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Understanding both patient and clinician perspectives on communication challenges in virtual primary care consultations is important to ensure safe and effective care. This commentary reviews the important work of Alboksmaty and colleagues, highlighting their contributions and noting some limitations. To further support translation of clinical practice–based recommendations from this original research, this commentary relates the study findings to patient-centered communication frameworks and evidence-based virtual communication strategies. This commentary also extends the helpful mitigation strategies offered in the original research, demonstrating how they apply to the Expert Recommendations for Implementing Change (ERIC) implementation framework to facilitate organization-based change. The need for additional research differentiating phone-based and videoconferencing-based primary care consultation communication strategies is highlighted.

The growing reliance on virtual consultations in primary care has reshaped traditional general practitioner (GP)-patient communication dynamics, presenting new challenges that affect care quality and safety. This study explores communication challenges and gaps, particularly relevant to virtual consultations compared with face-to-face interactions, as well as identifying mitigation strategies from both GPs' and patients' perspectives. This qualitative study employed 4 online focus group discussions with a purposive sample of UK-based GPs and patients. Data were analyzed using a deductive-inductive thematic approach with NVivo software. The extended Shannon-Weaver communication model and the Capability, Opportunity, Motivation and Behavior model guided the analysis of communication challenges and mitigation strategies, respectively. The Consolidated Criteria for Reporting Qualitative Research were followed to ensure rigorous reporting. A total of 21 participants (12 patients and 9 GPs) took part in 4 online focus group discussions, 2 for patients and 2 for GPs. Six key themes on communication challenges emerged: 5 aligned with the extended Shannon-Weaver communication model (related to the sender-encoder, message, channel, receiver-decoder-feedback, and context), and a new one was inductively identified (patient autonomy and inclusivity). GPs, as senders, highlighted missing visual cues, affecting message clarity in remote communication channels. Patients, as receivers, reported difficulties explaining symptoms remotely, reduced emotional connection, and perceived empathy, linked to contextual challenges and the need for inclusive communication. Mitigation strategies were mapped to the Capability, Opportunity, Motivation and Behavior model: capability (training/resources), opportunity (triage/tools), and motivation (patient engagement/system adaptability), with participants emphasizing tailored training, standardized approaches, and flexible models to support effective and inclusive virtual communication. This study highlights communication gaps in virtual consultations and proposes actionable mitigation strategies. Tailored use of virtual modalities, supported by structured training and policy efforts, is essential to ensure effective and safe remote communication.

Noncommunicable diseases (NCDs) account for over 70% of global deaths, with hypertension and diabetes serving as major contributors. The COVID-19 pandemic disrupted traditional health care services for NCDs and highlighted telehealth as a crucial alternative. Telehealth-encompassing synchronous and asynchronous electronic communication to deliver clinical services remotely-can overcome geographical barriers and enhance patient engagement. However, telehealth usability among health care professionals (HCPs) remains under-studied across low-, middle-, and high-income countries. This study aimed to examine which telehealth engagement patterns, technical infrastructure factors, and user profiles were most strongly associated with usability among HCPs and to descriptively compare these across 4 diverse countries: Brazil (high- to middle-income country), Ghana (low- to middle-income country), Honduras (low- to middle-income country), and the United Kingdom (high-income country). A multinational cross-sectional survey was conducted with 290 HCPs across 4 countries. Participants completed the System Usability Scale and provided data on telehealth engagement (eg, frequency, duration, and number of systems used), technical infrastructure (connection stability and support satisfaction), and their user profile (demographics, job role, and training received). Descriptive statistics summarized these patterns and usability scores. Multiple linear regression with bootstrap-based sensitivity analyses identified factors associated with telehealth usability. Given the nonprobability design, no formal inferential comparisons were made between countries. Instead, observed patterns were reported descriptively. Higher telehealth usability scores were associated with greater connection stability (b=5.06, 95% CI 3.06-7.05), higher satisfaction with online support information (b=5.02, 95% CI 3.27-6.75), more frequent use (b=3.05, 95% CI 1.36-4.73), longer duration of use (b=1.59, 95% CI 0.49-2.68), and being a physician by profession (b=3.82, 95% CI 0.23-7.40). Average usability scores were highest among users in Ghana (mean 79.75, SD 14.19) and the United Kingdom (mean 79.00, SD 14.71), followed by Brazil (mean 72.01, SD 14.62) and Honduras (mean 63.09, SD 15.57). According to System Usability Scale guidelines, scores corresponded to \"good\" usability for users in Ghana, the United Kingdom, and Brazil and were below the \"good\" threshold for users in Honduras. While most users in Ghana (97/111, 87.4%), Honduras (31/38, 81.6%), and Brazil (57/80, 70.4%) reported using only 1 telehealth system, two-thirds of UK users (40/60, 66.7%) reported using 2 or more systems. User profiles also varied; prepandemic use was highest in Ghana (84/111, 75.7%) and lowest in Honduras (7/38, 18.4%). Other engagement patterns across countries were reported. Telehealth usability is driven by technical infrastructure reliability, a robust online support infrastructure, and an \"experience effect\" from frequent and long-term engagement. Descriptive differences in engagement patterns and infrastructure highlight the need for tailored strategies to address setting-specific challenges. These are essential to optimize telehealth integration and improve health care outcomes for patients with NCDs worldwide.

While digital health technologies promise to reshape the medical journey, their potential might not be realized due to unforeseen implementation challenges. Notably, the future impact of artificial intelligence (AI) in virtual consultations has been poorly investigated. This study aims to explore, across 8 areas, the future impacts of a bespoke, co-designed AI tool for remote chronic obstructive pulmonary disease care from the perspectives of patients and health care professionals (HCPs) with the Futures Wheel (FW) method. It provides practical recommendations for conducting FW activities involving novel digital health tools. A pilot FW workshop was conducted with public and patient involvement members to gather feedback on the process. Subsequently, an exploratory, in-person FW workshop was conducted with 2 patients with chronic obstructive pulmonary disease and 2 HCPs who had previously been involved in the co-design of the bespoke AI tool. The central statement was as follows: \"The bespoke AI tool is used in every virtual consultation.\" Participants identified first- and second-order consequences across the following 8 areas of impact: HCP-patient relationship impact, psychological impact, social impact, educational impact, legal impact, ethical impact, health care delivery impact, and technology impact. Each participant discussed their individual input to provide additional context. Regarding the HCP-patient relationship, patients foresee the tool's impact as redefining the remote care dynamic with enhanced patient involvement, while HCPs identify its meaningful communication assistance. On the psychological impact, patients expect an enhanced level of empowerment and confidence, and HCPs anticipate improved understanding of patients' emotional well-being with the AI tool's assistance. As for social impacts, patients view the AI support as beneficial for social patient-HCP interactions, and HCPs foresee their workflow being enhanced with flexibility and collaboration. The AI's educational impacts are expected to include, from patients' perspectives, better familiarization of HCPs with individual patient cases and, from HCPs' perspectives, improved support for training, upskilling, and administrative tasks. On the legal front, patients identify limited risks associated with the tool, and HCPs expect its features to lead to safer practices, contingent on regulatory compliance. Provided integrity and ethical use, the tool's ethical impact is not perceived as significant by patients, while HCPs see its personalized features as leading to fair, individual remote assessments. Patients envision the AI tool's impact on health care delivery as fostering patient-centricity, and HCPs anticipate strengthened remote care processes. Technologically, patients forecast a significant improvement to the current system, requiring adequate investment and resources, while HCPs expect complementarity between human input, AI, and the current system. The plausible AI-driven future of remote chronic care is a nuanced one. The FW method indicated that a bespoke, co-designed AI tool can positively support virtual care delivery and remote interactions while indicating potential risks. These insights can inform strategies related to early planning, governance, and implementation considerations.

Access to care for patients with musculoskeletal disorders (MSKDs) remains a significant challenge. Telehealth has emerged as a promising solution to improve access to care. However, conducting initial evaluations of MSKDs remotely raises concerns about patient safety and clinical efficacy due to the necessary adaptations required for a clinical examination and the challenges of obtaining an accurate and reliable diagnosis. We aim to explore the use of telehealth for the initial evaluation of MSKDs in the province of Quebec, Canada. Through semistructured interviews with selected patients, health care providers, and other key stakeholders involved in telehealth, this study aims to provide a comprehensive and detailed understanding of its application, benefits, and challenges. Semistructured interviews were conducted in the province of Quebec with patients, clinicians, telehealth software specialists, and professional bodies' representatives. Five tailored interview guides were developed using the Consolidated Framework of Implementation Research and the Framework of Mathieu-Fritz and Esterle for the study of telehealth interventions. The themes explored included participants' prior experiences with telehealth, perceived strengths and limitations of telehealth, particularly regarding the initial evaluation and diagnosis of new patients, and the current global environment of telehealth use. All interviews were transcribed verbatim, and a reflexive thematic analysis was performed using the Mathieu-Fritz Framework. Thirty-eight participants, including patients (n=11), health care providers (family physicians and musculoskeletal medical specialists: n=11; and physiotherapy professionals: n=10), telehealth software specialists (n=2), and representatives from professional bodies (n=4), shared their perspectives on telehealth for the initial evaluation of MSKDs. Five key themes emerged: (1) several participants viewed telehealth, including remote evaluations, as a solution to improve access to care; (2) patients and health care providers reported that a remote evaluation was more appropriate for simpler MSKD presentations; (3) some health care providers expressed concerns about the potential for an increase in diagnostic errors and the challenges of performing all usual components of a standard MSKD physical examination remotely; (4) patients expressed doubts about their ability to effectively perform certain tasks or tests on themselves; and (5) broader challenges were also highlighted by all participants, such as the impact on the patient-clinician relationship, access to appropriate hardware, digital literacy, and confidentiality concerns. Telehealth is seen as a valuable solution to improve access to care for patients with MSKDs, especially for simpler cases or urgent needs. However, remote physical examination poses challenges associated with concerns about diagnostic accuracy and limited remote physical examination procedures and components. Effective implementation will likely require more evidence-based guidelines, provider training on remote techniques and strategies to maintain patient-provider relationships. Addressing access to technology, digital literacy, and privacy concerns is also essential to ensure equitable adoption and to optimize telehealth in musculoskeletal care.

With the COVID-19 pandemic, the method for delivering healthcare changed overnight. Telehealth became a primary method of delivering care. Suddenly, nurses were expected to utilize technology with very little, if any, training in telehealth. All evidence suggests that telehealth is here to stay. As such, it is now time for healthcare providers to reflect on best practices for telehealth, and for nurse educators to ensure that graduates are prepared to function in the new telehealth arena. This article provides an introductory overview of the history of telehealth nursing; uses for telehealth with the COVID-19 pandemic; new awareness of telehealth challenges, and nursing roles. We also discuss sites that require a telehealth nurse and the Four P’s framework for telehealth education.

Telehealth includes health care services provided using audio and video technology. Telehealth was originally developed to provide basic care to rural and underserved patients. Higher rates of use of telehealth are now standard in many practices since the coronavirus disease 2019 pandemic. Increasing emphases on patient satisfaction, providing efficient and quality care, and minimizing costs have also led to higher telehealth implementation. Patients and providers have enjoyed the benefits of telehealth, but widespread adoption has been hindered by regulatory, legal, and reimbursement barriers. Recent legislative initiatives have advocated for further telehealth advancements, especially with the rapid implementation of telehealth in the times of coronavirus disease 2019. •Telehealth includes health services provided using telecommunications technology.•Telehealth has been used in a variety of specialties and settings.•Telemedicine has the potential to reduce American health care spending.•Telehealth barriers include legal and regulatory issues at state and federal levels.

BackgroundThe use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations.ObjectiveThe objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency.MethodsBoolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE.Results2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.ConclusionThis review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.

Increased utilization of videoconferencing platforms to conduct meetings and patient encounters has illuminated the need to focus on video etiquette. Though telehealth has been utilized since the 1950s, the SARS-COV-2 (COVID-19) pandemic propelled virtual care into the forefront of healthcare to protect both patients and providers. Historically, few academic programs have incorporated telehealth into the curriculum, and the rapid transition to telehealth typically left providers to learn the art of virtual care without education. The experience of many nurse providers is often limited to virtual platforms typically used for casual interactions versus a successful patient encounter. A quality telehealth encounter that enhances patient-provider communication and strengthens the provider-patient relationship must include telehealth etiquette and webside manner. This article describes the PEP framework for telehealth encounters to provide a detailed description of the elements of performance, environment, and privacy/security as best practices to underpin successful virtual health visits.

In rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health.BACKGROUNDIn rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health.The aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States.OBJECTIVEThe aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States.A narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms included telehealth, telemedicine, rural, and outcomes.METHODSA narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms included telehealth, telemedicine, rural, and outcomes.Among 15 included studies, 9 studies analyzed telehealth interventions in patients, 3 in health care professionals, and 3 in both patients and health care professionals. The included studies reported positive outcomes and experiences of telehealth use in rural populations including acceptability and increased satisfaction; they also noted that technology is convenient and efficient. Other notable benefits included decreased direct and indirect costs to the patient (travel cost and time) and health care service provider (staffing), lower onsite health care resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and health care professionals.RESULTSAmong 15 included studies, 9 studies analyzed telehealth interventions in patients, 3 in health care professionals, and 3 in both patients and health care professionals. The included studies reported positive outcomes and experiences of telehealth use in rural populations including acceptability and increased satisfaction; they also noted that technology is convenient and efficient. Other notable benefits included decreased direct and indirect costs to the patient (travel cost and time) and health care service provider (staffing), lower onsite health care resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and health care professionals.Telehealth models were associated with positive outcomes for patients and health care professionals, suggesting these models are feasible and can be effective. Future telehealth interventions and studies examining these programs are warranted, especially in rural communities, and future research should evaluate the impact of increased telehealth use as a result of the COVID-19 pandemic.CONCLUSIONSTelehealth models were associated with positive outcomes for patients and health care professionals, suggesting these models are feasible and can be effective. Future telehealth interventions and studies examining these programs are warranted, especially in rural communities, and future research should evaluate the impact of increased telehealth use as a result of the COVID-19 pandemic.