Going remote in general practice: Investigating the transformation of healthcare delivery enabled by remote consultations

Abstract

The background for this PhD project is the substantial increase in the use of remote consultations (RCs) – video, telephone, and asynchronous text-based e-consultations – that took place in general practice in the aftermath of the COVID-19 pandemic in Norway. General practice as a medical discipline is unique, compared to secondary healthcare, characterised by a strong GP-patient relationship, continuity of care, and pragmatic reasoning. The influx of RCs has fundamentally transformed the delivery of healthcare in general practice, and this project therefore wanted to explore these significant changes in the conduct of general practice, through investigating GPs’ views and experiences with these new technologies. The aims for the project thus revolved around capturing various aspects of this topic. Paper I aimed to summarize the scientific knowledge on the topic of video consultations (VCs) between GPs and patients. Paper II aimed to explore GPs’ experiences with VCs and their attitudes towards it in a post-pandemic setting. Paper III aimed to explore GPs’ views on the transformation of healthcare delivery that has taken place due to RCs. For the thesis itself, the aim was to explore possible factors and mechanisms that might influence this transformation of healthcare delivery. The thesis explores factors and mechanisms that influence the use of RCs and the accompanying transformation of healthcare delivery in general practice. By applying elements from Complexity theory, I discuss our findings on a holistic system level. This discussion shows how our findings revolve around five central voices related to general practice that may influence the use of RCs: GPs, patients, RC technology, the government, and market forces. Additionally, the influence from voices not directly affiliated with general practice is explored. I discuss how uptake of RCs is an unpredictable behaviour, and how self-organisation and an altered understanding of the attractor of general practice seems to have played a central role in uptake of RCs. The implications of this thesis point to additional main points. In an increasingly digital society, our participants still highlighted the importance of physical consultations to secure core aspects of general practice. RCs have changed the transition from self-care to healthcare – with a lower threshold for contacting the GP, patients’ altered health-seeking behaviour may negatively impact the issue of medical overuse. RCs have also raised a possible dilemma between quantity and quality of consultations in general practice. As a GP myself, I believe it is important that GPs embrace the technological advances and claim a normative role in the development of digital “best practice”. Further research should aim to deepen the understanding of influences on the transformation of healthcare delivery in general practice to ensure a sound balance between quality of care and technological developments.