Telemedicine consultations with physicians in Swedish primary care: a mixed methods study of users' experiences and care patterns

Felicia Gabrielsson-Järhult, Sofia Kjellström, Kristina Areskoug Josefsson, Felicia Gabrielsson-Järhult, Sofia Kjellström, Kristina Areskoug Josefsson

Abstract

Objective: The study aimed to explore users' experiences and care patterns concerning telemedicine consultations with physicians in Swedish primary care from 2017 to 2019.Design and participants: A mixed methods study involving 26 qualitative interviews with users of telemedicine consultations from a national sample, complemented by a quantitative registry study of data from 10,400 users in a Swedish region.

Results: Users mainly described telemedicine consultations as a positive experience and perceived that the service met their current health care needs. Users also valued high accessibility, timesaving, and the contribution to ecological sustainability. Users felt competent about choosing when to use telemedicine consultations, most commonly for less severe health care concerns. This was confirmed by the quantitative results; only a few users had other care contacts within physical primary care before, or after, the telemedicine consultation, attended acute care or phoned 1177 Health Care Guidance.

Conclusions: This study provides a rare account of users' experiences of telemedicine consultations. Users expressed satisfaction with this up-to-date use of health care resources for them as individuals, the health care system, and the environment. Telemedicine consultations were perceived as efficient and safe according to users. In addition, the study shows a low degree of further physical contacts in primary care or in acute care related to the telemedicine consultations.Key pointsUsers have positive experiences of telemedicine consultations with physicians and experienced that the service had meet their actual needs for health care.Users were mainly satisfied with the service and highlighted the value of high accessibility.Users experienced that telemedicine consultants provided an alternative care service for mostly minor health problems, perceiving them to save time and resources for themselves, the health care system, and the environment.Most telemedicine consultations did not result in additional contacts with 1177 Health Care Guidance, physical visits to primary care, or acute health care.Telemedicine consultations with physicians were mainly used by persons aged 0-30 years and need to be further developed to suit other age groups.

Keywords: Primary health care; Sweden; care patterns; e-health; mixed methods; patient experiences; patient satisfaction; telemedicine.

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Ashwood JS, Mehrotra A, Cowling D, et al. . Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Aff . 2017;36(3):485–491.
    1. Cameron MPL, Robin R, Sabesan S.. Physicians' perceptions of clinical supervision and educational support via videoconference: a systematic review. J Telemed Telecare. 2014;20(5):272–281.
    1. Greenhalgh T, Shaw S, Wherton J, et al. . Real-world implementation of video outpatient consultations at macro, meso, and micro levels: mixed-method study. J Med Internet Res. 2018;20(4):e150.
    1. Assing Hvidt E, Søndergaard J, Klausen M, et al. . Not just an information delivery tool. An ethnographic study exploring Danish GP’s perspectives with the relational potential of e-mail conversation. Scand J Prim Health Care. 2020; 38:411–420.
    1. Chen J, Lan YC, Chang YW, et al. . Exploring doctors’ willingness to provide online counselling services: the roles of motivations and costs. IJERPH. 2019;17(1):110.
    1. Fernemark H, Skagerström J, Seing I, et al. . Digital consultations in Swedish primary health care: a qualitative study of physicians' job control, demand and support. BMC Fam Pract. 2020;21(1):241.
    1. Gabrielsson-Järhult F, Areskoug-Josefsson K, Kammerlind P. Digitala vårdmöten med läkare. Rapport av en kvantitativ och kvalitativ studie. [Documentation: Digital care meetings with doctors. Report of quantitative and qualitative study]. 2019. .
    1. Ekeland AG, Bowes A, Flottorp S.. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform. 2010;79(11):736–771.
    1. Greenhalgh T, Vijayaraghavan S, Wherton J, et al. . Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open. 2016;6(1):e009388.
    1. Hansen A, Herrmann M, Ehlers JP, et al. . Perception of the progressing digitization and transformation of the German health care system among experts and the public: mixed methods study. JMIR Public Health Surveill. 2019;5(4):e14689.
    1. Blix M, Levay C. Digitalization and health care – a report to the Swedish Government's expert group on public economics. 2018. The Expert Group on Public Economics. .
    1. Regeringskansliet . Digifysiskt vårdval – Tillgänglig primärvård baserad på behov och kontinuitet. SOU 2019. 42. .
    1. Topol E. Digital medicine: empowering both patients and clinicians. Lancet. 2016;388(10046):740–741.
    1. Regeringskansliet . Vision e-hälsa 2025 – gemensamma utgångspunkter för digitalisering i socialtjänst och hälso- och sjukvård [Vision e-health 2025 – common starting points for digitalisation in social services and health and medical care]. 2016. .
    1. Ellegård LM, Kjellsson G.. Telemedicine services associated with higher use of regular primary care in a Swedish region. Läkartidningen. 2019;116:1–5 [in Swedish].
    1. Areskoug Josefsson K, Avby G, Andersson BM, et al. . Workers' experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study. Scand J Prim Health Care. 2018;36(4):406–414.
    1. Kjellström S, Avby G, Areskoug Josefsson K, et al. . Work motivation among healthcare professionals: a study of well-functioning primary healthcare centers in Sweden. J Health Organ Manag. 2017;31(4):487–502.
    1. Fredriksson M, Blomqvist P, Winblad U.. Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden. BMC Health Serv Res. 2014;14(1):509.
    1. Anell A. The public-private pendulum-patient choice and equity in Sweden. N Engl J Med. 2015;372(1):1–4.
    1. Burstrom B, Burstrom K, Nilsson G, et al. . Equity aspects of the Primary Health Care Choice Reform in Sweden – a scoping review. Int J Equity Health. 2017;16(1):29.
    1. Ekman B, Thulesius H, Wilkens J, et al. . Utilization of digital primary care in Sweden: descriptive analysis of claims data on demographics, socioeconomics, and diagnoses. Int J Med Inform. 2019;127:134–140.
    1. Andersson Back M. Risks and opportunities of reforms putting primary care in the driver's seat. Comment on "governance, government, and the search for new provider models. Int J Health Policy Manag. 2016;5(8):511–513.
    1. Anell A. Choice and privatisation in Swedish primary care. Health Econ Policy Law. 2011;6(4):549–569.
    1. Banks J, Farr M, Salisbury C, et al. . Use of an electronic consultation system in primary care: a qualitative interview study. Br J Gen Pract. 2018;68(666):e1–e8.
    1. Edwards HB, Marques E, Hollingworth W, et al. . Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England. BMJ Open. 2017;7(11):e016901.
    1. Ekman B-O. Cost analysis of a digital health care model in Sweden. Pharmacoecon Open. 2018;2(3):347–354.
    1. Zandbelt LC, de Kanter FEC, Ubbink DT.. E-consulting in a medical setting: medicine of the future? Patient Educ Couns. 2016;99(5):689–670.
    1. Farr M, Banks J, Edwards HB, et al. . Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production. BMJ Open. 2018;8(3):e019966.
    1. Zanaboni P, Fagerlund Johansen A.. Patients' use and experiences with e-consultation and other digital health services with their general practitioner in Norway: results from an online survey. BMJ Open. 2020;10(6):e034773.
    1. Fagerlund Johansen A, Holm IM, Zanaboni P.. General practitioners' perceptions towards the use of digital health services for citizens in primary care: a qualitative interview study. BMJ Open. 2019;9(5):e028251.
    1. MacNeill V, Sanders C, Fitzpatrick R, et al. . Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract. 2014;64(624):e401–e407.
    1. SOU 2018:55 Control and consumption of care from an equality perspective. Mapping socio-economic differences in health care utilization and starting points for better control. Stockholm; 2018.
    1. SOU 2019:42 Digi physical care choice. Available primary care based on needs and continuity. Stockholm; 2019.
    1. Fetters MD, Curry LA, Creswell JW.. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–2156.
    1. Braun V, Clarke V.. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
    1. Fadahunsi KP, Akinlua JT, O'Connor S, et al. . Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth. BMJ Open. 2019;9(3):e024722.
    1. Galdas P, Cheater F, Marshall P.. Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005;49(6):616–623.
    1. van der Gugten AC, de Leeuw RJ, Verheij TJ, et al. . E-Health and health care behaviour of parents of young children: a qualitative study. Scand J Prim Health Care. 2016;34(2):135–142.
    1. Sveriges kommuner och Regioner . Pandemin och hälso- och sjukvården. Läget och utvecklingen i hälso- och sjukvården med anledning av covid-19. Rapport; 2020. .
    1. Baxter R, Wossenseged BJ, Li X, et al. . COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden. Scand J Public Health. 2021;49(1):29–24.
    1. Creswell W, Plano Clark VL, editors. Designing and conducting mixed methods research. 2nd ed. Thousand Oaks (CA): Sage Publications; 2011.
    1. Wisdom JP, Cavaleri MA, Onwuegbuzie AJ, et al. . Methodological reporting in qualitative, quantitative, and mixed methods health services research articles. Health Serv Res. 2012;47(2):721–745.
    1. Nymberg VM, Bolmsjö BB, Wolff M, et al. . 'Having to learn this so late in our lives…' Swedish elderly patients' beliefs, experiences, attitudes and expectations of e-health in primary health care . Scand J Prim Health Care. 2019;37(1):41–52.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi