Background: Digital proximity-tracing apps have been deployed in multiple countries to assist with SARS-CoV-2 pandemic mitigation efforts. However, it is unclear how their performance and effectiveness were affected by changing pandemic contexts and new viral variants of concern. Objective: The aim of this study is to bridge these knowledge gaps through a countrywide digital proximity-tracing app effectiveness assessment, as guided by the World Health Organization/European Center for Prevention and Disease Control (WHO/ECDC) indicator framework to evaluate the public health effectiveness of digital proximity-tracing solutions. Methods: We performed a descriptive analysis of the digital proximity-tracing app SwissCovid in Switzerland for 3 different periods where different SARS-CoV-2 variants of concern (ie, Alpha, Delta, and Omicron, respectively) were most prevalent. In our study, we refer to the indicator framework for the evaluation of public health effectiveness of digital proximity-tracing apps of the WHO/ECDC. We applied this framework to compare the performance and effectiveness indicators of the SwissCovid app. Results: Average daily registered SARS-CoV-2 case rates during our assessment period from January 25, 2021, to March 19, 2022, were 20 (Alpha), 54 (Delta), and 350 (Omicron) per 100,000 inhabitants. The percentages of overall entered authentication codes from positive tests into the SwissCovid app were 9.9% (20,273/204,741), 3.9% (14,372/365,846), and 4.6% (72,324/1,581,506) during the Alpha, Delta, and Omicron variant phases, respectively. Following receipt of an exposure notification from the SwissCovid app, 58% (37/64, Alpha), 44% (7/16, Delta), and 73% (27/37, Omicron) of app users sought testing or performed self-tests. Test positivity among these exposure-notified individuals was 19% (7/37) in the Alpha variant phase, 29% (2/7) in the Delta variant phase, and 41% (11/27) in the Omicron variant phase compared to 6.1% (228,103/3,755,205), 12% (413,685/3,443,364), and 41.7% (1,784,951/4,285,549) in the general population, respectively. In addition, 31% (20/64, Alpha), 19% (3/16, Delta), and 30% (11/37, Omicron) of exposure-notified app users reported receiving mandatory quarantine orders by manual contact tracing or through a recommendation by a health care professional. Conclusions: In constantly evolving pandemic contexts, the effectiveness of digital proximity-tracing apps in contributing to mitigating pandemic spread should be reviewed regularly and adapted based on changing requirements. The WHO/ECDC framework allowed us to assess relevant domains of digital proximity tracing in a holistic and systematic approach. Although the Swisscovid app mostly worked, as reasonably expected, our analysis revealed room for optimizations and further performance improvements. Future implementation of digital proximity-tracing apps should place more emphasis on social, psychological, and organizational aspects to reduce bottlenecks and facilitate their use in pandemic contexts.

Introduction: Telemedicine reduces greenhouse gas emissions (CO₂eq); however, results of studies vary extremely in dependence of the setting. This is the first study to focus on effects of telemedicine on CO₂ imprint of primary care. Methods: We conducted a comprehensive retrospective study to analyze total CO₂eq emissions of kilometers (km) saved by telemedical consultations. We categorized prevented and provoked patient journeys, including pharmacy visits. We calculated CO₂eq emission savings through primary care telemedical consultations in comparison to those that would have occurred without telemedicine. We used the comprehensive footprint approach, including all telemedical cases and the CO₂eq emissions by the telemedicine center infrastructure. In order to determine the net ratio of CO2eq emissions avoided by the telemedical center, we calculated the emissions associated with the provision of telemedical consultations (including also the total consumption of physicians’ workstations) and subtracted them from the total of avoided CO2eq emissions. Furthermore, we also considered patient cases in our calculation that needed to have an in-person visit after the telemedical consultation. We calculated the savings taking into account the source of the consumed energy (renewable or not). Results: 433 890 telemedical consultations overall helped save 1 800 391 km in travel. On average, 1 telemedical consultation saved 4.15 km of individual transport and consumed 0.15 kWh. We detected savings in almost every cluster of patients. After subtracting the CO2eq emissions caused by the telemedical center, the data reveal savings of 247.1 net tons of CO2eq emissions in total and of 0.57 kg CO2eq per telemedical consultation. The comprehensive footprint approach thus indicated a reduced footprint due to telemedicine in primary care. Discussion: Integrating a telemedical center into the health care system reduces the CO₂ footprint of primary care medicine; this is true even in a densely populated country with little use of cars like Switzerland. The insight of this study complements previous studies that focused on narrower aspects of telemedical consultations.

Background: The transition from hospital to primary care is a vulnerable period for patients. Telemedicine may enhance continuity of care; however, evidence on its role in supporting hospital-to-primary-care transitions remains limited. Objective: We implemented and evaluated a telephone-based follow-up program to support the transition from hospital to home and primary care, focusing on patient health as well as patient and health care provider satisfaction. Methods: In this prospective, single-center intervention study (University Hospital Basel, September 2022-December 2024), 234 patients discharged from the emergency unit or internal medicine wards received structured telemedical follow-up for up to 10 days until their first primary care appointment. Primary outcomes were patient health and satisfaction; secondary outcomes were health care provider satisfaction. Data were collected using patient-reported outcome measures, patient-reported experience measures, and provider assessments and analyzed descriptively and analytically ( P =.05). Results: Patient-reported outcome measure and patient-reported experience measure scores changed during follow-up, while no deterioration was observed. Health care provider satisfaction varied, with telemedical physicians reporting the highest ratings, hospital physicians intermediate ratings, and general practitioners the lowest, citing challenges in information transfer and perceived added value. Conclusions: This study outlines both the potential benefits and the practical challenges of implementing a telephone follow-up program after hospital discharge. Variations in physician satisfaction highlight the need for more user-friendly technical infrastructure and clearer role definitions. Future multicenter studies with broader patient samples, usual care controls, and simplified recruitment processes are required to strengthen the feasibility and generalizability of this approach.

Introduction: This is the first study evaluating the picture of a pediatric telephone triage service's (PTTS) quality from the hospital, telemedical, and patient perspective, to provide a deeper understanding of its contribution to the relief of pediatric emergency burden.Methods: We conducted a prospective multicenter study from April 3 to May 15, 2023. All calls to the Medgate Kids Line of six hospitals providing pediatric emergency care in German-speaking Switzerland were included. Following telemedical counselling, patients were advised to visit a pediatric emergency department (PED) or a primary care provider (PCP) or were treated telemedically by the Kids Line team. Patients presenting to participating PEDs after calling were evaluated by a hospital triage specialist (HTS) to define telemedical triage's appropriateness [appropriate triage, undertriage (safety), overtriage (efficiency); hospital perspective]. Only PED presentations evaluated as undertriage or overtriage were peer-reviewed (telemedical perspective), while appropriate triages were adopted. Additionally, patients’ intention, adherence and satisfaction were assessed.Results: We included 4,061 calls. 24.9% cases were advised to go to a PED, 20.7% to a PCP, and 54.3% were allocated to telemedicine. HTSs evaluated 556 cases. The PTTS appropriately triaged 78.2% of cases according to the hospital perspective (undertriage: 8.1%; overtriage: 13.7%). After telemedical peer-review overall appropriateness was 91.7% (undertriage: 3.8%; overtriage: 4.5%). 606 patients provided feedback. Without PTTS, 76.9% would have consulted face-to-face medical care (PED: 60.6%). Adherence to triage recommendation was mostly high (PED: 84.1%; PCP: 23.3%; Telemedicine: 83.5%). Net promoter score was high (48.5).Conclusion: This PTTS (>100,000 calls/year) based on clinical expertise and guidelines is appropriate, safe, efficient, and patient-satisfactory and prevents a considerably high percentage of patients from visiting a PED. While patient adherence to triage recommendations “PED” and “Telemedicine” was high, lower adherence to PCP referrals might be explained by deviations in parents' perception of acuity, and/or limited PCP availability (at out-of-office hours). Triage appropriateness varied across perspectives. Incorporating such high-quality PTTSs into further regions of Switzerland may help alleviate the burden on the healthcare system.