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ObjectivesOur recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions.DesignRealist review—a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015–2020 and used RPM to monitor an individual’s biometric data (eg, heart rate, blood pressure) from a distance.Primary and secondary outcome measuresContextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations).ResultsAcross a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care.ConclusionWhile RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events.PROSPERO registration numberCRD42020142523.

Chronic wounds, those which have not healed in a timely manner, are a significant health and economic burden. Older people, especially those living in nursing homes, are disproportionately affected by chronic wounds, and effective management and prevention is a persistent challenge. Specialized wound care can improve outcomes; however, access is limited by aged care workforce shortages, fragmented care, and lack of local services, especially in rural and nursing home settings. Virtual wound care interventions such as WoundView (Coviu Global Pty Ltd), a novel computer vision-based artificial intelligence wound analysis app embedded in Coviu's existing telehealth platform, offer a potential solution to enhance engagement with specialized wound care services. This protocol aims to outline a pilot and feasibility study for WoundView to assess the acceptability and feasibility of the intervention in preparation for a planned implementation study. The pilot and feasibility study will estimate recruitment and retention rates along with protocol adherence and adaptations. Qualitative exploration of the acceptability of recruitment processes, training and education, participant assessments, intervention delivery, and secondary outcome measures will inform the development of an implementation study of WoundView. The WoundView pilot and feasibility study is a prospective, nonrandomized study in 2 nursing homes in New South Wales, Australia. The research population will comprise up to 10 nursing home residents, 10 to 30 nursing home staff, and 10 wound care clinicians. All resident participants will receive the intervention, WoundView, as routine clinical care throughout the study period. Virtual care will be conducted with a specialized wound care clinic using WoundView's wound analysis and telehealth features to guide the clinical management of chronic wounds. Wound measures, health-related quality of life, virtual care activity, hospitalization rates, health resource use case studies, and participant satisfaction will be assessed. Nursing home staff and wound care clinicians' satisfaction with WoundView will be collected through brief surveys and in-depth interviews. The WoundView pilot and feasibility study was approved by the university's ethics committee and registered on the Australian New Zealand Clinical Trial Registry. Recruitment and enrollment for the study began in May 2025. Results are expected in the second half of 2025. The design and implementation of virtual care interventions in nursing homes is an underinvestigated issue. Outcomes from this study will contribute to the design of an implementation study testing WoundView in a range of nursing homes around Australia. The integration of WoundView is expected to transform the use of virtual care for wound management and lead to earlier intervention and increased access to specialist wound advice services for nursing home residents.

Group therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions. The aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional-led group videoconferencing to provide education or social support or both, into the home setting. Electronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings. Of the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and skills. Videoconference groups were able to replicate group processes such as bonding and cohesiveness. Similar outcomes were reported for those comparing face-to-face groups and videoconference groups. Groups delivered by videoconference are feasible and potentially can improve the accessibility of group interventions. This may be particularly useful for those who live in rural areas, have limited mobility, are socially isolated, or fear meeting new people. Outcomes are similar to in-person groups, but future research on facilitation process in videoconferencing-mediated groups and large-scale studies are required to develop the evidence base.

While the burden of caring for people living with dementia has been well documented, considerably less is known about how carers transition into post-care life. This study aimed to understand the experiences of primary family care-givers of people with dementia after the person with dementia has died. A specific focus of the research was understanding the barriers to transitioning into a positive post-care life, and facilitators that help sustain carers as they move forward after their care journey has ended. A qualitative exploratory, descriptive study was undertaken with nine primary carers for a family member who died with dementia (five spouses and four adult children). Semi-structured face-to-face or telephone interviews were conducted with carers between July and August 2016. Interview transcripts were analysed using a thematic approach. A number of factors that can act as barriers or facilitators to transition for carers were identified. Contextualising loss, restructuring identity, psychological health issues and the influence of social attitudes seemed to have a strong influence on carer outcomes. The findings highlight the need for further systematic social and informational support for carers to moderate post-care trajectories and improve carer transition.

Objective The aim of the present study was to evaluate the effect of a high-speed telemonitoring project for older people with chronic disease in a regional Australian town. Participants' vital signs were monitored and triaged daily by a telehealth nurse. Methods A prospective, uncontrolled study design evaluated the effect of home-based telemonitoring on older people with chronic disease. Evaluation included surveys (including the Stanford Chronic Disease Self-Efficacy tool and the Self-Rated Health Questionnaire), self-reported health service use and interviews and focus groups exploring client experiences. Results Participants reported an improved understanding of their vital signs monitoring (48%) and consequently better self-management of health (48%) and that they were better informed (44%) and more confident (25%) to discuss health with their doctor. Patients also reported making medication changes (17%), positive dietary changes (34%) and increasing their physical activity (33%). Overall, patients' self-rated general health improved (mean (± s.d.) improvement 0.30±0.80; 95% confidence interval (CI) 0.16-0.45; 118 d.f.; P<0.001), with more participants reporting that their health is 'excellent' or 'very good' at the end of the trial. Patients also reported fewer doctor visits (P<0.001), fewer visits to the local hospital emergency department (P=0.021) and fewer non-local hospital admissions (P<0.001) compared with the preceding year. There was no significant reduction in local hospital admissions (P=0.171). Conclusions The findings of the present study suggest that telemonitoring with videoconferencing empowers older people to better understand and manage their own health, and is associated with improved health outcomes and reduced service use. Having regular, daily access to a Telehealth nurse reassured participants, and triggered changes to services and behaviour that are likely to have positively affected patient outcomes. What is known about this topic? Telehealth is increasingly being used in the care of older people with chronic conditions and can reduce health service use. Previous research has indicated that telehealth has the potential to provide patients with greater knowledge and understanding of their condition. What this paper adds? Our research demonstrates that older people with limited experience of technology can be taught to successfully use telehealth equipment. We observed regular contact with telehealth nurses enables health promoting behaviour messages to be tailored to patients' needs. What are the implications for practitioners? Providing older people with tailored health support alongside an understanding of vital signs readings can enhance self-efficacy.

Demand for non-psychiatry telemental health services (NPTHS), especially telehealth services, continues to grow in Australia and overseas as a result of the coronavirus disease 2019 (COVID-19) pandemic.1 It is well recognised that a sound business case is required to successfully establish and routinely deliver telehealth services.1-3 In this letter, we describe the results of a national survey comprising 229 mental health professionals who provide NPTHS services and attended the Mental Health Academy training webinar in February 2021. Other research has reported that many providers transitioning to videoconsultations report an initial resource-intensive time period;4 and many clinicians report a steep learning curve.5 Of the 204 respondents who provided information about the efficiency of their consultation services with telehealth, 26% reported increased efficiency because they were able to perform more consultations when using telephone compared to pre-COVID-19 inperson services. Using telehealth for mental health consultations is perhaps one the most commonly reported service examples of telehealth, because NPTHS do not require physical examination and can be successfully managed virtually.6 Despite its popularity in this field, overall delivery of NPTHS in Australia has, until 2020, been minimal.7 Other research focusing on NPTHS during the COVID-19 pandemic has demonstrated increased service volume, efficiency, and overall adoption.8-10 Our study provides additional insight into the business challenges faced by service providers when delivering services by telehealth.