JMIR Publications

ABSTRACT

Background:

Video consultation is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and growing demand for healthcare globally. Therefore, the sustainable implementation of video consultation is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Existing studies are often criticized for not being robust enough as the research settings are mostly small-scale pilot projects and so are unable to reflect on long-term implementation. COVID-19 pandemic has compelled clinicians across the world to conduct remote consultation creating a favorable context to study large scale remote consultation implementation.

Objective:

The aim is to investigate thoroughly how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reason(s) are for their choices. We posit that, a deeper understanding of clinicians’ perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and be sustained as a regular service.

Methods:

A qualitative approach is taken in this study, where the unit of analysis is the clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which are used as primary data source. Using performative model of routine as the theoretical framework, data was analyzed following the content analysis method.

Results:

Clinicians have mixed opinion on the merits and demerits of video consultation and where it stands between in-person and telephone consultation. 6 different planning criteria have been identified, and individual clinicians use different combination of these criteria when choosing a mode of consultation. The ideals clinicians hold for conducting consultation are divided into 3 aspects: clinical, interpersonal, and managerial. Video consultation engenders a new ideal but also endangers the existing ideal(s) according to the clinicians. Video consultation causes minor changes in the actions the clinicians perform in a consultation, thus do not play significant role in their choice of consultation. Clinicians cannot identify any changes in the outcome of a consultation as a result of incorporating remote mode of consultation.

Conclusions:

Clinicians feel there is a lack of scientific evidence on long-term effect of remote consultation on clinical efficacy, and effect on interpersonal and managerial aspects, which are crucial for consultation service. The absence of (1) sufficient scientific evidence and clear understanding on the merits and demerits of VC; (2) standard practices and shared norms among clinicians regarding the use of video for consultation create a void in the consultation practice. This void leads the clinicians to use their personal judgments and preferences to justify the choices they make for consultation mode. Thus, diverse opinions emerge including some paradoxical ones, which results into an uncertain future for sustainable large-scale implementation.