JMIR Publications

ABSTRACT

Background:

The COVID-19 crisis has led to a radical transformation of care delivery. To avoid contamination and maintain the required care for patients, teleconsultation is more widely used than ever before. Beyond contributing to managing the crisis, this practice is also considered a significant opportunity to address persistent health system challenges, including accessibility, continuity, and cost of care, while maintaining quality. Given the expected benefits of teleconsultation, this article focuses on teleconsultation continuance in the aftermath of the pandemic. In an effort to build on the digital momentum gained through the crisis, understanding what drives patients to keep on consulting physicians online supports the improvement of the overall quality of care over the long term.

Objective:

This study aimed at identifying the determinants of patients' intention to continue their use of a teleconsultation platform based on a contextualized research model.

Methods:

Two data collections were conducted in November 2018 and May 2019 with Canadian patients who have access to the Dialogue teleconsultation application. Measures included patients' intention to continue their use, teleconsultation usefulness, teleconsultation quality, patients' trust towards the digital platform, its provider and healthcare professionals, and confirmation of patients' expectations towards teleconsultation. Since survey responses collected during the crisis are unlikely to be representative for post-crisis continuance, we test our research model with a dataset collected before the COVID-19 pandemic. Structural equation modeling (SEM), employing the PLS component-based technique, was used to analyze the data.

Results:

We analyzed a sample of 178 participants, who had prior experience with Dialogue teleconsultation services. Our findings reveal that the main determinants of continuance intention are usefulness, quality, and confirmation of expectations. Confirmation of expectations has the greatest influence on continuance intention (total effects=0.722; P<.001), followed by usefulness (total effects=0.587; P<.001) and quality (total effects=0.511; P<.001). Usefulness (ß=0.587; P<.001) and quality (ß=0.339; P=.013) have direct effects on the dependent variable. The confirmation of expectations has direct effects both on usefulness (ß=0.571; P<.001) and quality (ß=0.751; P<.001) in addition to having an indirect effect on usefulness (indirect effects=0.282; P<.001). Last, quality directly influences usefulness (ß=0.340; P=.002) and trust (ß=0.875; P<.001). Trust does not play a role in the context under study.

Conclusions:

As usefulness, the main predictor, largely depends on initial expectations confirmation, patients should be provided with proper information about the possibilities, limitations, and potential benefits of teleconsultation platforms and services. As service quality is the most important dimension of the quality of a teleconsultation, the speed and scope of services and the commitment of providers are appealing avenues for sustained teleconsultation use by patients.