Journal of Telemedicine and Telecare

Publisher: SAGE Publications

Journal description

Telemedicine' has been defined in general terms to be 'medicine practised at a distance' and as such it encompasses both diagnosis and treatment, as well as medical education. During the last decade certain telemedicine applications, such as videoconsulting and teleradiology, have matured to become essential health care services. Others, such as telepathology, remain the subject of intensive research effort. The Journal of Telemedicine and Telecare publishes peer-reviewed papers on all aspects of both telemedicine and telecare - the latter covering distance nursing and community support. It is relevant to both the primary and secondary medical sectors, as well as having application to the veterinary field, and includes papers on all aspects of these emerging fields. In addition to original articles, the journal publishes preliminary communications, commissioned review articles, case reports, letters to the Editor and book reviews.

Current impact factor: 1.54

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.542
2013 Impact Factor 1.736
2012 Impact Factor 1.467
2011 Impact Factor 1.207
2010 Impact Factor 1.274
2009 Impact Factor 0.921
2008 Impact Factor 0.89
2007 Impact Factor 0.963
2006 Impact Factor 0.802
2005 Impact Factor 0.749
2004 Impact Factor 0.749
2003 Impact Factor 1.094
2002 Impact Factor 1.366
2001 Impact Factor 1.351
2000 Impact Factor 1.733

Impact factor over time

Impact factor

Additional details

5-year impact 1.78
Cited half-life 6.90
Immediacy index 0.19
Eigenfactor 0.00
Article influence 0.56
Website Journal of Telemedicine and Telecare website
ISSN 1758-1109

Publisher details

SAGE Publications

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors retain copyright
    • Pre-print on any website
    • Author's post-print on author's personal website, departmental website, institutional website or institutional repository
    • On other repositories including PubMed Central after 12 months embargo
    • Publisher copyright and source must be acknowledged
    • Publisher's version/PDF cannot be used
    • Post-print version with changes from referees comments can be used
    • "as published" final version with layout and copy-editing changes cannot be archived but can be used on secure institutional intranet
    • Must link to publisher version with DOI
    • Publisher last reviewed on 29/07/2015
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Few studies in developing nations have assessed the use of short messaging services (SMS) to identify psychological challenges in refugee populations. This study aimed to assess the feasibility of SMS-based methods to screen for depression risk among refugees in South Africa attending mental health services, and to compare its reliability and acceptability with face-to-face consultation. Methods: Of the 153 refugees enrolled at baseline, 135 were available for follow-up assessments in our cohort study. Depression symptomatology was assessed using the 16-item Quick Inventory of Depressive Symptomatology (QIDS) instrument. Results: Nearly everyone possessed a mobile phone and utilized SMS. Furthermore, low incomplete item response in QIDS and high perceived ease of interacting via SMS with service providers supported the feasibility of this method. There was a fair level of reliability between face-to-face and SMS-based screening methods, but no significant difference in preference rating between the two methods. Conclusion: Despite potential implementation barriers (network delay/phone theft), depression screening using SMS may be viable for refugee mental health services in low-resource settings.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15605406
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    ABSTRACT: Tele-ophthalmology using portable retinal imaging technology, mobile phone and Internet connectivity offers a solution to improve access to diabetic retinopathy (DR) screening services in sub-Saharan African (SSA) countries where the burden of diabetes is increasing and there is limited access to eye care services and specialists. The Zimbabwe Retinopathy Telemedicine Project (ZRTP) established routine DR screening at a hospital-based diabetic clinic in the urban capital city, Harare. A handheld 'point and shoot' digital camera operated by a trained nurse was used to acquire retina images of 203 diabetic patients. A secured 'store-and forward' approach was set up and used for sharing and transfer of images to a retinal specialist at a remote site for reading. This method enabled detection of non-macular DR (11%), diabetic macular oedema (5%), cataract (5%) and glaucoma (6%) among the patients screened. ZRTP demonstrated the utility of tele-ophthalmology for routine retinal screening for diabetic patients in Zimbabwe who have limited access to eye care services. In addition, ZRTP showed how tele-ophthalmology services can provide an empirical framework for providing patient education, and a platform for research in the detection of DR. This approach could be used as a model to address the DR challenges in other countries in SSA.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15604083
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    ABSTRACT: Introduction: E-consultations are asynchronous, text-based consultations. The specialist e-consultant answers clinical questions in a similar way to a standard consultation but the questions and answers are sent electronically. The e-consultant has access to some or all of the medical record but does not have contact with the patient. Although e-consultations are meant to substitute for face-to-face (F2F) consultations, a significant proportion of e-consultations are converted to F2F consultations. Methods: We examined e-consultation content from a sample of e-consultations that had subsequent F2F visits in the same specialty as the e-consultation within 28 days of the e-consultation. Results: Out of 5115 e-consultations, there were a total of 547 (10.7%) early F2F conversions. One hundred and fifty-one e-consultations with subsequent early F2F conversions were reviewed in eight specialties. In 64% of the F2F conversions, specialists recommended the F2F consultations. In 75% there were complex diagnostic or treatment considerations. In only 1% was there a sense of medical urgency or a stated need for physical examination. Discussion: E-consultations convert to F2F consultations primarily at the request of the specialist. Diagnostic and treatment complexity appear to be the main reasons. We found little evidence that patients decided independently to get a F2F visit or that specialists needed a F2F visit to perform a physical examination. Although e-consultations might not be a complete substitute for F2F consultations, they may serve as an entry level consultation that could be supplemented by a video consultation as needed for cases with more diagnostic and treatment complexity.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15602634
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    ABSTRACT: Background: Despite the significant access and cost-saving potential of telehealth, the uptake of telehealth services in Australia has been sporadic. Understanding the factors that drive the uptake of home-telehealth services from the consumer perspective has received scant attention in the literature. Aim: The aim of this study was to explore how a comprehensive set of factors may influence the intention of older Australians to adopt home telehealth services. Methods: A survey of 306 Australians aged between 50 and 68 years was conducted to examine the influence of six categories of predictors on the intention of older Australians to adopt home telehealth: (a) demographics, (b) health status and usage, (c) mobility and ease of access to healthcare, (d) technology usage and anxiety with technology, (e) telehealth attitudes, and (f) personality traits. Results: Hierarchical regression analysis revealed that significant predictors were: trust in telehealth (β = 0.35); the technology acceptance model (β = 0.27); healthcare habits (β = -0.20); dissatisfaction with traditional healthcare (β = 0.19) and online behaviors (β = 0.09). The model explained 63% of the variance in intention to adopt home telehealth. Conclusion: This study is the first of its kind in Australia and provides valuable insight into the factors which impact consumer's intention to adopt telehealth services.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15606264
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    ABSTRACT: The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) programme using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. We used a Solomon four-group (two intervention and two control groups) randomised design. The study population was 144 randomly selected, HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling. A total of 132 participants (33 per site) were enrolled in the study from the two intervention and two control sites. In the pre-tests, the intervention and control groups did not differ significantly with regard to demographics. Evaluation of the pre- and post-tests of the intervention group indicated significantly higher Action and Acceptance Questionnaire (AAQ-II) scores. The introduction of a mobile phone acceptance and commitment therapy programme may result in greater psychological flexibility in women diagnosed with HIV.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15605408
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    ABSTRACT: Introduction: The world population is aging. By 2050, the global population aged over 65 years will have doubled, leading to big societal challenges for ensuring healthy, independent, and productive lives for older people. Thus, innovative local and national initiatives for e-health services are growing in an attempt to overcome such problems. Methods: We examined the effects of a telehealth system, i.e. tele-monitoring of vital parameters and neurological/psychological tele-counseling, within a family-centred service provided by a local day centre. We evaluated the clinical and neurobehavioral symptoms of 18 elderly patients (aged 65 years and over) and the care burden of their 20 caregivers, besides the usability of the tool. Results: The one-way repeated analysis revealed a significant worsening in daily living activities (p < 0.01 and p = 0.02, respectively for Activities of Daily Living (ADL) and Independent IADL (IADL)) versus a significant improvement of the patients' psychiatric condition (p < 0.001), besides a significant gradual reduction of the caregivers burden (p < 0.001). Health status perception increased through time (from an average score of 5.67 ± 1.08 at baseline to 7.72 ± 1.32 at the end of the study). Discussion: It appears that a telehealth system integrated in a local health care service may significantly improve elderly persons' behaviour, and also reduce the caregivers' burden.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15604290
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    ABSTRACT: The prevalence of ear disease and hearing loss is greater for Indigenous children than for their non-Indigenous counterparts. In 2009, we established a mobile ear-screening service in South Burnett, in which an Indigenous Health Worker (IHW) assesses children at school and shares results by telemedicine with ear, nose and throat (ENT) specialists, who in turn provide review and biannual surgical outreach to the community. We reviewed service data for the first six years of the service (Jan 2009-Dec 2014), to calculate: total number of completed assessments; total number of patients failing at least one screening test; and overall proportion of failed screening assessments per annum. Subgroup analysis was conducted by usual home postcode. The service has provided 5539 screening assessments. The mean screening failure rate for children outside of postcode 4605 (Cherbourg/Murgon area) was 22% (range 17-29%) and 38% for children living inside postcode 4605 (range 34-41%). While screening activity has increased by more than 50% since 2009, there has been a slight reduction in the proportion of children failing assessment, with the mean failure rate changing from 33% in 2009 to 26% in 2014. These early results suggest that community-based screening, integrated with specialist ENT services may improve ear and hearing health.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15605407
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    ABSTRACT: Many hospitals have limited inpatient dermatology consultation access. Most dermatologists are outpatient-based and may find the distance and time to complete inpatient consultations prohibitive. Teledermatology may improve access to inpatient dermatology care by reducing barriers of distance and time. We conducted a prospective two-phase pilot study at two academic hospitals comparing time needed to complete inpatient consultations after resident dermatologists initially evaluated patients, called average handling time (AHT), and time needed to respond to the primary team, called time to response (TTR), with and without teledermatology with surveys to capture changes in dermatologist opinion on teledermatology. Teledermatology was only used in the study phase, and patients were seen in-person in both study phases. Teledermatology alone sufficiently answered consultations in 10 of 25 study consultations. The mean AHT in the study phase (sAHT) was 26.9 min compared to the baseline phase (bAHT) of 43.5 min, a 16.6 min reduction (p = 0.004). The 10 study cases where teledermatology alone was sufficient had mean study TTR (sTTR) of 273.3 min compared to a baseline TTR (bTTR) of 405.7 min, a 132.4 min reduction (p = 0.032). Teledermatology reduces the time required for an attending dermatologist to respond and the time required for a primary team to receive a response for an inpatient dermatology consultation in a subset of cases. These findings suggest teledermatology can be used as a tool to improve access to inpatient dermatology care.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15603298
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    ABSTRACT: Little is understood about factors that influence speech-language pathologists' (SLPs') acceptance of telepractice. The aim of this study was to investigate SLPs' perceptions and experiences of transitioning to a school-based telepractice service to identify factors that contributed to positive clinician attitudes. In-depth interviews were conducted with 15 SLPs who recently commenced providing school-based telepractice services. Interviews were recorded and transcribed verbatim and thematic analysis was used to interpret interviews, with themes compared and contrasted across the group. Results indicated that although SLPs reported initially having mixed feelings towards telepractice, they later evaluated telepractice positively and viewed it as a legitimate service delivery mode. The overarching theme was that positive beliefs about telepractice were associated with perceptions of its consistency with the underlying principles of face-to-face therapy. In evaluating telepractice, SLPs considered: (a) therapeutic relationships with children; (b) collaboration with parents and teachers; (c) adequacy of technology and resources; and (d) access to support for learning telepractice. Therapy assistants and specific clinician attributes emerged as key strategies used to manage threats to acceptability. Preparation of SLPs transitioning to telepractice should address factors that support positive experiences with, and attitudes towards, telepractice to ensure that training achieves the greatest, most sustained change.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15604555
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    ABSTRACT: Introduction: Behavioural interventions have been shown to improve outcomes in patients with type 1 diabetes mellitus (T1DM). There are a small number of studies that suggest text-messages (TM), native mobile applications (NMAs), and other mobile tools may be useful platforms for delivering behavioural interventions to adolescents. Aim: The aim of this study was to explore, by way of a systematic review of available literature, (a) the outcomes of interventions using mobile technology for youth with T1DM and (b) what mobile technologies, functional design elements and aesthetic design elements have the best evidence to support their use. Methods: A search of six online databases returned 196 unique results, of which 13 met the inclusion criteria. Results: Four studies were randomised controlled trials (RCTs), and all others prospective cohort studies. TM (10) was the most common intervention technology, while NMAs were used in four studies. The most common outcome measured was HbA1c (9); however, only three studies showed a significant decrease. Similarly, the results reported for other outcome measures were mixed. The studies included in this review suggest that interventions which have data collection and clinician support functionality may be more effective in improving adherence and glycaemic control, but more evidence is needed. Further, the evidence base supporting the use of NMAs in T1DM management for adolescents is weak, with most studies adopting TM as the intervention tool. Overall, the studies lack adequate descriptions of their methodology, and better quality studies are required to inform future intervention design.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15605223
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    ABSTRACT: Aim: The aim of this review was to determine if photographic examination and subsequent image analysis provides comparable accuracy to visual inspection for the diagnosis of common dental conditions in children and adolescents. Methods: We searched the PubMed database for studies that compared diagnostic accuracy of the two inspection techniques. Studies were screened for inclusion and were assessed for quality and risk of bias using the quality assessment of diagnostic accuracy studies tools. Findings were reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Findings: Sixteen studies met the inclusion criteria. Nine of the included studies evaluated dental caries and eight evaluated enamel defects (one study evaluated both conditions). Conclusions: Three studies found image analysis to be superior. For the remaining six studies the diagnostic accuracy was comparable. For enamel defects, three studies found image analysis to be superior, two found visual inspection to be superior and three studies reported comparable diagnostic accuracy. Most studies have found at least comparable results between photographic and visual inspection techniques. However, the wide variation in equipment and personnel used for the collection and interpretation of photographic images made it impossible to generalise the results. It remains unclear exactly how effective store-and-forward teledentistry is for the diagnosis of common dental conditions in children.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15605225
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    ABSTRACT: Introduction: The Flinders University Telehealth in the Home (FTH) trial was an action research initiative that introduced and evaluated the impact of telehealth services on palliative care patients living in the community, home-based rehabilitation services for the elderly, and services to the elderly in residential aged care. The aim of this study was to understand the issues encountered during the provision of technology services that supported this trial. Methods: A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Results: Use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Usability of applications was key to their subsequent use. Management of design creep and technology services, coupled with support and training for clinicians were important to maintenance of a telehealth service. Discussion: In the setting described, an iterative approach to the development of telehealth services to the home using consumer technologies was needed. The efficient management of consumer devices in multiple settings will become critical as telehealth services grow in scale. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15601523
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    ABSTRACT: Background: The role of telemedicine in the management of patients with chronic heart failure (HF) has not been fully elucidated. We hypothesized that multidisciplinary comprehensive HF care could achieve better results when it is delivered using telemedicine. Methods and results: In this study, 178 eligible patients with HF were randomized to either structured follow-up on the basis of face-to-face encounters (control group, 97 patients) or delivering health care using telemedicine (81 patients). Telemedicine included daily signs and symptoms based on telemonitoring and structured follow-up by means of video or audio-conference. The primary end-point was non-fatal HF events after six months of follow-up. The median age of the patients was 77 years, 41% were female, and 25% were frail patients. The hazard ratio for the primary end-point was 0.35 (95% confidence interval (CI), 0.20-0.59; p-value < 0.001) in favour of telemedicine. HF readmission (hazard ratio 0.39 (0.19-0.77); p-value=0.007) and cardiovascular readmission (hazard ratio 0.43 (0.23-0.80); p-value=0.008) were also reduced in the telemedicine group. Mortality was similar in both groups (telemedicine: 6.2% vs control: 12.4%, p-value > 0.05). The telemedicine group experienced a significant mean net reduction in direct hospital costs of €3546 per patient per six months of follow-up. Conclusions: Among patients managed in the setting of a comprehensive HF programme, the addition of telemedicine may result in better outcomes and reduction of costs.
    Journal of Telemedicine and Telecare 09/2015; DOI:10.1177/1357633X15600583
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    ABSTRACT: Virtual reality therapy is already used for anxiety disorders as an alternative to in vivo and in imagino exposure. To our knowledge, however, no one has yet proposed using remote virtual reality (e-virtual reality). The aim of the present study was to assess e-virtual reality in an acrophobic population. Six individuals with acrophobia each underwent six sessions (two sessions per week) of virtual reality exposure therapy. The first three were remote sessions, while the last three were traditional sessions in the physical presence of the therapist. Anxiety (STAI form Y-A, visual analog scale, heart rate), presence, technical difficulties and therapeutic alliance (Working Alliance Inventory) were measured. In order to control the conditions in which these measures were made, all the sessions were conducted in hospital. None of the participants dropped out. The remote sessions were well accepted. None of the participants verbalized reluctance. No major technical problems were reported. None of the sessions were cancelled or interrupted because of software incidents. Measures (anxiety, presence, therapeutic alliance) were comparable across the two conditions. e-Virtual reality can therefore be used to treat acrophobic disorders. However, control studies are needed to assess online feasibility, therapeutic effects and the mechanisms behind online presence.
    Journal of Telemedicine and Telecare 08/2015; DOI:10.1177/1357633X15598243
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    ABSTRACT: An increasing number of patients with diabetes mellitus has created a need for innovative delivery of specialized care not only by diabetes specialists but also by primary care providers (PCPs) as well. A potential avenue to address this need is training of PCPs by specialists via telehealth. The Veteran Affairs (VA) Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) program includes education and case-based learning for PCPs by a multidisciplinary specialty team utilizing videoconferencing technology. Two PCPs completed a year of SCAN-ECHO diabetes training. These two PCPs set up "diabetes mini-clinics" to treat difficult-to-control high-risk patients with diabetes mellitus from their own panel and from their colleagues in the same community-based outpatient clinic (CBOC). We utilized a retrospective program evaluation by t-test using pre/post glycated hemoglobin (HbA1c) lab values after being seen by the two PCPs. A total of 39 patients, all with HbA1c > 9.0%, were seen in the two PCP mini-clinics over 15 months. The mean HbA1c improved from 10.2 ± 1.4% to 8.4 ± 1.8% (p < 0.001) over the average follow-up period of five months. This was not explained by system-wide changes or improvements. Care of veteran patients with poorly controlled diabetes by PCPs who participated in SCAN-ECHO program leads to improvement in glycemic control. This model of health care delivery can be effective in remote or rural areas with limited availability of specialists. © The Author(s) 2015.
    Journal of Telemedicine and Telecare 08/2015; DOI:10.1177/1357633X15598052
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    ABSTRACT: Monitoring medication adherence in multiple sclerosis (MS) can be time consuming and expensive; however, non-adherence is common and is very costly in terms of lost therapeutic benefit and unused medications. To address this problem, we employed a web-based system to monitor and potentially modify medication adherence. Participants (n = 30) were randomized either to routine care or to the MS Home Automated Telehealth (MS HAT) system. Weekly interferon beta-1a intramuscular (INFbeta-1a IM) injections and daily vitamin D adherence were tracked over a six-month period using multiple modalities: self-reported adherence, calendar diaries, pharmacy refill rates, blood serum levels, and MS HAT alerts. Weekly INFbeta-1a IM adherence was highly correlated across measures; however, vitamin D adherence was not as consistent. Healthcare providers were able to efficiently monitor adherence in a patient-centered way by using the MS HAT system to monitor adherence rather than employing chart reviews and phone calls. In addition, patients with more preserved cognitive function appeared to benefit more from use of the MS HAT system than those with cognitive impairment. While further research is needed to understand the differential effects of MS HAT on specific medications and for different individuals, it is a promising tool for monitoring medication adherence in patients with MS. © The Author(s) 2015.
    Journal of Telemedicine and Telecare 08/2015; DOI:10.1177/1357633X15597115