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 uses quantitative and qualitative methods to evaluate the large-scale implementation of e-consultations in Norway. Research is structured around three main activities.
1. Retrospective cohort study. 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. The relationships between utilization and patients’ characteristics will be explored to measure the impact of e-consultations on equitable access to care.
2. Prospective cross-sectional study. Focus groups and interviews will explore the topics of clinical appropriateness, safety, communication, doctor-patient relationship, organizational models and workload. A prospective cross-sectional study will be conducted to investigate the perspectives of gps and patients towards e-consultations. At least 100 gps and their patients will be asked to evaluate the perceived quality of 1,500 conducted e-consultations. Gps will also evaluate organizational models and workload.
3. Patient interviews and survey. In-depth interviews with elderly patients recruited through the Pensioners Association will be conducted as elderly patients are considered the main group of non-users. A national citizen survey will be conducted on the national health portal helsenorge.no to explore how e-consultations are used by patients.
1. Retrospective cohort study. Applications to the regional ethics committee and data protection officer were sent and approved 2022. An application was sent to helsedata at the end of 2022 and approved in may 2024. Data from helfo are expected to be delivered by the norwegian directorate of health in spring 2024 due to high demand and long processing times.
2. Prospective cross-sectional study. Five focus group interviews with gps have been conducted to explore how they perceive clinical appropriateness, safety, communication, doctor-patient relationship in e-consultations. Data have been analysed and two scientific papers focusing on quality of communication and impact on gp practice will be sent to the journal of medical internet research by the end of 2023. A course named “better quality in e-consultations” has been developed by the project team in collaboration with skil in 2022 and 2023. As part of this course, participating gps will answer two surveys focused on perceived quality of e-consultations and organizational models and workload. The course was launched in february 2023 and it is expected a recruitment of at least 100 gps by the end of 2023. Data from both surveys will be analyzed in 2024.
3. Patient interviews and survey. Semi-structured interviews were conducted in november-december 2022 with 16 patients over 65 years with experience of using text-based e-consultations. Data were analysed through thematic analysis. Four themes were identified: 1) the importance of digital health literacy and the fear of losing it, 2) the high availability of the service as the main advantage, 3) the importance of voluntary use of e-consultations, 4) the importance of a trusting relationship with the GP. A scientific paper has been published in 2023 in the Scandinavian Journal of Primary Health Care. A national citizen survey was conducted to explore: 1) when and for what purposes patients use e-consultations with the GP, 2) whether e-consultations replace a traditional GP appointment or create new demand, 3) which characteristics of the patients and e-consultations are associated with the different use of e-consultations. The survey was developed in collaboration with helsenorge and published in January-February 2023. Data have been analysed and a scientific paper submitted to the Journal of Medical Internet Research.
This project will provide key stakeholders, policymakers and practitioners with research-generated knowledge on the impact of e-consultations, thus supporting optimal use of the service in routine practice and maximize its benefits.
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.
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. Additional interviews will be conducted on elderly as the main group of non-users who are not digitally active.