Norberg Børge Lønnebakke, Austad Bjarne, Kristiansen Eli, Zanaboni Paolo, Getz Linn Okkenhaug
General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Norwegian Center for E-health Research, University Hospital of North Norway, Tromsø, Norway.
JMIR Form Res. 2024 Dec 17;8:e63068. doi: 10.2196/63068.
The digital shift toward remote consultations in general practice needs ongoing monitoring to understand its impact on general practice organizations and the wider health care system.
This study aimed to explore how remote consultations impact on contracted general practitioner (GP) practices and how GPs perceive the implications of this uptake for the overall health care system.
In total, 5 focus groups were conducted with a total of 18 GPs from all 4 health regions of Norway in 2022. The material was subjected to Braun and Clarke's thematic analysis.
The analysis yielded six themes: (1) the design of novel effective clinical pathways: remote consultations empower GPs to tailor new effective clinical trajectories, blending modalities to address diverse needs across clinical episodes-from initial triage, through investigations to case closure; (2) increased workday flexibility: remote consultations introduce variability into daily work, allowing GPs to adjust patient contact intensity, and leading to a less stressful work-home balance; (3) erosion of organizational boundaries: easy remote access to GPs appears to reduce patients' tolerance for minor illness and self-care, hindering effective gatekeeping and shifting GPs' focus from proactive to more reactive work, increasing work-related stress; (4) degradation of clinical shrewdness: confronted with an increasing amount of unsorted and trivial remote inquiries, GPs observe challenges in detecting and prioritizing serious cases; (5) dilemmas related to responsibility, ethics, and legislation: remote consultations highlight a tension for contract GPs between legal responsibilities and ethical obligations, with implications for patients with limited health literacy; this may entail suboptimal evaluation or delayed treatment-potentially contributing to increased health care inequity; and (6) retaining clinical core values in a changing world. Overall, GPs affirm that remote consultations have come to stay and describe efforts to effectively manage the advantages and disadvantages inherent in such interactions to safeguard clinical effectiveness and organizational sustainability of primary health care.
The widespread adoption of remote consultations in the Norwegian contract GP scheme fundamentally reshapes the dynamics of GP work and the overall health care system. Awareness and proactive management of these changes are essential for maintaining sustainable, high-quality primary health care.
基层医疗向远程会诊的数字化转变需要持续监测，以了解其对基层医疗机构和更广泛的医疗保健系统的影响。
本研究旨在探讨远程会诊如何影响签约全科医生（GP）的诊疗实践，以及全科医生如何看待这种应用对整个医疗保健系统的影响。
2022年，对来自挪威所有4个卫生区域的18名全科医生共进行了5次焦点小组访谈。对材料进行了布劳恩和克拉克的主题分析。
分析得出六个主题：（1）设计新颖有效的临床路径：远程会诊使全科医生能够定制新的有效临床路径，融合多种方式以满足临床过程中从初始分诊、检查到病例结束的各种需求；（2）工作日灵活性增加：远程会诊给日常工作带来了变化，使全科医生能够调整与患者接触的强度，从而减轻工作与家庭平衡方面的压力；（3）组织边界的侵蚀：患者能够轻松远程联系全科医生似乎降低了他们对小病和自我护理的耐受性，阻碍了有效的守门作用，并使全科医生的工作重点从主动转向更被动，增加了工作压力；（4）临床敏锐度的下降：面对越来越多未经分类的琐碎远程咨询，全科医生在发现严重病例并确定其优先级方面面临挑战；（5）与责任、伦理和立法相关的困境：远程会诊凸显了签约全科医生在法律责任和道德义务之间的紧张关系，对健康素养有限的患者有影响；这可能导致评估不充分或治疗延迟，可能加剧医疗保健的不平等；（6）在不断变化的世界中保持临床核心价值观。总体而言，全科医生确认远程会诊已成为常态，并描述了为有效管理此类互动中固有的优缺点以保障初级卫生保健的临床有效性和组织可持续性所做的努力。
挪威签约全科医生计划中远程会诊的广泛采用从根本上重塑了全科医生工作的动态以及整个医疗保健系统。对这些变化的认识和积极管理对于维持可持续、高质量的初级卫生保健至关重要。
