Health Informatics J. 2025 Jan-Mar;31(1):14604582251315595. doi: 10.1177/14604582251315595.

ABSTRACT

Background: The HIV epidemic in Indonesia is one of the fastest growing in Southeast Asia and is characterised by a number of geographic and sociocultural challenges. Can large language models (LLMs) be integrated with telehealth (TH) to address cost and quality of care? Methods: A literature review was performed using the PRISMA-ScR (2018) guidelines between Jan 2017 and June 2024 using the PubMed, ArXiv and semantic scholar databases. Results: Of the 694 records identified, 12 studies met the inclusion criteria. Although the role of eHealth interventions as well as telehealth in HIV management appears well established, there is a significant literature gap on the integration of telehealth and LLM technology. To address this, we provide a blueprint for the safe and ethical integration of LLM-TH into triage, history taking, patient education highlighting opportunities for reduced consultation time and improved quality of care. Conclusions: Variable access to mobile technology and the need for empirical validation stand out as limitations for LLM-TH. However, we argue that the current evidence base suggests the benefits far outweigh the challenges in applying LLM-TH for HIV care in Indonesia. We also argue this novel therapeutic modality is broadly applicable to the subacute general practice setting.

PMID:39825860 | DOI:10.1177/14604582251315595

Addict Sci Clin Pract. 2025 Jan 17;20(1):4. doi: 10.1186/s13722-024-00534-x.

ABSTRACT

BACKGROUND: Women involved in the criminal legal system have elevated rates of opioid use disorder, which is treatable, and HIV, which is preventable with pre-exposure prophylaxis (PrEP). There are significant social and structural barriers to integrated delivery of PrEP and medications for opioid use disorder (MOUD), limiting women's ability to access these life-saving interventions. In a two parallel-arm randomized controlled trial, we are assessing an innovative eHealth delivery model that integrates PrEP with MOUD and is tailored to meet the specific needs of women involved in the criminal legal system.

METHODS: We will recruit and enroll 250 women involved in the criminal legal system with opioid use disorder across two diverse settings (New Haven, CT and Birmingham, AL). Participants will be randomized to (a) the "Athena strategy," which includes a PrEP decision aid and integrated PrEP/MOUD delivery via eHealth; or (b) enhanced standard of care (SOC) that includes a decision aid-only. During 6-month follow-up, we will assess PrEP initiation as the primary clinical outcome and implementation outcomes that include acceptability, adoption, feasibility, fidelity, implementation cost, and sustainability.

DISCUSSION: Results could help determine if reducing the social and structural barriers to PrEP and MOUD for women involved in the criminal legal system will facilitate engagement in treatment and prevention services, thus alleviating health disparities.

TRIAL REGISTRATION: Clinicaltrials.gov (NCT05547048). Registered September 15, 2022. https://clinicaltrials.gov/study/NCT05547048?term=NCT05547048&rank=1 .

PMID:39825419 | DOI:10.1186/s13722-024-00534-x

BMC Public Health. 2025 Jan 17;25(1):211. doi: 10.1186/s12889-025-21389-0.

ABSTRACT

BACKGROUND: eHealth literacy (eHL) is positively associated with health-related behaviors and outcomes. Previous eHL studies primarily collected data from online users and seldom focused on the general population in low- and middle-income countries (LMIC). Additionally, knowledge about factors that affect eHL is limited. Chronic lung disease (CLD) has brought a large burden in LMIC, making it a relevant example for studying eHL. This study aims to explore eHL and its associated factors within the general population of China, encompassing sociodemographic characteristics, CLD knowledge, digital access, eHealth use and attitudes towards eHealth.

METHOD: Data were collected from November 2023 to January 2024 via online and hard-copy questionnaires among the general population in China. Descriptive analyses were performed to explore eHL, CLD knowledge, digital access, and attitudes towards eHealth at different sociodemographic levels. Univariable and multivariable regression analyses were performed to identify factors associated with eHL.

RESULTS: 439 valid questionnaires were collected. Participants demonstrated a mean eHL of 24.7 ± 8.2 and CLD knowledge of 5.9 ± 3.7, obtained a score of 6.9 ± 1.8 in attitudes towards eHealth. A notable percentage of participants (45/439, 10.3%) reported no digital access, especially those aged 66+, the unemployed, retired, those with a primary school or below degree and earning ≤ 1500 RMB monthly. Multivariable hierarchical regression analysis showed higher eHL was uniquely associated with younger age (b=-0.10, P < .001), higher educational level (b = 2.02, P < .001), higher income (b = 1.10, P < .001), having digital access (b = 6.35, P < .001), more frequent eHealth use (b = 1.14, P < .001), and more positive attitudes towards eHealth (b = 0.47, P = .003).

CONCLUSION: Our sample from the general population in China had a relatively low eHL and CLD knowledge level, but held a positive attitudes towards eHealth. A digital divide was noticed between the elderly, low socioeconomic population and other groups. Younger age, higher educational and income level, having digital access, more frequent eHealth use and more positive attitudes towards eHealth were significantly associated with higher eHL. Efforts at both individual and systematic levels should be made to improve eHL, and promote CLD knowledge and digital access, especially in disadvantaged populations. Moreover, there is a pressing need to develop and refine national and international standards for eHL.

PMID:39825311 | DOI:10.1186/s12889-025-21389-0

J Gen Intern Med. 2025 Jan 17. doi: 10.1007/s11606-025-09355-3. Online ahead of print.

NO ABSTRACT

PMID:39825182 | DOI:10.1007/s11606-025-09355-3

Dermatologie (Heidelb). 2025 Jan 18. doi: 10.1007/s00105-024-05463-z. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous patients admitted to a general hospital present skin changes as secondary findings. Approximately 800 dermatological consultations are performed annually at the Leipzig University Medical Center.

OBJECTIVES: The aim of this study was, after implementation of teledermatological consulting, the retrospective evaluation of that and the resulting satisfaction of the physicians involved.

MATERIALS AND METHODS: We carried out an analysis of all consultation requests, which were answered using store-and-forward technology via the photo documentation app imitoCAM® (imito AG Zurich/Switzerland) and the clinical information system SAP® (SAP Deutschland SE & Co. KG Walldorf/Germany) from 1 February to 31 July 2023, as well as of questionnaires on satisfaction, which were sent to the participating physicians after the consultation.

RESULTS: Our analysis included 419 consultation requests, 90 of which were answered teledermatologically. The consultation dermatologists stated that 92% of the cases could be solved using only telemedical instruments. Moreover, 90.9% of the consulting physicians rated the technical implementation as good to very good and 47.5% of the consultation dermatologists estimated a time saving of at least 30-60 min.

CONCLUSIONS: Our study shows the enormous potential of teledermatology in the inpatient setting. Implementation of teleconsultation enables more efficient consultations, reduces time- and cost-intensive transportation and offers patients a more comfortable dermatological evaluation with reduced risk of infection.

PMID:39824933 | DOI:10.1007/s00105-024-05463-z

JMIR Form Res. 2025 Jan 17;9:e57614. doi: 10.2196/57614.

ABSTRACT

BACKGROUND: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians.

OBJECTIVE: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services.

METHODS: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed.

RESULTS: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial.

CONCLUSIONS: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.

PMID:39823632 | DOI:10.2196/57614

J Med Internet Res. 2025 Jan 17;27:e56601. doi: 10.2196/56601.

ABSTRACT

BACKGROUND: Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted.

OBJECTIVE: This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women.

METHODS: Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated.

RESULTS: A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant.

CONCLUSIONS: A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health.

TRIAL REGISTRATION: Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r.

PMID:39823585 | DOI:10.2196/56601

PLoS One. 2025 Jan 17;20(1):e0299751. doi: 10.1371/journal.pone.0299751. eCollection 2025.

ABSTRACT

INTRODUCTION: Language barriers within clinical settings pose a threat to patient safety. As a potential impediment to understanding, they hinder the process of obtaining informed consent and uptake of critical medical information. This study investigates the impact of the current use of interpreters, with a particular focus on of engaging laypersons as interpreters, rather than professional interpreters potentially affecting patient safety. A further objective is to explore the reliability of phone-based telemedicine in terms of the retention of important medical facts.

METHODS: In three groups (N per group = 30), we compared how using lay or professional interpreters affected non-German speaking patients' subjectively perceived understanding (understood vs. not understood) and recollection (recollected vs. not recollected) of information about general anaesthesia. Proficient German speaking patients served as the control group. Statistical analyses (χ2 tests and binomial) were calculated to show differences between and within the groups.

RESULTS: All three groups indicated similar, high self-reported levels of having understood the medical information provided. This was in stark contrast to the assessed objective recollection data. In the lay interpreter group, recollection of anaesthesia facts was low; only around half of participants recalled specific facts. For patients supported by professional interpreters, their recollection of facts about anaesthesia was significantly enhanced and elevated to the same level of the control group (fluent in German). Moreover, for these patients, providing information by means of phone-based telemedicine before anaesthesia yielded high levels of understanding and recollection of anaesthesia facts.

CONCLUSION: Phone-based telemedicine is a safe and reliable method of communication in the professional interpreter group and German speaking control group, but not in the lay interpreter group. Compared to lay interpreters, professional interpreters significantly improve patients' uptake of critical information about general anaesthesia, thus highlighting the importance of professional interpreters for patient safety and informed consent.

PMID:39823485 | DOI:10.1371/journal.pone.0299751

Med Res Arch. 2024 Sep;12(9):5728. doi: 10.18103/mra.v12i9.5728. Epub 2024 Sep 30.

ABSTRACT

AIMS: To evaluate the use of hybrid (telehealth and in-person) care on visitation and glycaemia in older adults with type 1 diabetes (T1D).

METHODS: In this retrospective study, we examined clinical characteristics, number of visits (telehealth and in-person) and continuous glucose monitoring (CGM) metrics for older adults (≥65 years) with T1D from electronic health records during the pre-COVID-19 pandemic (March 1, 2019-March 1, 2020; in-person) and pandemic (September 1, 2020-August 31, 2021; hybrid) periods. Main outcomes were the number of visits and changes in glycaemic control (HbA1c), and in a sub-group of older adults using CGM, changes in CGM metrics between in-person and hybrid care.

RESULTS: We analysed data of 661 older adults with T1D (age 72±5 years). The hybrid care resulted in an increased number of annual diabetes visits (6.3 vs 4.2 visits/person) without change in glycaemic control (HbA1c 7.4% vs 7.2%) compared with in-person care alone. In the sub-group of 299 older adults with T1D using CGM, hybrid care compared with in-person care resulted in an improvement of time-in-range (70-180 mg/dL) (68% to 71%; p<0.001) without increasing hypoglycaemia (<70 mg/dL).

CONCLUSION: Compared with in-person only visits, hybrid care maintained visit frequency and preserved glycaemic control measured as HbA1c. In a sub-group of older adults with T1D using CGM, time-in-range improved while time in hypoglycaemia did not change. These data suggest that a hybrid care model is efficacious in maintaining visitation and glycaemic control, and, as demonstrated in a sub-group of older adults with T1D using CGM, safe with respect to time in hypoglycaemia.

PMID:39822330 | PMC:PMC11737547 | DOI:10.18103/mra.v12i9.5728

Digit Health. 2025 Jan 15;11:20552076241312562. doi: 10.1177/20552076241312562. eCollection 2025 Jan-Dec.

ABSTRACT

OBJECTIVE: This study aimed to identify barriers and facilitators surrounding the implementation of TDOCS from Community Health Workers (CHW)'s perspective before TDOCS implementation.

METHODS: A descriptive qualitative study was conducted through semistructured interviews with a purposive sampling of CHWs from partner nursing homes and home care teams. A French framework outlining barriers to asynchronous oral teleconsultation adoption was used to develop the topic guide for this study. Then, the Consolidated Framework for Implementation research (CFIR 1.0) was used to guide coding and analysis.

RESULTS: A total of 43 CHWs from participating institutions were interviewed prior to receiving teledentistry training. Perceived barriers included low awareness about the importance of dental care, limiting conditions to T-DOCS participation among beneficiaries, limited understanding of T-DOCS, perceived low self-efficacy among CHWs, manpower shortages, perceived low priority of dental care, competition with other nursing duties and restricted access due to COVID-19. Facilitators included existing relationships between CHWs and beneficiaries, receptivity towards participation, CHWs' motivation to upskill and improve dental care for seniors, prior experience with other telemedicine technology, perceived need for change, supportive management, colleagues and existing impediments to access dental care.

CONCLUSION: This study identified barriers and facilitators to implementing T-DOCS from the CHWs' perspectives. We recommend for targeted CHW training, programme champions, workflow integration and incentivisation schemes. Addressing challenges like manpower strain and resource limitations through efficient scheduling and capacity building is vital for sustainability. Policy-level support, including legal frameworks, funding and regulatory structures, is essential for integrating teledentistry into mainstream healthcare.

PMID:39822301 | PMC:PMC11736726 | DOI:10.1177/20552076241312562