Mélanie Raimundo Maia

Digital health is increasingly promoted to address rural health and care workforce shortages. However, its workforce consequences are usually evaluated through implementation or service-delivery outcomes rather than the conditions that enable rural workers to remain, develop, and practice sustainably. We conducted a Joanna Briggs Institute-informed scoping review reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The protocol was prospectively registered on the Open Science Framework. Five databases were searched for studies published between 2015 and 2025 in English, Spanish, and Portuguese. Two reviewers independently screened records and charted data using a prespecified framework. Synthesized entries were verified against full texts, with disagreements resolved by a third reviewer. Fifty-five sources were included. Telehealth or telemedicine was the most common intervention, followed by tele-education or distance education and multicomponent interventions. Direct retention or workforce-stability outcomes were uncommon, whereas most outcomes concerned proximal determinants of retention or implementation-related sustainability. Digital interventions most frequently influenced professional connection, supervision, continuing education, clinical confidence, and workflow support. Interpretive synthesis identified four workforce redistribution pathways (labor, authority, dependency, and infrastructure risk) through which interventions may strengthen or undermine rural workforce sustainability. Current evidence concerns retention pathways more than retention effects. Digital health should therefore be evaluated as a sociotechnical workforce intervention, extending beyond implementation success to examine how interventions redistribute labor, authority, dependency, and infrastructure risk across rural health systems.

Digital health technologies are increasingly transforming pharmaceutical care, yet pharmacy education has been slow to integrate structured digital health content into curricula. This study aimed to co-design a modular digital health curriculum framework for pharmacy education through a qualitative, stakeholder-driven process grounded in the ADDIE instructional design model and informed by the DECODE digital health competency framework. Two structured expert workshops, conducted at the 10th PCNE Working Symposium (Innsbruck, Austria, February 2026), engaged 30 participants from 13 European countries in three sequential co-design activities: competency needs mapping, curricular design sprints, and framework integration. Competency prioritization identified four workshop-level agreement pillars: artificial intelligence in healthcare, electronic health records, ethics and legal–professional foundations, and digital health literacy, alongside strong support for telehealth and wearable/sensor technologies. Eight module outlines were co-designed, spanning electronic health records, health applications, large language models, telehealth, digital health literacy, artificial intelligence in healthcare and ethics/legal/regulatory topics, and were organized into a three-tier curricular sequence (foundational, applied and advanced) that differentiates mandatory core, pathway-specific and postgraduate/CPD content. Reported feasibility was shaped by faculty expertise, curriculum crowding, governance, accreditation and institutional digital maturity, while accreditation mandates, European regulatory directives, interprofessional collaboration and pilot programs emerged as key enablers. Participants critically appraised the DECODE framework, noting its medical education origins and advocating action-oriented learning outcomes and pharmacy-specific contextualization rather than direct transposition. By combining Theory of Change with an instructional, competency-based approach, this study provides an early-stage multinational co-designed digital health curriculum blueprint, tailored for pharmacy education, representing the Analysis and Design phases of ADDIE; Development, Implementation and Evaluation phases constitute future work. It offers an implementation-conscious blueprint for strengthening the digital readiness of the pharmacy workforce.

O uso da Tecnologia da Informação e Comunicação (TIC) é uma ferramenta poderosa em todas as áreas do conhecimento, inclusive na saúde. No setor saúde, há contribuições significativas do uso de novas tecnologias, e a Organização Mundial da Saúde considera o uso de tecnologias digitais uma ação importante na redução da incidência de tuberculose em populações vulneráveis. Este artigo tem como objetivo descrever o processo de desenvolvimento de aplicativo para controle e monitoramento da tuberculose por meio do gerenciamento do seu processo terapêutico. A abordagem metodológica inclui a Metodologia de Pesquisa Design Science, abrangendo revisão de literatura, desenvolvimento inicial de protótipo no Brasil e experiência do usuário em Portugal utilizando validação de Inteligência Artificial (IA) com Eye Tracking. Os resultados orientam a equipe de pesquisa a melhorar os recursos de monitoramento e acompanhamento de pacientes do aplicativo de tuberculose. Simulações utilizando IA para validação da aplicação demonstraram a possibilidade de simular sua utilização, possibilitando antecipar problemas e melhorar a aplicação.

Chronic diseases are increasingly significant in global health, particularly among older individuals. Managing multiple chronic conditions in a single patient poses substantial challenges for healthcare systems worldwide. Poor management strategies have led to reduced quality of life and increased healthcare utilization. Digital health technologies hold the potential to transform healthcare delivery, but low digital health literacy remains a significant barrier. This paper presents a blended learning training program for Goal-Oriented Care (GOC) aimed at addressing multimorbidity management in primary healthcare (PHC). Using the GOC Model and Design Science Research Methodology (DSRM), the program integrates clinical, digital, and organizational elements to equip healthcare professionals with essential skills and tools for effective multimorbidity management. The Multimorbidity Management Health Information System (METHIS) is embedded into the curriculum to support and enhance learning. The well-structured curriculum and comprehensive evaluation methods aim to prepare healthcare professionals to provide patient-centered care and improve healthcare outcomes. The course was conducted in the Lisbon and Tagus Valley regions and targeted family medicine doctors and nurses. Results indicate moderate engagement from participants, who highlighted the practical value of the course while suggesting improvements in promotion and structure. The proposed frameworks address challenges in digital tool adoption and implement capacity-building initiatives within the DSRM framework. Combining GOC and digital health solutions shows significant potential for managing multimorbidity in PHC effectively. Training and capacity-building programs offer healthcare systems the chance to leverage technology to enhance patient outcomes and improve primary care delivery. Ongoing research and collaboration are crucial for maximizing the effectiveness of digital health solutions in the healthcare industry.

Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient’s health related outcomes.

BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. CONCLUSIONS Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient’s health related outcomes.

Background: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. Methods: This study aims at exploring the Pediatric Telecardiology Service’s evolution, through a comprehensive assessment of the PCS’s development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon’s framework helped to understand the implementation and scale-up process and the role of policy-making. Results: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant “Clan” culture. The Momentum’s critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals’ engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. Conclusion: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.

HAITooL information system design and implementation was based on Design Science Research Methodology, ensuring full participation, in close collaboration, of researchers and a multidisciplinary team of healthcare professionals. HAITooL enables effective monitoring of antibiotic resistance, antibiotic use and provides an antibiotic prescription decision-supporting system by clinicians, strengthening the patient safety procedures. The design, development and implementation process reveals benefits in organizational and behavior change with significant success. Leadership commitment multidisciplinary team and mainly informaticians engagement was crucial to the implementation process. Participants' motivation and the final product delivery and evolution depends on that.