Health Care Professionals’ Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study

Abstract

Background Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care. Objective The objective of our study was to describe health care staff’s experience with a digital communication system intended for patient-staff encounters via a digital route in primary care. Methods In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis. Results While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient’s voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service—at least for a while—if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers. Conclusions A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.

A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients

“…A health care organization will have to balance the desire to provide access and simplicity for patients with the obligation to provide healthy and safe working conditions for staff and uphold data privacy, security, and high-quality care ( human-organization ). Compared with the earlier study from our research group regarding the perspectives of HCPs, patients in this study seemed to be somewhat more satisfied with the chat service than the HCPs were [ 4 ]. For example, although anxious to offer patients ample availability, HCPs reported that patients used the chat service to gain quicker access to health care regardless of the degree of urgency of their health problems and sometimes initiated contact for the same complaint through several channels in parallel, which may add to the workload of primary care.…”

“…Both patients in this study and HCPs in the earlier study [ 4 ] regarded the chat as being more on the patients’ terms than traditional face-to-face or telephone communication, although patients, by comparison, seemed to find that as more positive than did the HCPs. Although no earlier interview studies were found with patients regarding modern and fast, primarily mobile phone based, chat services for all inquiries in primary care, there are several studies (both interview and questionnaire studies) regarding patients’ views on other text messaging services in primary care, for inquiries in general, such as in this study, and for the self-management of chronic diseases or health-related interventions, where the patient-professional contact has already been established.…”

“…Although chatting may diminish problems such as interruptions and not getting enough time to express yourself, new problems seem to emerge instead, such as HCPs inexperience with professional chat communication about health and health care issues. Interestingly, regarding the chat service in this study, this issue was only raised by patients and not by the HCPs themselves [ 4 ]. One might expect patients’ opinions to change when the service has settled after having been operational for some time; however, in fact, patients’ views in this study were unexpectedly similar to those in interviews conducted during the pilot study in May 2019 (data not yet published).…”

“…Subsequently, chat services are emerging also in regular tax-based, not-for-profit primary care, and contrary to the web-based medical services described earlier, the regular primary care offers the opportunity to convert chat conversations into clinical visits [ 3 ]. Despite the growing use of these chat services by patients, earlier interview studies have focused on the perspectives of health care professionals (HCPs) [ 4 - 7 ]. To our knowledge, before our study, no reports on patients’ experiences of chat services for all kinds of inquiries in regular primary care had been published, from neither Sweden nor elsewhere.…”

Optimizing telemedical care in neurological outpatients by characterizing the patients’ needs in the physician–patient relationship—content analysis of guideline-based interviews

“…Because innovations in communication technology and clinical data systems are emerging rapidly, there is enormous opportunity. At the same time, substantial uncertainty persists about the consequences of these tools and platforms for the patient care and provider experiences [ 8 , 9 ].…”