Conceptual Overview of Telemedicine in Primary Care: A Grounded Theory Perspective

Hans Thulesius, Eva Arvidsson, Ulrika Sanden, Jens Wilkens, Björn Ekman

Keywords: Telemedicine, Primary Care, Digital text contacts, Grounded Theory

Background:

Telemedicine, which involves delivering medical care from a distance, has experienced rapid growth due to technological advancements. Physicians' acceptance of telemedicine plays a crucial role in its long-term adoption. Rogers' theory of “diffusion of innovations” explains the slow progress of telemedicine. Yet, the COVID-19 pandemic accelerated telemedicine usage pushed Rogers’ curve of innovation adoption to the right (innovators, early adopters, early majority, late majority, and laggards). Retail telemedicine, primarily focusing on minor conditions, has gained traction in Swedish primary care since 2016. Furthermore, Sweden is implementing a national digital text platform for asynchronous contacts in 2023.

Research questions:

This study aims to examine the status of telemedicine in primary care and present a conceptual framework for its understanding.

Method:

A classic grounded theory approach was employed for data analysis, adhering to the "all is data" principle. The study drew on diverse sources, including primarily secondary analysis of literature and multiple interviews with telemedicine caregivers, users and stakeholders, with a specific emphasis on the Swedish context.

Results:

Telemedicine is defined as remotely delivered care assisted by digital technology. It offers substantial "convenience capital" to patients, saving working hours, travel costs, and leisure time. However, primary care providers exhibit hesitancy towards telemedicine, perceiving it as having low value with few personal contacts hindering integration into blended care models. After the COVID-19 pandemic surge telemedicine has lost in volume. To overcome this inertia, technical improvements, regulatory adjustments, and remuneration changes are necessary to integrate telemedicine seamlessly into primary care. Adequate training for primary care providers in telemedicine is crucial to recognize its limitations and advantages, including telework opportunities.

Conclusions:

Telemedicine, providing cost and time-saving benefits, is well-received by patients. Nonetheless, its growth has been impeded by primary care providers' hesitancy. Addressing the mismatch between caregivers and patients is pivotal to ensuring the future success of telemedicine.

Points for discussion:

How much experience of telemedicine do you have in your country and practice?

Will telemedicine be here to stay in blended care models in the near or distant future?

What will it take for telemedicine to become a fully integrated care model in your country/practice?

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