Telemedicine technology in primary care in Sweden: Quantitative and qualitative perspectives

Abstract

The overall aim of this thesis was to explore experiences of and potentialconsequences associated with the incorporation of telemedicinetechnology such as digital patient–provider contact into traditional primarycare, and its implications for patients, healthcare professionals, andprimary care organisations.Specific aims:I. To explore health care staff experiences of using adigital platform for contact in primary care.II. To describe differences regarding age, sex, socioeconomicstatus, morbidity and healthcare seekingbehavior between users and non-users of a digitalplatform for contact in primary care.III. To explore patients’ experiences with using a digitalplatform for contact in primary care.IV. To explore potential system effects of using digitaltechnology in primary care.Background: The use of telemedicine technology is increasing in Swedishprimary care. Nevertheless, digital contacts still constitute a relativelysmall proportion of all patient–provider contacts. In the context of anageing population, changing patterns of morbidity, and growingexpectations that healthcare services should offer digital alternatives it isimportant to understand factors influencing the use of, and the widereffects of telemedicine technology such as digital platforms for contact intraditional primary care in Sweden.Methods: The thesis use a multi-methods design combining qualitativeand quantitative methods. Two qualitative studies investigated healthcareprofessionals’ experiences of incorporating a digital platform into primarycare practice, and patients’ experiences of using a digital platform tocontact primary care. Study I investigated experiences of healthcareprofessionals (n=18), Study III investigated experiences of patients(n=23). Two quantitative studies were included. Study II examineddifferences between users and non-users of digital contact (user; n=2,500,non-user: n=70,899), study IV assessed the association between share ofdigital contacts and patient satisfaction at clinic level over a period of fouryears (2019-2022) with the aim of exploring system effects of use of digitaltechnology. Two models were used Model A ‘clinics reporting outcomemeasures at least once during the study period (n=1,270), Model B clinicsreporting outcome measures every year (n=662).Findings across the four studies were analysed using the Human–Technology–Organisation (HTO) framework, with particular attention tohow alignment or misalignment between human, technological, andorganisational factors may influence the use and wider effects ofdigitalisation in primary care.Results: Quick access and the possibility to have a non-verbalcommunication was appreciated by both patients and providers. Thissuggests an alignment between human and technology. However,expectations related to access and more particularly quick handling wasnot always met, which caused misalignment. A low or unpredictablevolume of digital contacts also made it difficult to establish efficientworkflows and achieve anticipated efficiency gains. Administrativeprocesses associated with the platform were not integrated into routinepractice. Rather, cases handled through the digital platform oftencontinued to be managed as exceptions. This suggests a misalignmentbetween Human and Organisation. Consequences for patients were lessdirectly visible, but unexpected waiting times and uncertainty about howand when their requests would be handled may reflect a failure to adaptorganisational processes and resources to the requirements of the newcontact route. Misalignment in the interaction between Organisation andTechnology occurred when digital contacts generated additionaladministrative tasks without replacing or simplifying existing processes.Under these conditions, as described in study I, the anticipated efficiencygains were unlikely to be realised, and the platform could instead increaseworkload and reduce organisational performance.Conclusion: Misalignment raises pertinent questions about the intendedrole of telemedicine technology in primary care. The central policyquestion is not simply whether digital contact should be offered, but whatrole it should fulfil within primary care and how it should relate to existingforms of care.