Experiences of digital communication with automated patient interviews and asynchronous chat in Swedish primary care: a qualitative study

Entezarjou, Artin; Bolmsjö, Beata Borgström; Calling, Susanna; Midlöv, Patrik; Nymberg, Veronica Milos

doi:10.1136/bmjopen-2019-036585

Cited by 28 publications

(63 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Focusing on the context of Swedish primary care, three different studies recently found that physicians considered the types of telemedicine evaluated to be suitable for some patients and questions, but not for all. [35][36][37] This compares well to our category "Useful under certain conditions", underlining the need for implementation in cooperation with the profession.…”

Section: Comparison With Other Studiessupporting

confidence: 57%

“…Findings include increased efficiency and more precise communication, but also reports of overuse, information overload, and misinterpretations. [33][34][35][36][37] While most papers cover specific tools, PCPs' overall views and experiences of telemedicine have been little studied, and not at all in a Swedish context. Consequently, in 2019, we conducted a web-based survey regarding telemedicine among PCPs in southern Sweden.…”

Section: Introduction Backgroundmentioning

confidence: 99%

See 1 more Smart Citation

Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians: A Qualitative Study

Glock¹,

Nymberg²,

Bolmsjö³

et al. 2021

IJGM

Self Cite

View full text Add to dashboard Cite

Purpose: The primary care physician's traditional patient contacts are challenged by the rapidly accelerating digital transformation. In a quantitative survey analysis based on the theory of planned behavior, we found high behavioral intention to use telemedicine among Swedish primary care physicians, but low reported use. The aim of this study was to further examine the physicians' experiences regarding telemedicine, with a focus on possible explanations for the gap between intention and use, through analysis of the free-text comments supplied in the survey. Material and Methods: The material was collected through a web-based survey which was sent out to physicians at 160 primary health care centers in southern Sweden from May to August 2019. The survey covered four areas: general experiences of telemedicine, digital contacts, chronic disease monitoring with digital tools, and artificial intelligence. A total of 100 physicians submitted one or more free-text comments. These were analyzed using qualitative content analysis with an inductive approach. Results: The primary care physicians expressed attitudes towards telemedicine that focused on clinical usefulness. Barriers to use were the loss of personal contact with patients and a deficient technological infrastructure. The major concerns were that these factors would result in patient harm and an increased workload. The connection between intention and use postulated by the theory of planned behavior was not applicable in this context, as external factors in the form of availability and clinical usefulness of the specific technology were major impediments to use despite a generally positive attitude. Conclusion: All telemedicine tools must be evaluated regarding clinical usefulness, patient safety, and effects on staff workload, and end users should be included in this process. Utmost consideration is needed regarding how to retain the benefits of personal contact between patient and provider when digital solutions are introduced.

show abstract

Section: Comparison With Other Studiessupporting

confidence: 57%

Section: Introduction Backgroundmentioning

confidence: 99%

Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians: A Qualitative Study

Glock¹,

Nymberg²,

Bolmsjö³

et al. 2021

IJGM

Self Cite

View full text Add to dashboard Cite

show abstract

“…eVisits may also facilitate physicians to better manage emotionally demanding patients [ 37 ], possibly reducing the risk of prescribing antibiotics without proper indications. In addition, eVisits provide a convenient way for physicians to use watchful waiting prior to antibiotic prescription as patients easily can access the chat within 72 hours of a consultation.…”

Section: Discussionmentioning

confidence: 99%

“…There is a risk that the system would lead the physician into a logical conclusion and apparently guideline-coherent decision, increasing the risk of cognitive biases such as confirmation bias, which may not have occurred face-to-face in an office setting. eVisits may also facilitate physicians to better manage emotionally demanding patients [37], possibly reducing the risk of prescribing antibiotics without proper indications. In addition, eVisits provide a convenient way for physicians to use watchful waiting prior to antibiotic prescription as patients easily can access the chat within 72 hours of a consultation.…”

Section: Xsl • Fomentioning

confidence: 99%

Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study

Entezarjou¹,

Calling²,

Bhattacharyya³

et al. 2021

JMIR Med Inform

Self Cite

View full text Add to dashboard Cite

Background Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking. Objective The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits. Methods Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated. Results Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively. Conclusions The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits. Trial Registration ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887

show abstract

“…Such externalities may have been present to different extents among our panel, resulting in markedly variable triage decisions compared with each other and the model. Furthermore, the low agreement between the panel and the model in our study may be due to the fact that variation in human interpretation of text-based cues from automated patient interviewing software data in a primary care setting [26] prevents PCPs from determining urgency as consistently as the model, given access to the same amount of data. It should be noted, however, that in the clinical setting, PCPs would acquire additional data through the eVisit chat before making a triage decision.…”

Section: Discussionmentioning

confidence: 78%

Human- Versus Machine Learning–Based Triage Using Digitalized Patient Histories in Primary Care: Comparative Study (Preprint)

Entezarjou¹,

Bonamy²,

Benjaminsson³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

BACKGROUND Smartphones have made it possible for patients to digitally report symptoms before physical primary care visits. Using machine learning (ML), these data offer an opportunity to support decisions about the appropriate level of care (triage). OBJECTIVE The purpose of this study was to explore the interrater reliability between human physicians and an automated ML-based triage method. METHODS After testing several models, a naïve Bayes triage model was created using data from digital medical histories, capable of classifying digital medical history reports as either in need of urgent physical examination or not in need of urgent physical examination. The model was tested on 300 digital medical history reports and classification was compared with the majority vote of an expert panel of 5 primary care physicians (PCPs). Reliability between raters was measured using both Cohen κ (adjusted for chance agreement) and percentage agreement (not adjusted for chance agreement). RESULTS Interrater reliability as measured by Cohen κ was 0.17 when comparing the majority vote of the reference group with the model. Agreement was 74% (138/186) for cases judged not in need of urgent physical examination and 42% (38/90) for cases judged to be in need of urgent physical examination. No specific features linked to the model’s triage decision could be identified. Between physicians within the panel, Cohen κ was 0.2. Intrarater reliability when 1 physician retriaged 50 reports resulted in Cohen κ of 0.55. CONCLUSIONS Low interrater and intrarater agreement in triage decisions among PCPs limits the possibility to use human decisions as a reference for ML to automate triage in primary care.

show abstract

Experiences of digital communication with automated patient interviews and asynchronous chat in Swedish primary care: a qualitative study

Cited by 28 publications

References 21 publications

Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians: A Qualitative Study

Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians: A Qualitative Study

Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study

Human- Versus Machine Learning–Based Triage Using Digitalized Patient Histories in Primary Care: Comparative Study (Preprint)

Contact Info

Product

Resources

About