Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care

Sturesson, Linda; Groth, Kristina

doi:10.2196/jmir.9866

Cited by 49 publications

(63 citation statements)

References 18 publications

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“…Similar technical issues have been reported as a shortcoming and a source of stress in other studies concerning digital consultations [8,39,40]. Technical issues and problems were more common and pronounced among participants employed by publicly funded health care compared with participants employed by private companies, who perceived the technical equipment as well developed and highly user friendly.…”

Section: Discussionsupporting

confidence: 77%

Digital Consultations in Swedish Primary Health Care: A Qualitative Study of Physicians’ Job control, Demand and Support

Fernemark

Skagerström

Seing

et al. 2020

Preprint

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Background Digital consultation with primary care physicians via mobile telephone apps has been spreading rapidly in Sweden since 2014. Digital consultation allows remote working because physicians can work from home, outside their traditional primary care environment. Despite the spread of digital consultation in primary care, there is a lack of knowledge concerning how the new service affects physicians’ psychosocial work environment. Previous research has focused primarily on the patients’ point of view and the cost-effectiveness of digital consultation. Hence, there is a paucity of studies from the perspective of physicians, focusing on their psychosocial work environment. The aim of this study was to investigate primary care physicians’ perceived work demands, control over working processes, and social support when providing digital consultation to primary care patients.Methods The study has a qualitative design, using semi-structured interviews conducted in Sweden in 2019. We used a purposeful sampling strategy to achieve a heterogeneous sample of physicians who represented a broad spectrum of experiences and perceptions. The interviews were conducted by video meeting, telephone, or a personal meeting, depending on what suited the participant best. The interview questions were informed by the Job Demand-Control-Support (JDCS) model, which was also used as the framework to analyze the data by categorizing the physicians’ perceptions and experiences into the three categories of the model (Demand, Control, Support), in the deductive analysis of the data.Results Analysis of the data yielded 9 subcategories, which were mapped onto the 3 categories of the JDCS model. Overall, the participants saw numerous benefits with digital consultations, not only with regard to their own job situation but also for patients and the health care system in general even though they identified some shortcomings and risks with digital care.Conclusions This study has demonstrated that physicians perceive working with digital consultation as flexible with a high grade of autonomy and reasonable to low demands. According to the participants, digital consultation is not something you can work with full time if medical skills and abilities are to be maintained and developed.

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Section: Discussionsupporting

confidence: 77%

Digital Consultations in Swedish Primary Health Care: A Qualitative Study of Physicians’ Job control, Demand and Support

Fernemark

Skagerström

Seing

et al. 2020

Preprint

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“…Our analysis resulted in 2 overarching categories: the criteria used by clinicians when selecting patients for video visits and disturbances and limitations. The first category is presented in this paper, and the second has been addressed in another paper [ 12 ]. As the 2 categories result from the same research study, the same methods and materials were used.…”

Section: Methodsmentioning

confidence: 99%

“…Implementing telemedicine changes how work is organized in terms of roles, tasks, and processes [ 5 ], which in turn changes the power relationships between participants and their expectations of each other [ 6 - 9 ]. Video visits imply that technology is used for mediating the meeting, that there is a geographical separation between the clinician and the patient [ 10 , 11 ] and that a nonclinical space (the patient’s) is added to the meeting [ 10 , 12 ]. During a video visit, the place chosen by the patient might influence the complex communication between the clinician and patient [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Video visits imply that technology is used for mediating the meeting, that there is a geographical separation between the clinician and the patient [ 10 , 11 ] and that a nonclinical space (the patient’s) is added to the meeting [ 10 , 12 ]. During a video visit, the place chosen by the patient might influence the complex communication between the clinician and patient [ 12 , 13 ]. Introducing a nonclinical setting may affect those involved, the consultation, and the outcome of the meeting for example, because a health care environment manifests social orders [ 7 ] and facilitates the maintenance of professional and patient roles.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, limitations and disturbances may occur due to the technology, the patient’s surroundings, or the procedures deployed when conducting video visits. These are all aspects that might affect the behaviors of the patient and clinician, how the video visit is conducted, and its outcome [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinicians’ Selection Criteria for Video Visits in Outpatient Care: Qualitative Study

Sturesson¹,

Groth²

2018

J Med Internet Res

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BackgroundVideo visits with patients were introduced into outpatient care at a hospital in Sweden. New behaviors and tasks emerged due to changes in roles, work processes, and responsibilities. This study investigates the effects of the digital transformation—in this case, how video visits in outpatient care change work processes and introduce new tasks—to further improve the concept of video visits. The overarching goal was to increase the value of these visits, with a focus on the value of conducting the treatment for the patient.ObjectiveThrough the real-time, social interactional features of preparing for and conducting video visits with patients with obesity, this study examines which patients the clinicians considered suitable for video visits and why. The aim was to identify the criteria used by clinicians when selecting patients for video visits to understand what criteria the clinicians used as the grounds for their selection.MethodsQualitative methods were used, including 13 observations of video visits at 2 different clinics and 14 follow-up interviews with clinicians. Transcripts of interviews and field notes were thematically analyzed, discussed, and synthesized into themes.ResultsFrom the interviews, 20 different arguments for selecting a specific patient for video visits were identified. Analyzing interviews and field notes also revealed unexpressed arguments that played a part in the selection process. The unexpressed arguments, as well as the implicit reasons, for why a patient was given the option of video visits can be understood as the selection criteria for helping clinicians in their decision about whether to offer video visits or not. The criteria identified in the collected data were divided into 3 themes: practicalities, patient ability, and meeting content.ConclusionsNot all patients with obesity undergoing treatment programs should be offered video visits. Patients’ new responsibilities could influence the content of the meeting and the progress of the treatment program. The selection criteria developed and used by the clinicians could be a tool for finding a balance between what the patient wants and what the clinician thinks the patient can manage and achieving good results in the treatment program. The criteria could also reduce the number and severity of disturbances and limitations during the meeting and could be used to communicate the requirements they represent to the patient. Some of the criteria are based on facts, whereas others are subjective. A method for how and when to involve the patient in the selection process is recommended as it may strengthen the patient’s sense of responsibility and the relationship with the clinician.

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Videoconferencing at home for psychotherapy in the postpartum period: Identifying drivers of successful engagement and important therapeutic conditions for meaningful use

Hensel

Yang

Vigod

et al. 2020

Couns and Psychother Res

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Purpose: Virtual care has almost become the norm since COVID-19 mandated social distancing. Prior, the use of personal videoconferencing was being explored as an appealing option to overcome barriers to care, but little was studied about how we should do it and for whom. This study aimed to answer these questions for women receiving psychotherapy in the postpartum period when there are significant barriers to attending office-based care.Methods: Twelve postpartum women who had the option to attend their psychotherapy sessions for the treatment of mood and/or anxiety symptoms via videoconferencing over a 3-month time period were interviewed about their experience. The three therapists providing care were also interviewed early in adoption of the virtual treatment and at the end of the study. Thematic analysis was conducted to identify themes for the initial and ongoing engagement with videoconferencing, which were triangulated with therapist input. Findings: Major themes which emerged related to (a) initial willingness to engage with videoconferencing, (b) technological compatibility, and (c) a good patient fit, with positive and negative influencers for each. Therapeutic considerations were identified, including (a) an initial in-person meeting when possible, (b) matching the therapy format to the clinical situation, (c) attention to the home environment, and (d) a clear therapy frame. Conclusions: Therapists should consider that videoconferencing might not be appropriate for every patient; but in the right context and with appropriate therapeutic considerations, offering this treatment format may actually facilitate an individual's recovery. These findings can help to inform the future delivery of videoconferencing psychotherapy.

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Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care

Cited by 49 publications

References 18 publications

Digital Consultations in Swedish Primary Health Care: A Qualitative Study of Physicians’ Job control, Demand and Support

Digital Consultations in Swedish Primary Health Care: A Qualitative Study of Physicians’ Job control, Demand and Support

Clinicians’ Selection Criteria for Video Visits in Outpatient Care: Qualitative Study

Videoconferencing at home for psychotherapy in the postpartum period: Identifying drivers of successful engagement and important therapeutic conditions for meaningful use

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