JMIR Publications

ABSTRACT

Background:

Due to shortages of medical professionals, as well as demographic and structural challenges, new care models have emerged for finding innovative solutions to counter medical undersupply. Team-based primary care utilizing medical delegation appears to be a promising approach to address these challenges, but demands efficient communication structures and mechanisms to reinsure patients and caregivers receiving a delegated, treatment-related task. Here, digital healthcare technologies hold the potential to render these novel processes effective and demand-driven.

Objective:

The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) in order to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use.

Methods:

In total, 19 interviews with 12 GPs and 14 MAs were conducted, seeking to identify relevant technologies for delegation purposes as well as the stakeholders’ perceptions of their effectiveness. Further, an online survey was conducted asking the interviewees to order identified technologies by their assessed applicability in multi-actor patient care. Interview data was analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize survey data, leading to a triangulation of results.

Results:

Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed in order to improve the development and distribution of innovative technologies, as well as to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultation, portable electrocardiograms (ECGs), or telemedical stethoscopes, is able to counteract current challenges in primary care due to its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes.

Conclusions:

Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance for such innovative approaches increases at times of tremendous need for differentiated and effective care, like during the ongoing COVID-19 pandemic. For successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role of mediators between GPs and patients, MAs are potentially able to counteract resistance towards using innovative technology on both sides and compensate for patients’ limited access to technology and care facilities.