Primary care physicians’ experiences of video and online chat consultations: A qualitative descriptive study

Tuomas Koskela, Kaisa Kujansivu, Mervi Kautto, Elina Tolvanen

Keywords: Remote consultation, video consultation, chat consultation, telehealth, telemedicine, primary health care

Background:

The work of a primary care physician (PCP) is undergoing change as different digital services have increased in health care in recent years. PCPs have been satisfied with the smoothness and ease of use of the remote consultations as well as the reduced time in contact with health care. However, physicians have noted that remote consultations are not suitable for every complaint and all patient groups and non-verbal communication is scarce in remote consultations.

Research questions:

To explore the perceptions and views of remote consultations and patient care of PCPs who work remotely regularly and have experience of performing remote consultations.

Method:

PCPs who had performed video or online chat consultations with primary care patients for at least 6 months were interviewed in focus groups. Four online focus group interviews with 17 PCPs were performed. Thematic analysis with coding and hierarchical grouping into themes was used to analyse the data.

Results:

Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians’ new way of working, impacts on physicians' wellbeing, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities.

Conclusions:

Considering remote consultations from the PCPs’ point of view, it is important to find a good balance between the benefits of wellbeing at work and maintaining sufficient clinical competence through versatile work. Thus, we suggest that remote consultations should be only one part of the PCPs’ job description. In addition, the PCPs call for careful patient selection so that remote consultations complement other health care services safely and appropriately.

Points for discussion:

Sufficient previous clinical experience in face-to-face consultations and communication skills are needed for remote consultations.

Patient selection for remote consultations is critical.

Lack of continuity of care limits the issues that can be dealt with in a remote consultation.

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