Choosing Video Instead of In-Clinic Consultations in Primary Care in Israel: Discrete Choice Experiment Among Key Stakeholders—Patients, Primary Care Physicians, and Policy Makers

Abstract

Background: Despite its innovative benefits, the adoption of video consultations (VCs) in primary care settings is complex and slow.Objectives: To quantify the preferences of key stakeholders in Israel's primary care-patients, primary care practitioners, and policy makers-regarding VCs compared with traditional in-clinic consultations (ICC) in nonurgent conditions.Methods: Discrete choice experiment surveys were completed by 508 patients, 311 physicians, and 141 policy makers. These consisted of 12 choice tasks of 2 labeled alternatives (VC or ICC), with the 4 attributes most relevant to each stakeholder group. A random effects logit model analysis was used to estimate stakeholders' preferences.Results: All 4 experiments' attributes were significantly important in choosing VC versus ICC for the patient group and the physician group. Three out of 4 attributes were significantly important to policy makers. Differences and similarities between stakeholders were identified in attribute rank order, trade-offs, and VC uptake probabilities. Policy makers' VC uptake rate was 86%. Patients' preferences suggested that 68% of ICCs could be replaced by VCs. Physicians' VC uptake was 30% in cases in which the consultation purpose was to diagnose and provide treatment and 48% in cases in which the consultation purpose was follow-up.Conclusions: Our findings show key stakeholders' preferences about VC integration, to be considered when these systems are introduced into primary care and optimize the implementation process. Although there is a stronger preference for ICC among physicians and patients, alternative combinations of attribute levels might be used to compensate and reconfigure a more preferred VC service.

Using Telemedicine During the COVID-19 Pandemic: Attitudes of Adult Health Care Consumers in Israel

“…Similarly, based on a survey of 2,700 patients in the US, Heat (28) stated that 4 in 10 patients began using a new app or digital technology to stay connected to their health care providers at the onset of the COVID-19 epidemic. Previous studies conducted in Israel showed that patients and physicians are willing to use digital technology instead of faceto-face appointments when their preferences are considered (29). Another study found that the high use of HMOs' mobile health apps across the socio-demographic spectrum indicates telemedicine's high perceived usefulness (30).…”

Physicians’ experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study

“…Under optimal conditions, physicians equated the contact through the screen with the contact during an inperson visit, using terms such as 'eye contact' and 'face to face'. These findings were unexpected, given that according to the literature an existing doctorpatient relationship is important both for the video consultation to be successful [14,23] and for patients to be willing to use the service [10,24]. However, visual cues have previously been described as benefits of video consultation, favourably building rapport and communication [14].…”

Systematic review and validity assessment of methods used in discrete choice experiments of primary healthcare professionals

“…Fourteen of the studies assessed healthcare professional decision making about therapy and disease management [19][20][21][22][23][24][25][26][27][28][29][30][31][32], twelve assessed preferences for organisation characteristics of primary care practices [33][34][35][36][37][38][39][40][41][42][43][44], seven assessed the relative influence of implementation and knowledge translation strategies [45][46][47][48][49][50], and two assessed preferences for information and communication technologies [51,52].…”

“…Ten (29.4%) studies explicitly investigated internal or external validity. Examples of internal or external validity checks used in these studies included using a dominant choice task to assess internal consistency [51], detecting repetitive patterns or strait-lining in response patterns [25], rushing [25], including a duplicate question [26,27,44], tests of transitivity [26,35] using follow-up questions [45], and reviewing consistency of answers [19,35,50]. Studies assessed external validity by comparing the DCE findings with the predicted direction of preferences [19,37] or with findings from previously published surveys or clinical trials [25].…”