AIM
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.
METHODS
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. 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. Focus groups and interviews will explore the topics of clinical appropriateness, safety, communication, doctor-patient relationship, organizational models and workload. A 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 video consultations. GPs will also evaluate organizational models and workload.
3. Patient survey and patient interviews. 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 patients’ knowledge, use and attitudes towards e-consultations.
RESULTS
16 semi-structured interviews were conducted with patients over 65 years with experience of using text-based e-consultations. Data were analysed through thematic analysis. A scientific paper is under review in the Scandinavian Journal of Primary Health Care. 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 are currently being analysed and will be included in a scientific paper. A national citizen survey is under development in collaboration with helsenorge and is expected to be launched in early 2023. A course named “Better quality in e-consultations” has been developed by the project team in collaboration with the Centre for Quality Improvement in Medical Practice (SKIL). 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 will be launched in 2023 and it is expected a recruitment of more than 100 GPs.
CONCUSION
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.
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.
