CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Universiteitssingel 40, Maastricht 6229 ER, the Netherlands; Department of Paediatrics, The Chinese University of Hong Kong, 6/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, China; CAPHRI, Care and Public Health Research Institute, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, Maastricht 6202 AZ, the Netherlands.
Department of Paediatrics, The Chinese University of Hong Kong, 6/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, China.
Health Policy. 2022 Oct;126(10):933-944. doi: 10.1016/j.healthpol.2022.07.012. Epub 2022 Aug 7.
The COVID-19 pandemic has boosted the adoption of digital health technologies such as teleconsultation. This research aimed to assess and compare barriers and facilitators for teleconsultation uptake for primary care practitioners in Hong Kong and the Netherlands and evaluate the role of their different healthcare funding models in this adoption process within the context of the COVID-19 pandemic. A qualitative research following a social constructivist paradigm was performed. The study employed a conceptual framework from Lau and colleagues that identifies four levels of factors influencing change in primary care: (1) external contextual factors; (2) organization-related factors; (3) professional factors; and (4) characteristics of the intervention. The four levels were studied through semi-structured, open-ended interviews with primary care physicians. External factors were additionally assessed by means of a literature review. Hong Kong and the Netherlands showed different penetration rates of teleconsultation. Most stakeholders in both settings shared similar barriers and facilitators in the organizational, professional, and intervention levels. However, external contextual factors (i.e., current teleconsultation legislation, available incentives, and level of public awareness) played an important and differing role in teleconsultation uptake and had a direct effect on the organization, the professionals involved, and the type of technology used. Political and organizational actions are required to develop a comprehensive legal framework for the sustainable development of teleconsultation in both settings.
新冠疫情 推动了数字医疗技术的采用，如远程问诊。本研究旨在评估和比较香港和荷兰的初级保健医生采用远程问诊的障碍和促进因素，并评估在新冠疫情背景下，它们不同的医疗保健资金模式在这一采用过程中的作用。本研究采用了一种社会建构主义范式的定性研究。研究采用了 Lau 及其同事的概念框架，该框架确定了影响初级保健变革的四个层次的因素：（1）外部环境因素；（2）组织相关因素；（3）专业因素；和（4）干预措施的特征。通过对初级保健医生进行半结构化、开放式访谈来研究这四个层次。通过文献回顾评估了外部因素。香港和荷兰的远程问诊普及率不同。两个地区的大多数利益相关者在组织、专业和干预层面都有相似的障碍和促进因素。然而，外部环境因素（即当前的远程问诊立法、可用的激励措施和公众意识水平）在远程问诊的采用中发挥了重要且不同的作用，并直接影响到组织、涉及的专业人员和使用的技术类型。需要采取政治和组织行动，为两个地区远程问诊的可持续发展制定全面的法律框架。
