and debridement, completion of volar fasciotomy and ulnar nerve decompression. No complications were seen., Discussion: Our experience highlights two important clinical implications. First, telemedicine can be successfully implemented to facilitate clinical diagnosis of surgical emergencies in the rural setting. Second, telementoring can effectively allow surgeons to guide physicians remotely to perform emergency decompressive fasciotomy, which can help salvage the affected limb and significantly decrease the risk of debilitating complications.

Background: Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist., Methods: This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen's Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables., Results: Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81-0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound., Conclusion: This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.

Fetal alcohol spectrum disorder (FASD) is a diagnostic term used to describe an array of structural, neurocognitive, and behavioral effects that result from prenatal alcohol exposure. While ongoing efforts have been made to increase the capacity of communities to provide early FASD diagnosis, there continues to be on-going challenges, particularly for remote and rural communities. Telehealth is the use of technology to connect communities at a distance and has been effectively used in medicine for several decades. This literature review describes the use of telehealth in FASD and other developmental disabilities and makes recommendations for how telehealth can be used to facilitate the assessment and diagnosis of FASD in rural and remote communities.

Background: Greenland is a vast country, with immense geographical distances and often extreme weather conditions. Specialized health care is limited to larger cities, and qualified medical care is not always immediately available in rural areas. Telemedicine infrastructure is available throughout the country. Purpose: The purpose of this study was to identify the role of telemedicine in the diagnosis and treatment of acute medical emergencies in remote settlements. Materials and Methods: All medical emergencies were screened from 2015 to 2016 in remote settlements of the Avannaa Health Region in Northwest Greenland, and cases in which telemedicine was utilized were identified. Results: Three illustrative cases were identified. Diagnoses were severe asthma, bilateral pneumonia, and heart failure. All three patients were accurately diagnosed through a telemedical consultation, and early treatment was initiated. In two out of three patients, acute medical evacuation by air ambulance was avoided, and the third patient was stabilized by the time an air ambulance arrived. Conclusions: Telemedicine allows for the accurate diagnosis of acute medical emergencies in remote settlements of Greenland and facilitates timely initiation of treatment. This may reduce morbidity and mortality of acute medical illness. In addition, telemedicine may aid in the clinical decision-making on whether or not to arrange for medical evacuation. Avoiding unnecessary medical evacuations reduces cost and risk to air ambulance crews. In addition, telemedicine allows for close monitoring of the patient until the air ambulance arrives. Telemedicine also ensures diagnostic and treatment options when medical evacuation is impossible due to extreme weather conditions. From a global perspective, telemedicine may increase the availability and quality of health care in remote areas and reduce health inequalities between remote and urban areas.

Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Telemedicine consultations in remote intensive care units (ICUs) overseas were found to be effective in reducing mortality and hospital length of stay (LOS). In Australia, there were anecdotal reports of these clinical outcomes. This retrospective before and after study assessed the improvement in patient outcomes with the implementation of a telemedicine program in a regional high dependency unit. Daily virtual consultations were conducted between the rural facility and the intensivists at the regional centre. A total of 525 patients received intensive care support between 2010 and 2015. Hospital and High Dependency Unit mortality showed no evidence of significant differences between the telemedicine group and the baseline (relative risk 1.02, 95% confidence interval [CI] 0.99-1.06, P =0.25 and relative risk 1.00, 95% CI 0.98-1.03, P =0.67 respectively). The hospital LOS was lower in the baseline group by 1.5 days. There was no significant difference in High Dependency Unit LOS. To adjust for the covariates in LOS, log linear regression analysis was performed. The telemedicine intervention, Acute Physiology and Chronic Health Evaluation II scores and inter-hospital transfers were found to contribute significantly to hospital LOS. The most important result of the study was that the proportion of inter-hospital transfers was lower in the telemedicine group (relative risk 0.88, 95% CI 0.80-0.98, P =0.03) compared to baseline. This means that critically ill patients in our regional centre can continue to receive specialist care remotely through tele-ICU consultations thus avoiding the need for patient transport. However, further study is needed to establish the benefits and risks of telemedicine intervention in ICUs in Australia.

Objective: To identify the current scope of Tele-Derm, the types of dermatological complaints experienced in the rural primary care setting, and to assess the quality of patient clinical information provided to the consultant dermatologist., Design: Retrospective case analysis., Setting: Tele-Derm National is an initiative of the Australian College of Rural and Remote Medicine and has been providing online educational and consultational services in dermatology to doctors Australia-wide for over a decade., Participants: Patient cases that were submitted to Tele-Derm for specialist dermatologist advice., Interventions: Audit of submitted cases., Main Outcome Measures: The types of patient presentations and reason for submission for specialist opinion were analysed. The quality of clinical information provided was also evaluated., Results: A total of 406 cases submitted over 2012-2013 were analysed. Most patients were from the outpatient setting with 'rash' or dermatitis (66%). Almost one-third of patients were paediatric cases. The average time from submission to dermatologist reply was 5.5 hours. Clinical photos were provided in 83% of cases and 73% of these were assessed as being of good quality. Management advice was provided in 77% of cases, of which reference to the case-based learning modules on Tele-Derm was made in 21% of cases. Patient outcome was largely unknown (83%)., Conclusion: This study identified some of the common dermatological complaints presenting to rural and remote primary care doctors in Australia. The unique addition of professional development in Tele-Derm can be used as an adjunct to advice provided to the rural doctors seeking advice for patient management., (© 2015 National Rural Health Alliance Inc.)

This study was undertaken to determine whether antenatal care can be achieved in women with at-risk pregnancies residing in rural areas with limited access to antenatal care and maternal fetal medicine (MFM) specialists. Over a period of 15 months, 156 women with high-risk pregnancies (diabetes, hypertensive disorders, suspected fetal anomalies, prior caesarean complications) from six different healthcare units had 350 visits managed by telemedicine., (© 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Telemedicine is a patient consultation method commonly available to patients in rural and remote areas throughout Australia. Its use in paediatric orthopaedics has been rarely described. The primary aim of this study was to identify the patient cohort accessing the orthopaedic paediatric telehealth service through the Royal Children's Hospital Queensland, so as to better allocate this resource. The secondary aims were to identify the orthopaedic conditions the patients utilizing this service suffered and to follow-up on treatment outcomes to potentially assess clinical benefit., Method: A retrospective review of prospectively collected data of paediatric orthopaedic patients consulted using telehealth at the Royal Children's Hospital, Queensland over a 10-year period between January 2004 and September 2012 was conducted., Results: One hundred and twenty-six patient records were assessed with a mean age of 6 years. Results showed that 40% of patients seen using telehealth in paediatric orthopaedics had documented cerebral palsy, an intellectual disability or congenital syndrome. Common paediatric orthopaedic conditions were seen, with lower limb malalignment being the most common presenting complaint. About 58% of patients were seen exclusively via telehealth and did not require in-person consultation or operative therapy., Conclusion: We found that the orthopaedic telepaedriatic consultation service at the Royal Children's Hospital reviewed a large proportion of patients with a known disability. We believe there is a role for telehealth medicine for all patients; however, we propose that even greater benefit can be obtained from telehealth consultation in patients with a disability where the cost and inconvenience of patient transport is considerably increased., (© 2014 Royal Australasian College of Surgeons.)

There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The research team assessed community acceptability of prehospital stroke telemedicine services in rural O‘ahu communities. Tools were developed to evaluate patient-centered goals about implementing ambulance-based telemedicine which aimed to retain appropriate patients in community hospitals and improve thrombolytic treatment times. Using a mixed methods approach, the team surveyed well-appearing adults (ie, able to complete survey and interview) at O‘ahu community events. Participants were asked to complete a short Likert-scale questionnaire (n=263) followed by a semi-structured interview (n=29). Data were summarized by descriptive and inferential statistics. Comparisons between rural and urban groups were made by chi-square analysis and Wilcoxon rank-sum 2-tailed test. Interviews were transcribed, coded, and analyzed using inductive and deductive methods. The findings suggest that use of prehospital telemedicine for specialty care is viewed favorably by both rural and urban respondents. Additionally, most respondents felt comfortable staying at their local hospital if they had access to a specialist by telemedicine. However, mistrust in rural hospitals may be a potential barrier to implementation. Compared to urban respondents, rural respondents were less confident in their local hospital’s resources and capabilities for stroke care. The findings identified a potential misalignment of the project’s goal with some patients’ goal to use emergency medical services (EMS) to bypass rural hospitals for stroke care. Future community outreach efforts are needed to encourage activation of EMS and highlight the advantages of utilizing prehospital telemedicine for accessing specialty care thereby improving treatment times. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to address the challenges faced by rural emergency medical services in Europe, due to an increasing number of missions and limited human resources. The primary objective was to determine the necessity of having an on-site emergency physician (EP), while the secondary objectives included analyzing the characteristics of rural EP missions. Methods A retrospective study was conducted, examining rural EP missions carried out between January 1st, 2017, and December 2nd, 2021 in Burgenland, Austria. The need for physical presence of an EP was classified based on the National Advisory Committee for Aeronautics (NACA) score into three categories; category A: no need for an EP (NACA 1–3); category B: need for an EP (NACA 1–3 along with additional medical interventions beyond the capabilities of emergency medical technicians); and category C: definite need for an EP (NACA 4–7). Descriptive statistics were used for analysis. Results Out of 16,971 recorded missions, 15,591 were included in the study. Approximately 32.3% of missions fell into category A, indicating that an EP’s physical presence was unnecessary. The diagnoses made by telecommunicators matched those of the EPs in only 52.8% of cases. Conclusion The study suggests that about a third of EP missions carried out in rural areas might not have a solid medical rationale. This underscores the importance of developing an alternative care approach for these missions. Failing to address this could put additional pressure on already stretched EMS systems, risking their collapse.

Background: This study aimed to address the challenges faced by rural emergency medical services in Europe, due to an increasing number of missions and limited human resources. The primary objective was to determine the necessity of having an on-site emergency physician (EP), while the secondary objectives included analyzing the characteristics of rural EP missions. Methods: A retrospective study was conducted, examining rural EP missions carried out between January 1st, 2017, and December 2nd, 2021 in Burgenland, Austria. The need for physical presence of an EP was classified based on the National Advisory Committee for Aeronautics (NACA) score into three categories; category A: no need for an EP (NACA 1–3); category B: need for an EP (NACA 1–3 along with additional medical interventions beyond the capabilities of emergency medical technicians); and category C: definite need for an EP (NACA 4–7). Descriptive statistics were used for analysis. Results: Out of 16,971 recorded missions, 15,591 were included in the study. Approximately 32.3% of missions fell into category A, indicating that an EP's physical presence was unnecessary. The diagnoses made by telecommunicators matched those of the EPs in only 52.8% of cases. Conclusion: The study suggests that about a third of EP missions carried out in rural areas might not have a solid medical rationale. This underscores the importance of developing an alternative care approach for these missions. Failing to address this could put additional pressure on already stretched EMS systems, risking their collapse. [ABSTRACT FROM AUTHOR]

Introduction: Interprofessional consultations ("eConsults"), which facilitate asynchronous specialist consultations, remain understudied in neurological disorders. We aimed to describe the patient population receiving eConsult services for neurological disorders nationwide and to conduct a comparative analysis between rural and urban patients within this eConsult cohort. Methods: We analyzed a dataset of U.S. outpatient claims from employer-sponsored commercial and Medicare plans. Using standardized mean differences, we compared clinical and sociodemographic patient characteristics between urban and rural patients within the eConsult group. Results: We identified 1,374 patients who had an eConsult order for a neurological disorder. Overall eConsult volume increased by 548.5% between 2019 and 2021. A majority of the cohort were aged 65 years or older (23.7%), had an eConsult order in 2021 (52.4%), and live in an urban area (90.4%). The primary diagnosis for our cohort was likely to be a sleep-wake disorder (21.9%), cerebrovascular disease (14.3%), neurological sign or symptom (14.2%), or headache (13.7%). In the secondary analysis, rural eConsult patients exhibited higher rates of primary diagnoses for traumatic brain injury, neuroophthalmic disorders, or neuropathy than their urban counterparts. Discussion: In this national sample of commercially insured patients, the utilization of eConsults for neurological conditions increased nationwide since 2019, especially for patients living in rural areas. [ABSTRACT FROM AUTHOR]

Introduction: An estimated 20% of residents of Renfrew County, a rural and underserved community in Ontario, do not have a family physician or alternative primary care provider. Integrated virtual care (IVC) aims to address this crisis by enrolling individuals who are not currently attached to a primary care provider, to a named family physician who works predominantly remotely. The physician is embedded within an existing, local family health team. The aim of this study was to assess and describe the IVC model's capacity to enrol previously unattached patients in Renfrew County and provide adequate primary care. Methods: We conducted a cross-sectional, descriptive study of data collected from patients enrolled for at least 3 months to an IVC family physician from 15 November 2021 (earliest appointment date for first IVC patients) to 30 June 2022 inclusive. Results: N = 790 patients were successfully attached to a family physician and received at least 3 months of care through IVC within the study period. Of the study population, 65% were female and over 75% were under the age of 55. Among patients who were current smokers at the time of IVC enrolment (n = 115), approximately 1 in 5 (18.3%) started a smoking cessation programme following referral by their IVC physician. In addition, IVC physicians and allied health professionals performed 66 colorectal cancer screenings, 164 cervical cancer screenings and 39 breast cancer screenings during the study period, bringing many overdue patients up to date for routine testing. Conclusion: IVC has been successful in attaching previously unattached patients to a family physician and providing, comprehensive, team-based primary care during its initial 7 months of operation. Similar integrated primary care delivery concepts can also use these results to guide their own development and quality improvement. Résumé Introduction: On estime que 20% des habitants du comté de Renfrew, une communauté rurale et mal desservie de l'Ontario, n'ont pas de médecin de famille ou d'autre prestataire de soins primaires. Le programme de Soins virtuels intégrés (SVI) vise à résoudre cette crise en proposant aux personnes qui n'ont pas de prestataire de soins primaires de consulter un médecin de famille désigné qui travaille principalement à distance. Le médecin est intégré à une équipe de santé familiale locale existante. L'objectif de cette étude était d'évaluer et de décrire la capacité du modèle de SVI à inscrire des patients qui n'étaient pas rattachés à un prestataire de soins primaires dans le comté de Renfrew et à leur fournir des soins primaires adéquats. Méthodes: Nous avons mené une étude transversale et descriptive des données recueillies auprès des patients inscrits depuis au moins trois mois auprès d'un médecin de famille IVC entre le 15 novembre 2021 (date de rendez-vous la plus proche pour les premiers patients SVI) et le 30 juin 2022 inclus. Résultats: N = 790 patients ont été rattachés avec succès à un médecin de famille et ont reçu au moins 3 mois de soins par l'intermédiaire des SVI au cours de la période d'étude. Parmi la population étudiée, 65% étaient des femmes et plus de 75% avaient moins de 55 ans. Parmi les patients qui fumaient au moment de leur inscription aux SVI (n = 115), environ 1 sur 5 (18,3%) a entamé un programme de sevrage tabagique après avoir été orienté par son médecin en SVI. En outre, les médecins du centre et les professionnels paramédicaux ont effectué 66 dépistages du cancer colorectal, 164 dépistages du cancer du col de l'utérus et 39 dépistages du cancer du sein au cours de la période d'étude, ce qui a permis à de nombreux patients en retard de SE soumettre à des tests de routine. Conclusion: Le programme de SVI a réussi à mettre en relation des patients qui ne l'étaient pas auparavant avec un médecin de famille et à fournir des soins primaires complets en équipe au cours de ses sept premiers mois d'activité. Des concepts similaires de prestation de soins primaires intégrés peuvent également utiliser ces résultats pour guider leur propre développement et l'amélioration de la qualité. Mots-clés: Médecins de soins virtuels intégrés, médecine rurale, médecins de famille, patients ruraux isolés [ABSTRACT FROM AUTHOR]

Abstract Background In British Columbia (BC), rural and remote areas lack proximal access to radiographic services. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. As a solution to the lack of access to radiographic services in rural settings, the Rural Coordination Centre of BC (RCCbc) supported rural Family Physicians (FPs) wishing to use PoCUS through the Intelligent Network for PoCUS (IN PoCUS) program. This study evaluates FPs’ experience and use of PoCUS in their clinical practice. Methods This qualitative study conducted in-depth virtual interviews with 21 FPs across rural BC. The interview asked participants’ motivation to participate in the RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology, and their experience interacting with specialists in regional centres. Thematic analysis of findings was undertaken. Results This study used Rogers’ framework on the five elements of diffusion of innovation to understand the factors that impede and enable the adoption of PoCUS in rural practice. Rural FPs in this study differentiated PoCUS from formal imaging done by specialists. The adoption of PoCUS was viewed as an extension of physical exams and was compatible with their values of providing generalist care. This study found that the use of PoCUS provided additional information that led to better clinical decision-making for triage and allowed FPs to determine the urgency for patient referral and transport to tertiary hospitals. FPs also reported an increase in job satisfaction with PoCUS use. Some barriers to using PoCUS included the time needed to be acquainted with the technology and learning how to integrate it into their clinical flow in a seamless manner. Conclusion This study has demonstrated the importance of PoCUS in improving patient care and facilitating timely diagnosis and treatment. As the use of PoCUS among FPs is relatively new in Canada, larger infrastructure support such as improving billing structures, long-term subsidies, educational opportunities, and a quality improvement framework is needed to support the use of PoCUS among rural FPs.

Background: In British Columbia (BC), rural and remote areas lack proximal access to radiographic services. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. As a solution to the lack of access to radiographic services in rural settings, the Rural Coordination Centre of BC (RCCbc) supported rural Family Physicians (FPs) wishing to use PoCUS through the Intelligent Network for PoCUS (IN PoCUS) program. This study evaluates FPs' experience and use of PoCUS in their clinical practice. Methods: This qualitative study conducted in-depth virtual interviews with 21 FPs across rural BC. The interview asked participants' motivation to participate in the RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology, and their experience interacting with specialists in regional centres. Thematic analysis of findings was undertaken. Results: This study used Rogers' framework on the five elements of diffusion of innovation to understand the factors that impede and enable the adoption of PoCUS in rural practice. Rural FPs in this study differentiated PoCUS from formal imaging done by specialists. The adoption of PoCUS was viewed as an extension of physical exams and was compatible with their values of providing generalist care. This study found that the use of PoCUS provided additional information that led to better clinical decision-making for triage and allowed FPs to determine the urgency for patient referral and transport to tertiary hospitals. FPs also reported an increase in job satisfaction with PoCUS use. Some barriers to using PoCUS included the time needed to be acquainted with the technology and learning how to integrate it into their clinical flow in a seamless manner. Conclusion: This study has demonstrated the importance of PoCUS in improving patient care and facilitating timely diagnosis and treatment. As the use of PoCUS among FPs is relatively new in Canada, larger infrastructure support such as improving billing structures, long-term subsidies, educational opportunities, and a quality improvement framework is needed to support the use of PoCUS among rural FPs. [ABSTRACT FROM AUTHOR]

Since the onset of the COVID-19 pandemic, health care systems have increased their telehealth services to meet the changing public health needs. Before the pandemic, telehealth was used primarily in surgical specialties for postoperative visits and rural medicine. However, out of necessity, nearly all medical and surgical subspecialties incorporated this virtual technology to improve patient health care access in a short time. Few studies have addressed telehealth in pediatric and adolescent gynecology (PAG) to date. To describe the large-scale utilization of telehealth visits, assess patient experience, and improve access to care in a large academic ambulatory gynecology PAG clinic This retrospective, cross-sectional quality improvement study was performed by administering patient surveys and compiling aggregate data from the EPIC electronic health record in the Division of Pediatric and Adolescent Gynecology clinics at a single children's hospital between March 2020 and March 2021. Patient demographic characteristics, payer characteristics, visit type and purpose, and patient experience were reviewed. Wider expansion of telehealth in PAG clinics at a single institution A total of 6159 telehealth appointments were performed, involving 6 clinic sites and 9 providers. Telehealth visits constituted 50% of the total ambulatory volume (12,527). Most patients were located within the institution's state (99.5%), and the remaining called into their telehealth visits from a neighboring state. Most patients were 18 years of age or younger (73%). Video visits lasted 15-30 minutes and included routine follow-up (66.3%), new/consult visits (28.4%), postoperative visits (1.6%), and urgent follow-up (0.2%). The patient population was ethnically diverse by self-identification: 61.4% White, 38.4% Hispanic, 16% Black, 4.4% Asian, and 0.4% Native Hawaiian/American Indian/Alaska Native. Payer mix included self-pay (45.5%), private payer (32.2%), and Medicaid/CHIP (22.3%). Conditions seen ranged from menstrual management (71%) and routine preventive or acute gynecologic concerns (21%) to surgical evaluation for congenital anomalies, endometriosis, fertility preservation, and genital concerns or pelvic masses (8%). Telehealth visits met patient expectations for 87.3% of respondents. Patient-reported opportunities for improvement included improving set-up instructions and more consistent audio/video connections. Challenges identified by providers included difficulty utilizing interpreters, technology limitations, and privacy constraints during HEADSS examination. This study demonstrates how a large, diverse volume of patients with PAG needs received appropriate care through a telehealth format during the COVID-19 pandemic. Patients were satisfied with the services, but opportunities for improvement were elicited to allow for continued refining of this health care delivery tool in the future. [ABSTRACT FROM AUTHOR]

Objectives: Delayed inter‐hospital transfers of deteriorating neurotrauma patients from rural and regional hospitals to tertiary centres have seen the need for non‐neurosurgeons to undertake emergency intracranial haematoma evacuation surgery locally. In the present study, the authors contributed to the paucity in the literature regarding the widespread availability of cranial access equipment in non‐tertiary centres and patient outcomes in Queensland. Methods: We surveyed delegates (senior theatre nurses or surgical service directors) from rural and regional Queensland hospitals if they were located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes. Results: Twenty‐six delegates from eligible hospitals responded. Eighteen hospitals offered surgical services. Eleven hospitals housed complete mechanical cranial access kits. Five hospitals housed incomplete kits. Thirteen hospitals housed their equipment sterile in the operating theatre or ED. Eleven hospitals reported using the equipment, with last usage ranging from 4 months to over 30 years. Two hospitals reported using the equipment within 12 months while a further five reported using it within 10 years. Two hospitals reported 'good' outcomes, two 'ok' and one 'poor'. Conclusions: The availability of cranial access equipment outside Queensland tertiary centres has been limited. Inter‐hospital transfers are likely to persist in Queensland and haematoma evacuation surgery has been a life‐saving endeavour, so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted. [ABSTRACT FROM AUTHOR]

The article offers information that one of the biggest public health crises of our day is the opioid epidemic in the U.S. whereas the U.S. is experiencing a mortality crisis brought on by opioid overdoses, and opioid addiction is a key factor in the country's plummeting life expectancy. It also discusses that the U.S. opioid crisis has historically been divided into three primary periods, each driven by a distinct cause of opioid mortality.

Aim: To investigate patient and clinician feedback on remote telehealth consultations to determine their feasibility for use as an adjunct service. Methods: A cross‐sectional investigation of satisfaction with telehealth consultations. In total, one oral medicine specialist, four dentists and 88 patients were surveyed. Results: A total of 88 video consultations were completed with patients in Christchurch and Wellington hospitals. There was always a dentist present with the patient during the consultation. Overall, 95.5% of patients found the experience to be comfortable, with no systematic differences by sex, age, ethnicity or reason for the visit. Most patients were satisfied with the treatment received during the video consultations. Fewer patients who presented with pain were satisfied with the treatment received than were those who presented with oral mucosal disorders or other issues (61.8%, 75.0% and 76.9%, respectively). Both the oral medicine specialist and clinicians involved found the process comfortable and did not find diagnostic capabilities to be compromised. Conclusion: Video telehealth might be a valid alternative or adjunct to face‐to‐face consultations. This may open the way for remote video consultations to improve the availability of oral medicine services in rural areas. [ABSTRACT FROM AUTHOR]

Introduction: Acute care telemedicine is a critical resource for rural and community Emergency Medicine (EM) providers. To address potential barriers and promote use of these services throughout our health system Emergency Departments (EDs), we embed telemedicine consultations within in situ simulations. Materials and Methods: Care teams in health system EDs participated in multidisciplinary in situ simulations that focused on Difficult Airway management or Obstetric Emergencies. Physicians in EM and Neonatology at the referral center were available for assistance via telemedicine consultation. Participants were then surveyed regarding their experience with the telemedicine consultation during the simulations. Results: Participants reported increased likelihood to use telemedicine as well as increased understanding of the technology, awareness of available consultation services, and comfort interacting with the consultant. Conclusions: Embedding telemedicine consultations into in situ EM simulations is an effective approach to address implementation barriers and may promote increased use of telemedicine services among rural and community EM providers. [ABSTRACT FROM AUTHOR]

Background: Clinical practice is increasingly being digitalised. Little is known about how medical students learn and were exposed to telehealth during COVID-19. This is particularly important if we wish to further improve healthcare access and equity in rural areas and vulnerable populations. This formative study sought to explore the exposure and attitudes of medical students on telehealth and COVID-19 during their rural clinical placement in 2020 and provide recommendations. Methods: Focus groups were held in August 2020 after completion of a 12-month rural placement. Questions centred around students' exposure and experiences with telehealth during COVID-19. Data was analysed using thematic analysis. Results: There has been a clear shift in students now acknowledging the importance of telehealth and, more importantly, expressing a clear wish for telehealth to be embedded in the curriculum starting in their first year. In tandem with this, students expressed the need for their clinical supervisors or hospital teams to have the capability to practice telehealth efficiently as this will improve the telehealth experience and lead to better engagement for both staff and students. Furthermore, it was felt that rural clinicians should play a lead role in telehealth implementation given it is integral to rural practice. Conclusions: Medical students are more exposed to and more interested to learn about telehealth since COVID-19 and wish to see telehealth training built into their curriculum from the outset of medical school. Themes that emerged from this formative study can potentially assist in planning for telehealth education during and post COVID-19 and inform further telehealth research. Embedding telehealth skills training and guidelines into the medical program, and particularly rural medicine training programs, is essential to prepare the future medical workforce to ensure access and quality patient care during pandemics and also to improve access for rural Australians. [ABSTRACT FROM AUTHOR]

Context: Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at a patient's bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients' lives. Meta-analyses on point-of-care ultrasound have reported extremely high sensitivity and specificity when detecting lung pathology, and the potential applications of the technology are substantial. A significant application of the technology is in the care of rural paediatric patients, where acute lower respiratory pathology is the most common cause of preventable deaths, hospitalisations, and emergency medical retrievals from remote communities for children under five. Issues: Although widely available, point-of-care ultrasound technology is not widely utilised in Australian emergency departments and general practices. Issues with comprehensive training, maintenance of skills, upskilling and quality assurance programs prevent physicians from feeling confident when utilising the technology. In Canada, point-of-care ultrasound training is part of the core competency training in the Royal College of Physicians of Canada emergency medicine fellowship program. Point-of-care ultrasound is widely used in rural practice, although lack of training, funding, maintenance of skills and quality assurance were still listed as barriers to use. Lessons learned: Point-of-care ultrasound is a highly sensitive and specific technology with wide potential applications. Issues with quality control and maintenance of skills are preventing widespread use. Coupling point-of-care ultrasound with telemedicine could help increase the usability and accessibility of the technology by reducing the issues associated with maintenance of skills and quality assurance. [ABSTRACT FROM AUTHOR]

Background The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics. Results Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm3) than that of the F2F group (596.3 cells/mm3; P  < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P  = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 104 and –1 to 0.24 × 104, respectively (P  = 1.00). Conclusions TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted. [ABSTRACT FROM AUTHOR]

Background: Rural hospitals struggle to staff inpatient services and may not have the clinical expertise to achieve optimal outcomes. Telehospitalist services could address these problems by bringing hospital medicine expertise to rural communities. Introduction: Veterans Health Administration (VHA) rural hospitals need staffing alternatives to address gaps in inpatient coverage. This needs assessment identified perceived need for telehospitalist services as well as potential applications, benefits, and barriers from an administration perspective. Materials and Methods: We used a rapid qualitative assessment approach based on semistructured interviews with 15 physician administrators at 12 rural and low-complexity hospitals in VHA in 2018. Results: We identified a range of needs that could be addressed by telehospitalist services, including direct care delivery, support for local providers, and on-demand coverage to fill staffing gaps. Potential benefits included cost reductions, improved care quality, education, and addressing feelings of insular practice. Potential barriers included provider buy-in, cost, and technological limitations. Discussion: Our findings suggest that telehospitalist services could address inpatient coverage gaps, but with a range of views on how the service could be deployed. Telehospitalist services providing intermittent coverage could meet unmet clinical needs at appropriate economies of scale. Administrators were enthusiastic about applying innovative inpatient telemedicine initiatives, but perceived staff reluctance. The dynamic and multidisciplinary nature of inpatient care requires program acceptance at multiple levels, which may account for why it traditionally lags behind outpatient telemedicine. Conclusions: Rural hospital physician administrators perceived telehospitalist models as a viable option to address staffing needs and improve quality of care. [ABSTRACT FROM AUTHOR]

Background:Greenland is a vast country, with immense geographical distances and often extreme weather conditions. Specialized health care is limited to larger cities, and qualified medical care is not always immediately available in rural areas. Telemedicine infrastructure is available throughout the country. Purpose:The purpose of this study was to identify the role of telemedicine in the diagnosis and treatment of acute medical emergencies in remote settlements. Materials and Methods:All medical emergencies were screened from 2015 to 2016 in remote settlements of the Avannaa Health Region in Northwest Greenland, and cases in which telemedicine was utilized were identified. Results:Three illustrative cases were identified. Diagnoses were severe asthma, bilateral pneumonia, and heart failure. All three patients were accurately diagnosed through a telemedical consultation, and early treatment was initiated. In two out of three patients, acute medical evacuation by air ambulance was avoided, and the third patient was stabilized by the time an air ambulance arrived. Conclusions:Telemedicine allows for the accurate diagnosis of acute medical emergencies in remote settlements of Greenland and facilitates timely initiation of treatment. This may reduce morbidity and mortality of acute medical illness. In addition, telemedicine may aid in the clinical decision-making on whether or not to arrange for medical evacuation. Avoiding unnecessary medical evacuations reduces cost and risk to air ambulance crews. In addition, telemedicine allows for close monitoring of the patient until the air ambulance arrives. Telemedicine also ensures diagnostic and treatment options when medical evacuation is impossible due to extreme weather conditions. From a global perspective, telemedicine may increase the availability and quality of health care in remote areas and reduce health inequalities between remote and urban areas. [ABSTRACT FROM AUTHOR]

BACKGROUND: Disparities in healthcare access and delivery, caused by transportation and health workforce difficulties, negatively impact individuals living in rural areas. These challenges are especially prominent in older adults. DESIGN: We systematically evaluated the feasibility, acceptability, and effectiveness in providing telemedicine (TMed), searching the English‐language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO). PARTICIPANTS: Older adults (mean age = 65 years or older, and none were younger than 60 years). INTERVENTIONS: Interventions consisted of live, synchronous, two‐way videoconferencing communication in nonhospital settings. All medical interventions were included. MEASUREMENTS: Quality assessment, using the Cochrane Collaboration's Risk‐of‐Bias Tool, was applied on all included articles, including a qualitative summary of all articles. RESULTS: Of 6616 citations, we reviewed the full text of 1173 articles, excluding 1047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]), with cohort sizes ranging from 3 to 844 (median = 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that TMed can improve health outcomes in older adults and that it could be used in this population. CONCLUSIONS: TMed is feasible and acceptable in delivering care to older adults. Research should focus on well‐designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using TMed in routine practice to overcome barriers of distance and access to care. J Am Geriatr Soc 67:1737–1749, 2019 [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the feasibility and effectiveness of an intervention anchored on mHealth and task sharing strategy of involving non-physician health workers (NPHW) on population level detection, treatment and control of hypertension and diabetes in India. Methods: Non-physician health workers (NPHWs) equipped with tablet computers that were linked with point-of-care devices for blood pressure (BP) and blood sugar measurements visited households, screened adult individuals for hypertension and diabetes from two randomly selected villages in the Medchal district, Telangana, India. Further, they digitally connected those individuals with hypertension and diabetes to a study physician via Skype, and handed over a printed e-prescription. Medication adherence checks, BP and fasting blood sugar measurements were done once a month and doctor consultations once in three months during follow-up. Results: Among 2456 eligible individuals, 1751 and 1686 individuals were screened for hypertension and diabetes, respectively. Prevalence of hypertension was 23·6% (95% CI 21·6%-25·6%) and among them 38.9% were newly detected. Prevalence of diabetes was 11·2% (9·7%-12·7%) and 28.6% of them were newly detected. After 24 months of intervention, control of BP and blood sugar was achieved in 54.0% and 34·1% of individuals with hypertension and diabetes, respectively. Blood pressure control rate improved by 12% (7.9%-16.0%) in known hypertensive individuals over the intervention period. Interpretation: This research demonstrates the feasibility and local acceptability of a mHealth intervention strategy anchored on NPHWs guided by physicians for detection, treatment and regular follow-up of individuals with hypertension and diabetes in a community setting in India. [ABSTRACT FROM AUTHOR]

Telemedicine which is defined as the provision of healthcare services by a physician at a distance, is a method that provides it in many general and specialized field of medicine even in rural areas. COVID-19 is a singular disorder with an incompletely defined medical course, mainly for youngsters and susceptible populations. In 5% of COVID-19, severe diseases which needs intensive care unit has been reported. As it spreads rapidly and regarding it contagious feature even by healthcare facilities, new models of care are needed to decreases the probability of face-to-face contact between patients and caregivers. The integration of eHealth for patients with COVID- 19 is indicated as a global emergency to reduce virus transmission. [ABSTRACT FROM AUTHOR]

Objective: Rural areas in Ontario have fewer psychiatrists, making access to specialist mental health care challenging. Our objective was to characterise psychiatrists delivering and patients receiving telepsychiatry in Ontario and to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalisation.Method: We conducted a serial panel study to evaluate the characteristics of psychiatrists providing telepsychiatry from April 2007 to March 2013. In addition, we conducted a cross-sectional study for fiscal year 2012-2013 to examine telepsychiatry patient characteristics and create an in-need patient cohort of individuals with a recent psychiatric hospitalisation that assessed if they had follow-up with a psychiatrist in person or through telepsychiatry within 1 year of discharge.Results: In fiscal year 2012-2013, a total of 3801 people had 5635 telepsychiatry visits, and 7% ( n = 138) of Ontario psychiatrists provided telepsychiatry. Of the 48,381 people identified as in need of psychiatric care, 60% saw a local psychiatrist, 39% saw no psychiatrist, and less than 1% saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry within a year. Three northern regions had more than 50% of in-need patients fail to access psychiatry within 1 year.Conclusions: Currently, relatively few patients and psychiatrists use telepsychiatry. In addition, patients scarcely access telepsychiatry for posthospitalisation follow-up. This study, which serves as a preliminary baseline for telepsychiatry in Ontario, demonstrates that telepsychiatry has not evolved systematically to address need and highlights the importance of system-level planning when implementing telepsychiatry to optimise access to care. [ABSTRACT FROM AUTHOR]

This paper focuses on telemedicine implementation, which can be used to extend modern medical knowledge to remote areas in developing countries. By examining doctor- patient interactions in the context of a telemedicine program in India, we posit how the behaviour of the actors interacting over virtual media is determined by interplay between two dominant institutional logics, namely logic of care and logic of choice. The paper draws on the tenets of institutional logics to extend the theoretical understanding about processes of engagement of actors with a new technology and explicates how the engagement evolves with the use of technology. The research emphasizes the essential role of considering the dynamics of logic of care and logic of choice in the design and implementation process. [ABSTRACT FROM AUTHOR]

Introduction: Honduras is the second poorest country in Central America, and roughly 50% of the population lives in rural areas. A telehealth network linking these areas to larger health centers may improve patient access to care, and physician access to educational opportunities. This pilot study assessed the feasibility of establishing a pediatric telehealth network between underserved clinics in Honduras and the Medical University of South Carolina (MUSC). Methods: Two underserved Honduran clinics were identified and invited to participate in the telehealth network. Providers from these clinics connected remotely to educational conferences at MUSC, and received teleconsults from MUSC physicians and physicians from the other Honduran site. Honduran providers completed five-point Likert scale satisfaction surveys following participation in the conferences and teleconsults. Results: Survey feedback was positive, with 100% of respondents stating they would utilize telemedicine in the future. Dissatisfaction was expressed subjectively in the survey comments with regards to poor Internet connectivity and unreliable electrical power. Conclusions: The establishment of a telehealth network between Honduras and MUSC is feasible, and rural providers were receptive to the clinical and educational opportunities this network provides. Future projects will expand telehealth capabilities to other Honduran sites and focus on intra-country collaboration to ensure sustainability. [ABSTRACT FROM AUTHOR]

Background: Surgical telementoring, consisting of an expert surgeon guiding a less experienced surgeon through advanced or novel cases from a remote location, is an evolving technology which has potential to become an integral part of surgical practice. This study sought to apprise the attitudes of rural general surgeons toward the possible benefits and applications of surgical telementoring in their practices.Methods: A survey assessing demographics and attitudes toward telementoring was e-mailed to members of the American College of Surgeons (ACS) Advisory Council for Rural Surgery and posted to the ACS website in areas targeting rural surgeons. A link to a webpage with a description of surgical telementoring and brief demonstrative video were included with the survey.Results: There were 159 respondents, with 82.3 % of them practicing in communities smaller than 50,000 people. Overall, 78.6 % felt that telementoring would be useful to their practice, and 69.8 % thought it would benefit their hospitals. There was no correlation between years of practice and perceived usefulness of surgical telementoring. When asked the single most useful, or primary, application of surgical telementoring there was a split between learning new techniques (46.5 %) and intraoperative assistance with unexpected findings (39.0 %). When asked to select all applications in which they would be interested in using telementoring from a list of possible uses, surgeons most frequently selected: intraoperative consultation for unexpected findings (67.7 %), trauma consultation (32.9 %), and laparoscopic colectomy (32.9 %).Conclusions: Surgical telementoring is on the verge of widespread use but industry and surgical societies remain ambivalent about supporting its implementation due to concerns over lack of interest. This study demonstrates interest among rural surgeons. While there are differing opinions regarding compensation of the telementoring, the most common, single interest in the use of surgical telementoring was for learning new techniques or skill sets. [ABSTRACT FROM AUTHOR]

Introduction Tele-diagnostic audiological testing in a hearing screening program for infants and young children is a novel practice, and this study is the first to explore its application in a rural community. It is important to understand parental perceptions and confidence when introducing a new process such as tele-audiological diagnostic testing in rural areas. Method A questionnaire with 17 rater-administered items was designed to elicit comments concerning the quality of tele-hearing testing and video-conferencing, access to tele-hearing testing, and parents' attitudes regarding tele-hearing testing in the village. The questionnaire was administered by an audiologist not involved in tele-diagnostic testing to avoid bias. Results Parents perceived tele-hearing testing as equal in quality to in-person testing. Technical factors such as good video-conferencing quality and logistical factors such as ease of access due to reasonable travel time to testing facility could have influenced these perceptions. Conclusions While these results show tele-hearing testing is an acceptable alternative, occasional poor signal quality should be addressed prior to large-scale implementation. [ABSTRACT FROM AUTHOR]

Background: Teledermatology is a mainstream modality for delivering care in the Veterans Health Administration, especially in rural areas where access to traditional dermatology care is constrained. Previous investigations of the effect of teledermatology on improving patient access have focused largely on the metrics of visits avoided. However, the effect of teledermatology on improving patient access to face-to-face dermatology has not been well documented. The purpose of this study was to assess the impact of the implementation of store-and-forward teledermatology on access to face-to-face dermatology at the Mann-Grandstaff Spokane Veterans Administration (VA) Medical Center in Spokane, WA. Materials and Methods: Completed requests for dermatology and teledermatology consultation originating from the Spokane main facility from January 1, 2012 through June 30, 2013 were obtained from the Corporate Data Warehouse by SQL query. The numbers of consult requests and wait times for care for overall dermatology, face-to-face dermatology, and teledermatology were compared across the baseline, transition, and intervention periods. Results: Within 6 months of implementation, the total number of requests for dermatology services increased by 40%. Access to face-to-face dermatology care improved, with a decrease in the duration of the interval between consultation request and consultation completion from a mean of 64.2 days to 20.3 days; overall access to dermatology (teledermatology and face-to-face dermatology) care improved with a decrease in the duration of the same from a mean of 61.2 days to 10.3 days. Conclusions: Implementation of a teledermatology program at the Mann-Grandstaff Spokane VA Medical Center improved access to face-to-face dermatology care. [ABSTRACT FROM AUTHOR]

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