Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care. Laval University (CERSSPL-UL). CIUSSS-CN, Pavillon Landry-Poulin, 2525, chemin de la canardiere, Quebec, QC, G1J 0A4, Canada.
Research Centre of the CHU de Quebec-Universite Laval, Hopital St-François d'Assise, Edifice D, 45, rue Leclerc, Quebec, QC, G1L 2G1, Canada.
BMC Med Inform Decis Mak. 2017 Dec 28;17(1):180. doi: 10.1186/s12911-017-0576-4.
Norway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway.
We used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data.
Telemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified.
This study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems.
挪威有着使用远程医疗的悠久历史，尤其是出于地理原因。尽管有许多有前途的远程医疗应用，也实施了国家倡议和政策，但远程医疗在卫生系统中的可持续性和扩大规模仍远未实现。本研究的主要目的是探索和确定影响挪威远程医疗使用的多层次（微观、中观和宏观）因素。
我们使用混合方法。收集了来自国家登记处的数据，以分析 2009 年至 2015 年期间挪威的门诊就诊和远程医疗联系使用情况。对国家、地区和地方各级的利益相关者进行访谈，有助于完成和上下文分析数据，并探讨影响卫生当局和医院使用远程医疗的主要问题。还使用了相关的国家文件来支持、反驳、背景化或澄清信息和数据。
2009 年至 2015 年，挪威的远程医疗使用率仍然非常低，在地区层面不超过总门诊活动的 0.5%，在国家层面不超过 0.1%。所有四个地区都使用了远程医疗。在 29 家医院中，有 24 家在 7 年期间至少使用过一次。并非所有地方都定期使用远程医疗，有些医院只是偶尔使用。远程医疗主要用于一些专科，包括康复、神经外科、皮肤和性病科。有三个主要主题影响着挪威远程医疗的实施和使用：（i）治理和战略；（ii）组织和专业层面；（iii）经济和财务层面。对于每个主题，都确定了不同医疗保健层面面临的一些因素和挑战。
本研究揭示了影响挪威远程医疗使用的多层次和相互依存的因素。确定主要的实施和使用挑战可能会支持决策者和从业者成功扩大远程医疗规模。这项工作为其他计划将远程医疗或其他数字健康服务纳入其医疗保健系统的国家提供了有用的知识库。
