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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester

The large-scale implementation of e-consultations with the GP: a mixed-methods evaluation of the impact on health system, GPs and patients

Alternative title: Storskala implementering av e-konsultasjoner med fastlegen: evaluering av effekter på helsesystemet, fastleger og pasienter.

Awarded: NOK 11.8 mill.

The aim of this project is to study the impact of e-consultations with the GP on the health system, General Practitioners (GPs) and patients. The project will use quantitative and qualitative methods to evaluate the large-scale implementation of e-consultations in Norway. Research will be structured around three main activities. 1. ANALYSIS OF REGISTRY DATA Data from national health registries will be collected and analyzed to study changes in adoption and use of e-consultations with the GP over time (before, during and after the COVID-19 pandemic). The relationships between utilization and patient characteristics will be explored to measure the impact of e-consultations with the GP on equitable access to care. 2. EVALUATION OF E-CONSULTATIONS BY GPs AND PATIENTS A study will be conducted to investigate the perspectives of GPs and patients towards video consultations. Between 50 and 100 GPs and their patients will be asked to evaluate the perceived quality of 1,500 conducted video consultations. Focus groups and interviews will explore the topics of clinical appropriateness, safety, communication, doctor-patient relationship, organizational models and workload. 3. PATIENT SURVEY The perspectives of users and non-users of e-consultations with the GP will be explored through questions integrated in a national citizen survey conducted to explore citizens’ knowledge, use and attitudes towards digital health solutions. An additional paper-based survey will be developed to reach elderly patients as the main group of non-users.

BACKGROUND In Norway, e-consultations with the GP experienced a tremendous implementation pace following the COVID-19 pandemic. As a complex intervention, it is crucial to study the process of implementation, wider adoption and scale up. It is also important to understand whether the use of e-consultations ensures equity in access to care and assess the impact on the health system, GPs and patients. METHODS The project adopts a mixed-methods approach, combining quantitative and qualitative methods to evaluate the large-scale implementation of e-consultations in Norway. Research is structured around three working packages (WPs). WP1. A retrospective cohort study will be conducted to study changes in adoption and use of e-consultations over time and explore the impact on equitable access to care. Data will be obtained from national health registries. Temporal trends will be examined through time-series analysis. Multilevel regression models will be used to explore relationships between utilization and patient characteristics. WP2. A prospective cross-sectional study will be conducted to study the perspectives of GPs and patients towards the perceived quality of video consultations. Focus groups will explore the topics of clinical appropriateness, safety, communication, doctor-patient relationship, organizational models and workload. 50-100 GPs will be recruited and asked to evaluate 1,500 video consultations through an online survey. Patients will evaluate the same video consultations. Interviews with GPs will be conducted to study how different organizational models affect workload and availability. WP3. The perspectives of digitally active users and non-users will be explored through questions integrated into a national citizen survey conducted to explore citizens’ knowledge, use and attitudes towards digital health solutions. An additional paper-based survey will be developed to reach elderly as the main group of non-users who are not digitally active.

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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester