@Article{info:doi/10.2196/63068,
author="Norberg, B{\o}rge L{\o}nnebakke
and Austad, Bjarne
and Kristiansen, Eli
and Zanaboni, Paolo
and Getz, Linn Okkenhaug",
title="The Impact and Wider Implications of Remote Consultations for General Practice in Norway: Qualitative Study Among Norwegian Contract General Practitioners",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="17",
volume="8",
pages="e63068",
keywords="remote consultations; e-health; digital medicine; telemedicine; impact; downsides; disadvantages; pitfalls; safety; general practice; family medicine; practice organization; ecology of healthcare; remote consultation; monitoring; teleconsultation; social determinants of health",
abstract="Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. ",
issn="2561-326X",
doi="10.2196/63068",
url="https://formative.jmir.org/2024/1/e63068",
url="https://doi.org/10.2196/63068",
url="http://www.ncbi.nlm.nih.gov/pubmed/39688890"
}