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

AIM The aim of this project is to study the impact of e-consultations with the GP on the health system, GPs and patients. METHODS 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 (Kommunalt pasient- og brukerregister KPR) were collected and analyzed to study the use of e-consultations with the GP in Norway, and particularly exploring how frequent users of GP services engage or do not engage with e-consultations. 2. Prospective cross-sectional study. Focus group interviews explored how GPs experience clinical appropriateness, safety, communication, and the doctor-patient relationship in e-consultations. A prospective cross-sectional study was conducted, where at least 100 GPs and their patients were asked to evaluate the perceived quality of 1,500 e-consultations. GPs also evaluated organizational models and workload. 3. Patient interviews and survey. In-depth interviews with elderly patients, recruited through the Pensioners Association, were conducted, as elderly patients are considered the main group of non-users. A national citizen survey was conducted on the national health portal helsenorge.no to explore the patients’ knowledge, use, and attitudes towards e-consultations. RESULTS 1. Retrospective cohort study. Applications to the regional ethics committee and data protection officer were sent and approved in 2022. An application was sent to helsedata at the end of 2022 and approved in May 2023. Data from KPR were delivered by the Norwegian Directorate of Health in spring 2024. The data include all physical consultations and e-consultations with the GP conducted in Norway in the period 2022-2023. The data analysis has been finalized. The results will be published in a scientific article which is currently under peer review. 2. Prospective cross-sectional study. Five focus group interviews with GPs were conducted. Data were analyzed using thematic analysis. Two scientific articles ("The Dynamics of Doctor-Patient Communication in Remote Consultations. A qualitative Study among Norwegian Contract GPs" and "The Impact and Wider Implications of Remote Consultations for General Practice in Norway: A Qualitative Study Among Norwegian Contract GPs") were published in 2024 and 2025. A course for GPs named "Better quality in e-consultations" was developed by the project team in collaboration with SKIL in 2022 and 2023. Two surveys were included as part of this course. The first focused on how GPs and patients perceive clinical suitability, safety, communication, and the doctor-patient relationships in e-consultations. The other focused on organizational models and workload. The course was launched in February 2023 and ended in September 2024. One scientific article, focusing on the shared perception of suitability between patients and GPs, has been finalized and is currently under peer review. The project group is working on two other scientific articles, one focused on GPs evaluation of different types of e-consultations (text, telephone, video), and the other one focused on organizational models and workload. 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. 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 patients and e-consultations are associated with variation in use of e-consultations. The survey was developed in collaboration with Helsenorge and published in January-February 2023. Data have been analysed and two scientific articles ("Use of e-consultations with the general practitioner in Norway: An online survey of user experience" and "Patients' feedback on improvements to text-based e-consultations. A survey study of users of the official health portal in Norway") were published in 2024 and 2025. CONCLUSION A PhD thesis has been submitted, with the date for defence expected in November 2025. All data collection in the project has been completed. Publication of some scientific articles, as well as the completion of one PhD thesis, remains. The project is expected to be finalized on schedule. 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 maximizing its benefits.

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. Additional interviews will be conducted on elderly as the main group of non-users who are not digitally active.