Telemedicine-Supported Hybrid Primary Care in Rural Areas with Healthcare Workforce Shortages: A Qualitative Study from the Heves District, Hungary

Abstract

Highlights What are the main findings? A telemedicine-supported hybrid care model combining on-site nurse triage with remote physician consultations was perceived by participating professionals to improve patient safety and care access in permanently vacant Hungarian general practices, potentially reducing reliance on emergency services. Successful implementation was perceived to be hindered by patients’ limited familiarity with triage-based care pathways, unsustainable administrative burdens from dual paper-digital documentation, and unresolved IT/software integration challenges. What are the implications of the main findings? The future national scalability of hybrid telemedicine care models would likely require concurrent modernization of nursing education curricula to include telemedicine competencies and advanced triage skills. Sustainable implementation demands legislative-level resolution of medical software interoperability, reduction in administrative burden, and systematic community health literacy programs. Abstract Background/Objectives: Primary healthcare in Hungary faces acute physician shortages; in the Heves district, eight general practices are permanently vacant, leaving 11,191 residents without continuous care. In September 2025, the Hungarian Charity Service of the Order of Malta launched the Heves Haziorvosi Pilot (HHP), combining on-site nurse triage with remote telemedicine consultations. This study qualitatively evaluated its implementation and early operation. Methods: Three focus group discussions were held in two rounds, before and after implementation, with all 19 professionals delivering the programme (10 practice nurses, 4 general practitioners, 5 degreed professionals). Verbatim Hungarian transcripts were analysed in NVivo 15 (Lumivero, Denver, CO, USA) using the thematic analysis framework of Braun and Clarke with hybrid deductive-inductive coding by three independent researchers until full consensus. Results: Daily physician availability rose from approximately 2 to 8 h, and one remote physician concurrently supported four practices. Participants reported reduced professional isolation among nurses, longer and more focused consultations, and perceived, though unquantified, decreases in non-urgent ambulance use. Implementation was constrained by duplicate paper and digital documentation, patients’ limited familiarity with triage, and unresolved software interoperability and IT ergonomic problems. Conclusions: The hybrid model was perceived as operationally feasible; national scaling would require nursing curriculum reform, administrative simplification, interoperable medical software, and community health literacy programmes.