***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose of the study : to examine the costs and cost-effectiveness of ‘ second-generation ’ telecare , in addition to st and ard support and care that could include ‘ first-generation ’ forms of telecare , compared with st and ard support and care that could include ‘ first-generation ’ forms of telecare . Design and methods : a pragmatic cluster-r and omised controlled trial with nested economic evaluation . A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas . In the Whole Systems Demonstrator Telecare Question naire Study , 550 participants were r and omised to intervention and 639 to control . Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months , additional to their st and ard health and social care services . The control group received usual health and social care . Primary outcome measure : incremental cost per quality -adjusted life year ( QALY ) gained . The analyses took a health and social care perspective . Results : cost per additional QALY was £ 297,000 . Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £ 30,000 per QALY gained was only 16 % . Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £ 161,000 per QALY . Implication s : while QALY gain in the intervention group was similar to that for controls , social and health services costs were higher . Second-generation telecare did not appear to be a cost-effective addition to usual care , assuming a commonly accepted willingness to pay for QALYs . Trial registration number : IS RCT N 43002091 INTRODUCTION We wanted to examine how Danes use the Internet  for health-related purpose s. How much are the existing possibilities used ? Who are the users ? What are the consequences of this use ? MATERIAL S AND METHODS In October 2005 - -as part of a large EU supported study --a telephone survey was carried out among 1000 r and omly selected Danes between the age of 15 and 80 . RESULTS 60 % of the Danish population use the  Internet  to seek health-related information . The Internet is especially used for health purpose s by people with a high education , by women , by people with poor health and by people with children . Every fourth Dane experiences feelings of reassurance or relief after having read about illness on the Internet and this number is 3 times higher than the number of people that experience concern and anxiety . 3 % state that they have changed their medication after having read information on the Internet and this is done without prior contact to their doctor . 8 % of Danes have at some point consulted their doctor over the Internet , and if given the opportunity , 58 % would read their own patient record online . CONCLUSIONS For many Danes it is common practice to use the Internet for health-related purpose s. However , the position of the general practitioner as the primary source of health-related information is not threatened . Danes use the Internet as a supplement to their doctor and many -- especially women -- use the Internet information in their dialogue with their doctor . Danes increasingly seek solutions to enable them to get online contact with the different players in the health care sector BACKGROUND Pediatric subspecialists are often separated from the children who need them by distance , time , or socioeconomic factors . The Electronic Children 's Hospital of the Pacific  is an Internet-based store- and -forward pediatric consultation system established to overcome these barriers . OBJECTIVE To characterize the use of the Electronic Children 's Hospital of the Pacific and its impact on access to specialty care , the quality of the care provided , and cost savings . DESIGN Prospect i ve trial . SETTING Twenty-two military treatment facilities in the Pacific . PARTICIPANTS Primary care providers , pediatric consultants , and 5 review ers . MAIN OUTCOME MEASURES Consult response time , physician panel review , and evacuation cost avoidance . RESULTS There were 267 cases from 16 sites . The mean + /- SD response time by a consultant was 32 + /- 8 hours . The panel review deemed that the initial diagnosis was changed or modified in 15 % ( 39/267 ) of the cases , the diagnostic plan was changed or modified in 21 % ( 57/267 ) , and the treatment plan was changed or modified in 24 % ( 64/267 ) ( P < .01 for all ) . Routine air evacuations to a tertiary care medical center were avoided in 32 cases ( 12 % ) , with an estimated cost savings of $ 185 408 . CONCLUSIONS The Electronic Children 's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation . Significant cost avoidance in this military pediatric population was documented . Store- and -forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children Background Missed appointments are known to interfere with appropriate care and to misspend medical and administrative re sources . The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments . Methods We conducted a r and omised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients . All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention : 1 . Phone call ( fixed or mobile ) reminder ; 2 . If no phone response : a Short Message Service ( SMS ) reminder ; 3 . If no available mobile phone number : a postal reminder . The rate of missed appointment , the cost of the intervention , and the profile of patients missing their appointment were recorded . Results 2123 patients were included : 1052 in the intervention group , 1071 in the control group . Only 61.7 % patients had a mobile phone recorded at the clinic . The sequential intervention significantly reduced the rate of missed appointments : 11.4 % ( n = 122 ) in the control group and 7.8 % ( n = 82 ) in the intervention group ( p < 0.005 ) , and allowed to reallocate 28 % of cancelled appointments . It also proved to be cost effective in providing a total net benefit of 1846 . - EUR/3 months . A satisfaction survey conducted with 241 patients showed that 93 % of them were not bothered by the reminders and 78 % considered them to be useful . By multivariate analysis , the following characteristics were significant predictors of missed appointments : younger age ( OR per additional decade 0.82 ; CI 0.71 - 0.94 ) , male gender ( OR 1.72 ; CI 1.18 - 2.50 ) , follow-up appointment > 1year ( OR 2.2 ; CI : 1.15 - 4.2 ) , substance abuse ( 2.09 , CI 1.21 - 3.61 ) , and being an asylum seeker ( OR 2.73 : CI 1.22 - 6.09 ) . Conclusion A practical reminder system can significantly increase patient attendance at medical outpatient clinics . An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders IMPORTANCE Hospital readmissions are common and costly , and no single intervention or bundle of interventions has reliably reduced readmissions . Virtual wards , which use elements of hospital care in the community , have the potential to reduce readmissions , but have not yet been rigorously evaluated . OBJECTIVE To determine whether a virtual ward-a model of care that uses some of the systems of a hospital ward to provide interprofessional care for community-dwelling patients -can reduce the risk of readmission in patients at high risk of readmission or death when being discharged from hospital . DESIGN , SETTING , AND PATIENTS High-risk adult hospital discharge patients in Toronto were r and omly assigned to either the virtual ward or usual care .  A total of 1923 patients were r and omized during the course of the study : 960 to the usual care group and 963 to the virtual ward group . The first patient was enrolled on June 29 , 2010 , and follow-up was completed on June 2 , 2014 . INTERVENTIONS Patients assigned to the virtual ward received care coordination plus direct care provision ( via a combination of telephone , home visits , or clinic visits ) from an interprofessional team for several weeks after hospital discharge . The interprofessional team met daily at a central site to design and implement individualized management plans . Patients assigned to usual care typically received a typed , structured discharge summary , prescription for new medications if indicated , counseling from the resident physician , arrangements for home care as needed , and recommendations , appointments , or both for follow-up care with physicians as indicated . MAIN OUTCOMES AND MEASURES The primary outcome was a composite of hospital readmission or death within 30 days of discharge . Secondary outcomes included nursing home admission and emergency department visits , each of the components of the primary outcome at 30 days , as well as each of the outcomes ( including the composite primary outcome ) at 90 days , 6 months , and 1 year . RESULTS There were no statistically significant between-group differences in the primary or secondary outcomes at 30 or 90 days , 6 months , or 1 year . The primary outcome occurred in 203 of 959 ( 21.2 % ) of the virtual ward patients and 235 of 956 ( 24.6 % ) of the usual care patients ( absolute difference , 3.4 % ; 95 % CI , -0.3 % to 7.2 % ; P = .09 ) . There were no statistically significant interactions to indicate that the virtual ward model of care was more or less effective in any of the prespecified subgroups . CONCLUSIONS AND RELEVANCE In a diverse group of high-risk patients being discharged from the hospital , we found no statistically significant effect of a virtual ward model of care on readmissions or death at either 30 days or 90 days , 6 months , or 1 year after hospital discharge . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01108172 Background Computer-based decision support systems are a promising method for incorporating research evidence into clinical practice . However , evidence is still scant on how such information technology solutions work in primary healthcare when support is provided across many health problems . In Finl and , we design ed a trial where a set of evidence -based , patient-specific reminders was introduced into the local Electronic Patient Record ( EPR ) system . The aim was to measure the effects of such reminders on patient care . The hypothesis was that the total number of triggered reminders would decrease in the intervention group compared with the control group , indicating an improvement in patient care . Methods From July 2009 to October 2010 all the patients of one health center were r and omized to an intervention or a control group . The intervention consisted of patient-specific reminders concerning 59 different health conditions triggered when the healthcare professional ( HCP ) opened and used the EPR . In the intervention group , the triggered reminders were shown to the HCP ; in the control group , the triggered reminders were not shown . The primary outcome measure was the change in the number of reminders triggered over 12 months . We developed a unique data gathering method , the Repeated Study Virtual Health Check ( RSVHC ) , and used Generalized Estimation Equations ( GEE ) for analysing the incidence rate ratio , which is a measure of the relative difference in percentage change in the numbers of reminders triggered in the intervention group and the control group . Results In total , 13,588 participants were r and omized and included . Contrary to our expectation , the total number of reminders triggered increased in both the intervention and the control groups . The primary outcome measure did not show a significant difference between the groups . However , with the inclusion of patients followed up over only six months , the total number of reminders increased significantly less in the intervention group than in the control group when the confounding factors ( age , gender , number of diagnoses and medications ) were controlled for . Conclusions Computerized , tailored reminders in primary care did not decrease during the 12 months of follow-up time after the introduction of a patient-specific decision support system . Trial registration Clinical Trial.gov Background Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical setting s. Since text-messaging is less re source -dem and ing , we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic . Methods A r and omized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011 . Patients registered for an appointment at the clinic , and for whom a cell phone number was available , were r and omly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment . Patients were included each time they had an appointment . The main outcome was the rate of unexplained missed appointments . Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention . We defined non-inferiority as a difference below 2 % in the rate of missed appointments and powered the study accordingly . A satisfaction survey was conducted among a r and om sample of 900 patients ( response rate 41 % ) . Results 6450 patients were included , 3285 in the text-message group and 3165 in the telephone group . The rate of missed appointments was similar in the text-message group ( 11.7 % , 95 % CI : 10.6 - 12.8 ) and in the telephone group ( 10.2 % , 95 % CI : 9.2 - 11.3 p = 0.07 ) . However , only text message reminders were cost-effective . No patient reported any disturbance by any type of reminder in the satisfaction survey . Three quarters of surveyed patients recommended its regular implementation in the clinic . Conclusions Text-message reminders 
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RESULTS The majority of studies support the feasibility/acceptance of telemedicine  for use in primary care , although it varies significantly by demographic variables , such as gender , age , and socioeconomic status , and telemedicine has often been found more acceptable by patients than healthcare providers .
Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care .
Cost analyses vary , but telemedicine in primary care is increasingly demonstrated to be cost-effective .
CONCLUSIONS Telemedicine has significant potential to address many of the challenges facing primary care in today 's healthcare environment .