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Technology-enabled interventions for chronic disease management, such as telehealth systems for hypertension self-monitoring, have demonstrated effectiveness but face challenges with sustained usage and high attrition rates. Understanding the factors associated with continued engagement is crucial for enhancing intervention design and sustainability. This study aimed to explore the user behavior and user profiles under the Primary Technology Enhanced Care for Hypertension Program (PTEC-HT) intervention by: (1) quantitatively describing characteristics of participants generating Missed Reading (MR) alerts, (2) identifying factors associated with MR alert generation, (3) profiling participant subgroups based on MR alert patterns and blood pressure (BP) control, and (4) examining temporal trajectories of MR alerts and associated conversion rates over 12 months. A longitudinal observational study was conducted using backend data from the PTEC-HT system. The study included 491 participants, recruited before June 30, 2022, enrolled in the program for 1 year or more, categorized into MR alert generator and nongenerator groups, recruited before June 2022. Logistic regression identified factors associated with MR alert generation in an index month (August 2023), while latent class analysis profiled participant subgroups. Generalized estimating equations examined temporal trajectories of MR alerts and conversion rates. Statistical significance was set at 5%. Being younger (odds ratio [OR] 0.97, 95% CI 0.95-0.99; P=.007) and having a longer program duration (OR 1.11, 95% CI 1.01-1.22; P=.03) were significantly associated with MR alert generation. Latent class analysis identified 3 latent classes: (1) Compliant Triers (low MR alerts, poor BP control; 56/491, 11.4%), (2) Compliant Achievers (low MR alerts, good BP control; 368/491, 74.9%), and (3) Non-Compliant Achievers (high MR alerts, good BP control; 67/491, 13.6%). Temporal analysis showed consistent trajectories for Missed Reading Reminder message counts and conversion rates, with MR alert generators having higher Missed Reading Reminder message counts but lower conversion rates compared to nongenerators. Our study reported that younger participants and longer program durations were linked to higher MR alert generation. The identification of distinct user profiles suggests that tailored intervention features could enhance engagement and BP control. The study underscores the importance of monitoring compliance patterns and optimizing message content to improve conversion rates. These insights contribute to the understanding of telehealth engagement dynamics and support targeted interventions for hypertension management.

Postoperative rehabilitation after knee surgery is crucial for functional recovery, but traditional in-person methods can impose burdens on patients, particularly those with mobility limitations or living remotely. Telerehabilitation, leveraging digital platforms, offers a potential alternative, yet its comparative efficacy and acceptability remain debated, especially across surgery types. This study aims to evaluate whether telerehabilitation improves postoperative rehabilitation satisfaction and efficacy compared to traditional methods for patients undergoing knee joint surgery. Six databases (Web of Science, PubMed, MEDLINE, ScienceDirect, Embase, and Cochrane Library) were searched from inception to September 27, 2025. Eligibility criteria included randomized controlled trials (RCTs) comparing telerehabilitation with traditional rehabilitation in adult patients undergoing postoperative knee surgery, reporting patient satisfaction and/or efficacy outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 1 tool (developed by the Cochrane Collaboration). Data were synthesized using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method for CIs, reporting standardized mean differences or mean difference, τ2 (between-study variance), τ (between-study SD), and prediction intervals (PIs) where applicable. Heterogeneity was assessed with τ2, τ, and PIs. Certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. In total, 19 randomized controlled trials were included. Overall, patient satisfaction showed no significant difference between telerehabilitation and traditional rehabilitation (standardized mean difference [SMD] 0.15, 95% CI -0.48 to 0.78; P=.48; τ2=0.30; τ=0.55; PI=-1.17 to 1.47). Subgroup analysis revealed lower satisfaction with synchronous telerehabilitation (k=4 included studies; SMD -0.52, 95% CI -1.02 to -0.02; P=.04; τ2=0.17; τ=0.41) and higher with asynchronous (k=6 included studies; SMD 0.56, 95% CI 0.08-1.03; P=.02; τ2=0.30; τ=0.55). Telerehabilitation showed significant improvements on total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; k=4; SMD -0.76, 95% CI -1.38 to -0.14; P=.02; τ2=0.08; τ=0.29; PI=-1.85 to 0.33), Knee Injury and Osteoarthritis Outcome Score (KOOS; k=5; SMD 0.58, 95% CI 0.47-0.70; P=.01; τ2=0; τ=0; PI=0.36-0.80), timed-up-and-go (TUG) test (k=4; mean difference [MD]=-2.73 seconds, 95% CI -4.50 to -0.96; P=.04; τ2=1.14; τ=1.07; PI=-7.17 to 1.72) and knee extension range (k=3; MD=9.64°, 95% CI 6.89-12.39; P=.049; τ2=2.45; τ=1.56; PI=0.60-18.68). The pooled average effects suggest that telerehabilitation is noninferior to traditional care for patient satisfaction on average and may improve pain and function and some objective measures. However, bootstrapped PIs and between-study variability indicate that effects vary by context, so implementation should therefore be individualized with attention to modality, patient digital literacy, and technical support. Targeted trials with standardized measures are recommended to increase certainty and narrow the expected distribution of effects.

Pancreatic cancer is the third leading cause of cancer-related deaths, and although pancreatectomy is currently the only curative treatment, it is associated with significant morbidity. The objective of this study was to evaluate the utility of wearable telemonitoring technologies to predict treatment outcomes using patient activity metrics and machine learning. In this prospective, single-center, single-cohort study, patients scheduled for pancreatectomy were provided with a wearable telemonitoring device to be worn prior to surgery. Patient clinical data were collected and all patients were evaluated using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC). Machine learning models were developed to predict whether patients would have a textbook outcome and compared with the ACS-NSQIP SRC using area under the receiver operating characteristic (AUROC) curves. Between February 2019 and February 2020, 48 patients completed the study. Patient activity metrics were collected over an average of 27.8 days before surgery. Patients took an average of 4162.1 (SD 4052.6) steps per day and had an average heart rate of 75.6 (SD 14.8) beats per minute. Twenty-eight (58%) patients had a textbook outcome after pancreatectomy. The group of 20 (42%) patients who did not have a textbook outcome included 14 patients with severe complications and 11 patients requiring readmission. The ACS-NSQIP SRC had an AUROC curve of 0.6333 to predict failure to achieve a textbook outcome, while our model combining patient clinical characteristics and patient activity data achieved the highest performance with an AUROC curve of 0.7875. Machine learning models outperformed ACS-NSQIP SRC estimates in predicting textbook outcomes after pancreatectomy. The highest performance was observed when machine learning models incorporated patient clinical characteristics and activity metrics.

Razionale. Lo scompenso cardiaco (SC) è causa prevalente di morbilità e mortalità, con forte impatto sanitario, specie negli anziani e in aree isolate. Il telemonitoraggio può anticipare l’instabilità clinica e migliorare la gestione terapeutica. Scopo di questo studio è stato descrivere il modello integrato della ASL Nuoro per la presa in carico proattiva dei pazienti con SC.Materiali e metodi. Studio osservazionale prospettico su pazienti affetti da SC arruolati con stratificazione tramite 3C-HF score e monitoraggio domiciliare non invasivo, connesso alla piattaforma CARE MAP.Risultati. Da aprile 2023 a marzo 2025 sono stati arruolati 499 pazienti; 354 attivi al follow-up (età media 80 ± 11 anni, 61% uomini) con un’alta aderenza terapeutica (inibitori del cotrasportatore sodio-glucosio di tipo 2 85%, inibitori del recettore dell’angiotensina e della neprilisina 56%). Gli alert clinici mensili sono stati in media 1740, con 60% di rilevanza clinica; i contatti mensili sono stati in media 413. I ricoveri per SC si sono ridotti del 71% (giugno-dicembre 2023 vs 2022).Conclusioni. Il modello integrato si conferma fattibile, efficace e sostenibile, anche in contesti caratterizzati da elevata complessità organizzativa. A livello sociale, garantisce equità di accesso alle cure, risultando applicabile anche in territori logisticamente disagiati. Il limite intrinseco del 3C-HF score sottolinea la necessità di strumenti prognostici più evoluti e dinamici. L’intervento si dimostra inoltre economicamente vantaggioso, grazie alla riduzione dei ricoveri e all’ottimizzazione dell’impiego delle risorse.

Chronic obstructive pulmonary disease (COPD) and asthma belong to the most common chronic diseases and their incidence continues to rise. Many patients experience exacerbations leading to hospitalization, impacting quality of life and straining health care systems. Telemonitoring emerged as a substitute for outpatient clinic visits, aiming to intervene early and prevent hospitalization. However, studies evaluating telemonitoring are conducted in controlled settings and may not fully reflect real-world conditions. Real-world evidence is needed to understand how telemonitoring functions in routine clinical practice. This study aims to describe and compare patient characteristics and clinical outcomes of patients with COPD or asthma who received telemonitoring versus conventional care based on real-world data. An observational cohort study with retrospective data collection was conducted with data from newly diagnosed patients with COPD or asthma who received telemonitoring or conventional care with up to 1-year follow-up. Outcomes included patient characteristics, COPD- or asthma-related hospitalizations, emergency department visits, exacerbations, and outpatient clinic visits. The telemonitoring intervention involves a mobile app where patients weekly complete the Asthma Control Questionnaire or the Clinical COPD Questionnaire, allowing nurses to intervene if scores indicate deterioration. The app serves as a substitute for outpatient clinic visits for patients with COPD, while patients with asthma use it as a complement to these visits. The study included 614 patients in conventional care and 96 patients in telemonitoring. Telemonitoring users are younger, predominantly female, rarely current smokers, and have fewer comorbidities. More patients with asthma used telemonitoring than patients with COPD. Patients using telemonitoring showed more moderate exacerbations (incidence rate ratio [IRR] 2.15, 95% CI 1.16-3.98; P=.02). Although telemonitoring users experienced fewer hospitalizations, this was not significant after adjusting for confounders (IRR 0.68, 95% CI 0.15-3.11; P=.62). Telemonitoring users had more telephone and screen-to-screen consultations (IRR 7.16, 95% CI 5.47-9.36; P<.001), but outpatient clinic visits remained consistent across both groups (IRR 1.19, 95% CI 0.88-1.62; P=.27). Patient characteristic differences and clinical outcome differences were identified between telemonitoring and conventional care. Although telemonitoring facilitated earlier initiation of treatment, it did not lead to fewer hospital or outpatient clinic visits. More insight is needed into factors influencing participation in telemonitoring to better serve current users and improve accessibility for nonusers. Patients should be provided with additional guidance on effectively using the communication channels offered by telemonitoring. This may encourage them to use these methods instead of attending outpatient clinic visits. Additionally, when implementing telemonitoring, it is essential to critically evaluate and redesign care processes to prevent unnecessary health care use.

Health care systems are increasingly facing challenges posed by the aging of populations. In particular, hospitalization, both initial and subsequent, is often observed among older adult patients. However, research suggests that nearly 23% of all hospitalizations could be avoided. In this perspective, remote patient monitoring (RPM) systems are emerging as a promising solution, enabling professionals to detect and manage patient complexities early within home-based care settings. This study aims to provide additional analyses regarding the impact of the EPOCA RPM system for polypathological older adult patients on the total number of unplanned hospitalization days and admissions, as well as emergency department (ED) visits. In a prior study, we evaluated the impact when the operator of the RPM system is a geriatrician. In this study, we assess the impact when the general practitioner is the operator. We used a retrospective, before-and-after cohort design. Polypathological older adult patients aged 70 and older, who benefited from the EPOCA RPM system for at least 1 year (between February 2022 and August 2024), were included in the analysis. We compared the outcomes between the previous year (Y-1) and the follow-up year (Y) by the EPOCA RPM system. Statistical analyses were significant at P value <.05. In total, 80 patients were included in the analysis, with an average age of 87. The results showed a significant reduction (P<.001) between Y-1 and Y in the total number of unplanned hospital admissions (by 57%), hospitalization days (by 49%), and ED visits (by 62%). Our findings reflected a significant decrease per patient from 0.99 to 0.42 in hospital admissions, from 0.99 to 0.37 in ED visits, and a reduction of 9.7 hospitalization days per year (P<.001). Additional analyses stratifying by hospitalization history, disability level, and caregiver status showed that the greatest effect of the RPM system was on patients with high risk and severe disability. Finally, there was no observed increase in mortality or transfers to intensive care units. Our findings are consistent with our previous results regarding the potential benefits of the EPOCA RPM system in managing care for polypathological older adult patients, this time with general practitioners as system operators. They also support existing evidence on the promise of RPM in improving care and health outcomes for older adult patients while alleviating hospital burdens by reducing unplanned hospitalizations and ED visits. It is, therefore, essential to incorporate reimbursement policies for these RPM initiatives so as to facilitate their adoption within health care systems and enhance their impact on health outcomes.

Hypertension is a significant public health concern in low- and middle-income countries, where access to care is crucial for effective treatment and control. Web-based health modalities provide a promising solution to overcome barriers to care, particularly in underresourced communities, if those communities engage with the technology. This study aims to examine the past experiences, perceptions, and preferences of using web-based health modalities for health care access among community members with or at high risk for hypertension. Semistructured interviews were completed with individuals randomly selected from a sample of community members in Soweto, South Africa, previously screened as having either elevated (systolic blood pressure [BP]≥120-139 mm Hg or diastolic BP≥80-89 mm Hg) or high (systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg) BP to determine their past experiences using web-based services and what their perceptions were on using such services. An interview script, grounded in the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model, was used to guide the interviews. Deductive thematic analysis was used to code the interviews and identify common themes. A total of 178 community members (including 104 with elevated BP and 74 with high BP) were randomly selected and invited to participate in the study. Forty interviews were conducted with individuals from the elevated (n=20) and high (n=20) BP groups. Four major themes emerged from the interviews regarding using technology to receive health care services: (1) trust and credibility of health professionals in a web-based environment, (2) comfort level using technology to receive health care, (3) experience using technology to receive health care, and (4) preference for in-person versus web-based interactions. Despite being open and receptive toward the use of web-based health modalities to receive health care, participants preferred in-person interactions due to both a lack of experience using web-based health care and familiarity with traditional in-person health services. Further research is needed to understand how technology may aid future hypertension management efforts in urban African communities.

Telemedicine use has increased significantly in cardiology clinics, but the impact of initial telemedicine evaluation on total visit usage is unknown. This study aimed to determine the effect of initial telemedicine evaluation on the number of follow-up visits within 6 months for common cardiovascular conditions at an academic health system. Electronic health records data were extracted for general cardiology visits. New patient visits (NPVs) were included occurring from June 1, 2020, to May 31, 2023, for 10 common cardiovascular conditions-atrial fibrillation or flutter, chest pain, coronary artery disease, dyslipidemia, dyspnea, heart failure, hypertension, palpitations, preoperative evaluation, and syncope or dizziness. The effect of initial telemedicine versus in-person evaluation on follow-up visits within 6 months was assessed using a 2-stage least squares instrumental variable model with the proportion of clinician telemedicine use as the instrument and adjustment for patient and visit characteristics. There were 5528 NPVs conducted by 40 general cardiology clinicians during the study period. The average patient age was 56 (SD 17.5) years, 54.2% (2998/5528) were female, 43.2% (2389/5528) were non-Hispanic White, 24.7% (1368/5528) were Asian, 13.8% (761/5528) were Hispanic, 34.4% (1904/5528) were on Medicare, and 13.2% (729/5528) were on Medicaid. Of the NPVs, 53.5% (2959/5528) were conducted via telemedicine (2814/5528, 50.9% via video and 145/5528, 2.6% via phone). Telemedicine use for NPVs ranged from 0% to 100% (N=40) across individual clinicians. The average number of follow-up visits was 57 visits per 100 patients within 6 months across all diagnosis groups. Patients receiving telemedicine NPVs were more likely to have telemedicine follow-up visits than those receiving in-person NPVs (1354/1619, 83.6% vs 680/1533, 44.4%). In the instrumental variable analysis, the impact of initial telemedicine evaluation differed by presenting condition. There was an increase in follow-up visits for patients with syncope or dizziness (29.8 visits/100 patients, 95% CI 6.4-53.1), palpitations (34.9 visits/100 patients, 95% CI 18.6-51.1), chest pain (36.9 visits/100 patients, 95% CI 18.5-55.2), and dyspnea (37.0 visits/100 patients, 95% CI 11.8-62.0). There was a decrease in follow-up visits for patients with coronary artery disease (-29.5 visits/100 patients, 95% CI -50.3 to -8.6) and dyslipidemia (-24.5 visits/100 patients, 95% CI -40.2 to -8.8). There was no significant effect for patients presenting for atrial fibrillation or flutter, heart failure, hypertension, and preoperative evaluation. The effect of initial telemedicine evaluation on follow-up visits varied significantly by presenting condition in this cardiology practice. Telemedicine use resulted in increased follow-up visits for patients presenting with symptomatic complaints, while for those presenting with chronic conditions, there was no significant effect or a decrease in visits. Future studies should assess strategies to target initial care modalities to appropriate patients in cardiology clinics with early in-person evaluation for symptomatic patients.

Coronary heart disease (CHD) continues to be a leading cause of global morbidity and mortality, with patients undergoing percutaneous coronary intervention (PCI) facing a significant risk of recurrent cardiovascular events. While secondary prevention strategies, such as medication adherence and lifestyle modifications, are essential, implementation gaps remain due to limited health care access and inadequate patient engagement. Telemedical interventions offer a promising solution to these challenges by facilitating remote monitoring and providing individualized patient management strategies. This randomized controlled trial aimed to evaluate the efficacy of a comprehensive web-based telemedical interventional management system in reducing major adverse cardiac and cerebrovascular events (MACCE) and enhancing secondary prevention outcomes among patients with CHD following PCI, compared to usual care alone. We conducted a single-center, open-label, randomized controlled trial at a tertiary hospital in China. A total of 2086 patients with post-PCI CHD were randomly assigned in a 1:1 ratio to receive either telemedical management combined with usual care (intervention group; n=1040) or usual care alone (control group; n=1046). The control group received follow-up phone calls from health care providers at 1, 3, 6, and 12 months after discharge. In contrast, the remote patient management group benefited from multicomponent interventions delivered through a telemedicine platform, alongside usual care. This platform provided personalized health education, medication reminders, vital sign monitoring, and artificial intelligence-assisted consultations. The primary outcome was the composite incidence of MACCE, including cardiac death, myocardial infarction, stroke, or target vessel revascularization, at one year. Secondary outcomes included bleeding events, lifestyle changes, blood pressure control, and medication adherence. At the one-year follow-up, the intervention group demonstrated a significant reduction in MACCE compared to the control group (36/1040, 3.5% vs 55/1046, 5.3%, P=.04). This was primarily attributed to lower rates of cardiac death (10/1040, 1.0% vs 24/1046, 2.3%, P=.02) and myocardial infarction (8/1040, 0.8% vs 19/1046, 1.8%, P=.03). Additionally, bleeding events classified as BARC 3-5 were less frequent in the intervention group (6/1040, 0.6% vs 16/1046, 1.6%, P=.03). The intervention group also exhibited improved control over systolic blood pressure (mean 117.74, SD 13.80 mmHg vs mean 121.46, SD 16.85 mmHg, P=.002) and diastolic blood pressure (mean 73.60, SD 10.18 mmHg vs mean 75.72, SD 10.45 mmHg, P=.02), along with higher medication adherence to aspirin (896/1021, 87.8% vs 858/1017, 84.4%, P=.03) and angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors (489/1021, 47.9% vs 442/1017, 43.5%, P=.045). Furthermore, there was a notable reduction in alcohol consumption among participants in the intervention group (119/1021, 11.7% vs 168/1017, 16.5%, P=.002), alongside a trend towards decreased smoking rates (114/1021, 11.2% vs 142/1017, 14.0%, P=.06). Telemedical interventional management significantly enhanced clinical outcomes by reducing MACCE and improving risk factor control among patients with CHD who underwent PCI. These findings underscore the potential of telemedicine to bolster secondary prevention efforts and long-term care strategies. Further multicenter studies are necessary to validate these results and optimize telemedicine frameworks for broader implementation.

Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.