BACKGROUND: In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme.
OBJECTIVE: To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development.
METHODS: Qualitative focus groups.
METHODS: Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted.
RESULTS: Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes.
CONCLUSIONS: Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services\' goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

UNASSIGNED: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood.
UNASSIGNED: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff\'s perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery.
UNASSIGNED: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework.
UNASSIGNED: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families.
UNASSIGNED: In this qualitative study exploring health care staff\'s experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.

BACKGROUND: The COVID-19 pandemic created unprecedented challenges for people with type 2 diabetes (T2D) and prediabetes to access in-person health care support. Primary care teams accelerated plans to implement digital health technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and prediabetes adjusted to these changes.
OBJECTIVE: This study aimed to explore how people with T2D and prediabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic and beyond.
METHODS: A purposive sample of people with T2D and prediabetes was recruited by text message from primary care practices that served low-income areas. Semistructured interviews were conducted by phone or video call, and data were analyzed thematically using a hybrid inductive and deductive approach.
RESULTS: A diverse sample of 30 participants was interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge of accessing support by rationing or delaying seeking support or by proactively requesting appointments. Barriers to accessing health care support were associated with issues with using the total triage system, a passive interaction style with health care services, or being diagnosed with prediabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity to use DHTs, which was caused by lower digital skills, fewer financial resources, and a lack of support to use the tools.
CONCLUSIONS: Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs lead to unequal possibilities for people with T2D and prediabetes to self-care and receive care during the COVID-19 pandemic. These issues can be addressed by proactive arrangement of regular checkups by primary care services and improving capacity for people with lower digital skills to engage with DHTs.

BACKGROUND: Breastfeeding benefits both the mother and infant and is a topic of attention in public health. After childbirth, untreated medical conditions or lack of support lead many mothers to discontinue breastfeeding. For instance, nipple damage and mastitis affect 80% and 20% of US mothers, respectively. Lactation consultants (LCs) help mothers with breastfeeding, providing in-person, remote, and hybrid lactation support. LCs guide, encourage, and find ways for mothers to have a better experience breastfeeding. Current telehealth services help mothers seek LCs for breastfeeding support, where images help them identify and address many issues. Due to the disproportional ratio of LCs and mothers in need, these professionals are often overloaded and burned out.
OBJECTIVE: This study aims to investigate the effectiveness of 5 distinct convolutional neural networks in detecting healthy lactating breasts and 6 breastfeeding-related issues by only using red, green, and blue images. Our goal was to assess the applicability of this algorithm as an auxiliary resource for LCs to identify painful breast conditions quickly, better manage their patients through triage, respond promptly to patient needs, and enhance the overall experience and care for breastfeeding mothers.
METHODS: We evaluated the potential for 5 classification models to detect breastfeeding-related conditions using 1078 breast and nipple images gathered from web-based and physical educational resources. We used the convolutional neural networks Resnet50, Visual Geometry Group model with 16 layers (VGG16), InceptionV3, EfficientNetV2, and DenseNet169 to classify the images across 7 classes: healthy, abscess, mastitis, nipple blebs, dermatosis, engorgement, and nipple damage by improper feeding or misuse of breast pumps. We also evaluated the models\' ability to distinguish between healthy and unhealthy images. We present an analysis of the classification challenges, identifying image traits that may confound the detection model.
RESULTS: The best model achieves an average area under the receiver operating characteristic curve of 0.93 for all conditions after data augmentation for multiclass classification. For binary classification, we achieved, with the best model, an average area under the curve of 0.96 for all conditions after data augmentation. Several factors contributed to the misclassification of images, including similar visual features in the conditions that precede other conditions (such as the mastitis spectrum disorder), partially covered breasts or nipples, and images depicting multiple conditions in the same breast.
CONCLUSIONS: This vision-based automated detection technique offers an opportunity to enhance postpartum care for mothers and can potentially help alleviate the workload of LCs by expediting decision-making processes.

UNASSIGNED: COVID-19 challenges have underscored the potential of telemedicine in migraine management. This study focuses on assessing patients\' telemedicine experience for headache management in Lithuania and identifying key barriers and facilitators for its wider use.
UNASSIGNED: A nationwide e-survey was conducted in 2023 via the Lithuanian Association of Migraine Patients\' website, social media platforms, websites of public and private healthcare facilities, and migraine self-help groups. The survey covered sociodemographics, migraine characteristics, previous experience with teleconsultations for headaches with neurologists and general practitioners (GP), perceived advantages and disadvantages of telehealth, and preferred future consultation types.
UNASSIGNED: Eight hundred and forty seven respondents with a confirmed migraine diagnosis were analyzed. The majority were female (97.2%), with a median age of 35 (IQR 30-42) years and an average of 5 (IQR 3-9) monthly headache days (MHDs). 7.0% of respondents had chronic migraine (CM). Prior teleconsultations for headaches were reported by 35.2% of respondents, 26.2% with a GP and 17.0% with a neurologist (p < 0.0001). Teleconsultation outcomes included continuation of a prescribed treatment (84.7% for GPs and 83.3% for neurologists, p = 0.7295), initiation of new acute medications (12.2% for GPs with 70.4% reported as effective and 27.1% for neurologists with 84.6% effective, p = 0.0005 and p < 0.0001, respectively). Reasons for not undergoing remote neurology consultations: the lack of inquiry (69.7%), unavailability from neurologists (18.1%) and respondent\'s opposition to remote consultations (12.2%). Patients evaluated their experience with remote neurology services better than that of GPs (p = 0.0289). 67.3% of respondents preferred a mixed-mode approach for future consultations. In-person-only preference (29.0%) correlated with multiple factors, including history of remote primary neurology consultations (OR 5.89, p = 0.0022), lower education (OR 2.20, p = 0.0001), physically demanding work (OR 1.95, p = 0.0001), and number of drawbacks in telemedicine identified (OR 1.30, p < 0.0001), and worse experience of a prior remote GP consultation (OR 0.704, p < 0.0001). The main indicator of preference for remote-only consultations was the perception of fewer telemedicine disadvantages (OR 0.503, p = 0.0007).
UNASSIGNED: Our findings confirm that telemedicine contributes to effective migraine management and is used limitedly in Lithuania. Despite one-third of respondents having experienced teleconsultations, significant barriers remain. Our study highlights a clear preference for a hybrid consultation type.

Background: This will be a before-and-after study nested within a randomized clinical trial. Its objective will be to analyze the effectiveness of a teleconsultation and validate a questionnaire for performing teletriage in dental urgency/emergency situations in children aged 3 to 13, whose parents will have signed a free and informed consent form, and who have had full access to the internet. Methods: The Questionnaire for Teletriage of Emergencies and Urgencies in Pediatric Dentistry (QuesT-Odontoped)-will be validated by applying it to 140 randomized child parents/guardians. After validation, another 260 children seeking emergency dental care in the municipality of Carangola, Minas Gerais, Brazil, will receive a remote consultation, be randomized, and then allocated into two groups: G1, teleconsultation, and G2, teleconsultation and face-to-face consultation (immediately after the former) with a blinded evaluator, involving anamnesis and conventional clinical examination. The G2 sample will be used in the before-after study. Both groups will be followed-up for 7 and 14 days using pain and quality-of-life scales, applied at baseline and after each follow-up period. Clinical follow-up will be carried out after 12 and 24 months to assess the outcome of the tooth that had been indicated for treatment in the teletriage. The Mann-Whitney test will be used to assess pain; Student\'s t test or the Mann-Whitney test will be used to assess quality of life and the number of missing teeth after 24 months; and Poisson\'s regression analysis will be used to assess the influence of other variables. The significance level will be set at 5%. Conclusions: In conclusion, this study expects to confirm the hypothesis that remote urgency consultation (teletriage), through a validated questionnaire, will be able to define the planning of the clinical situation, reducing the chance of displacements and progression of infection, helping to eliminate patient pain and discomfort.

The use of Remote Consultations (RCs) in primary care expanded rapidly during the Covid-19 pandemic: their ongoing use highlights a need to improve experiences of them. We interviewed 17 adults in the UK, including a sub-sample of five people with a First Language other than English (FLotE). Interpretative Phenomenological Analysis identified five major themes: (1) RCs are convenient, but they require appropriate technology and appropriate conditions of use; (2) even those with good general eHealth literacy and connectivity may struggle with systems that are not user-friendly; (3) greater reliance on verbal communication was experience as limiting empathy, and also made RCs more difficult for people with a FLotE; (4) RCs are considered inappropriate for complex conditions, or those with major psychological components; (5) continuity of care is important, but is often lacking. Overall, interviewees emphasised the need for more user-friendly processes, and greater attention to patients\' preferences for consultation type.

Background Teledentistry, defined as the use of telecommunication technologies for dental care, has emerged as a transformative approach to oral health services. This prospective observational analysis aims to comprehensively assess the impact of teledentistry on patient outcomes and satisfaction, addressing key aspects such as diagnostic accuracy, longitudinal treatment outcomes, and economic and logistical considerations. Methods The study involved 242 participants selected from diverse dental clinics offering teledentistry services. Participants could choose between traditional in-person visits and teledentistry consultations. The teledentistry interventions included remote consultations, diagnostic evaluations, and treatment planning facilitated through virtual communication tools. Baseline assessments captured initial dental conditions, and follow-up assessments were conducted at three, six, and 12 months. Outcome measures included diagnostic accuracy, patient satisfaction, changes in dental conditions over time, and economic and logistical feedback. Results Descriptive statistics revealed baseline characteristics, with participants evenly distributed between in-person and teledentistry groups. However, the overall satisfaction with diagnoses was significantly lower in the teledentistry group as compared to the in-person group (p < 0.001). Longitudinal assessments demonstrated comparable changes in dental conditions between the two groups. Economic feedback highlighted a cost-saving advantage for teledentistry users, with 80% reporting reduced expenses. Conclusion This study highlights the transformative potential of teledentistry in expanding access to oral health services, reducing costs, and providing comparable treatment outcomes to traditional in-person care. Future efforts should focus on enhancing the teledentistry experience, addressing patient satisfaction concerns, and refining the delivery of remote dental care to maximize its benefits for both patients and healthcare systems.

BACKGROUND: Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people\'s perceptions of remote consultations and identify potential resulting inequalities.
OBJECTIVE: To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels.
METHODS: A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic.
METHODS: In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression.
RESULTS: A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = -0.82, 95% confidence interval [CI] = -1.41 to -0.23) or those with low or no qualifications (B = -1.65, 95% CI = -2.29 to -1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = -1.94, 95% CI = -3.11 to -0.78), although caution is warranted due to small group numbers.
CONCLUSIONS: These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.

OBJECTIVE: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic.
METHODS: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders.
METHODS: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust.
RESULTS: Participants continued to deliver a significant proportion of patient care in-person. However, remote and technology-mediated care could meet patients\' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks.
CONCLUSIONS: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice.
CONCLUSIONS: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward.
UNASSIGNED: Standards for Reporting Qualitative Research (O\'Brien et al., 2014).
UNASSIGNED: This was a workforce study so there was no patient or public contribution.
UNASSIGNED: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward.