Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 5, 2023
Date Accepted: Sep 5, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Accessibility, cost, and quality of online regular follow-up visit service: a mixed study of Internet Hospital in China
ABSTRACT
Background:
Telemedicine provides remote healthcare services to overcome constraints of time and space in accessing medical care. During the pandemic of Covid-19, Internet hospitals in China developed rapidly. Many new services on Internet hospitals appeared. Internet hospitals in China offer online consultations, including online regular follow-up visit service. However, the accessibility, cost, and quality advantages of online regular follow-up visit service remain unclear.
Objective:
This study aimed to evaluate the accessibility, costs, and quality of online regular follow-up visit service provided by an internet hospital in China. By analyzing the accessibility, costs and quality of online regular follow-up visit service from supply-side and demand-side, practical and theoretical experience will be summarized.
Methods:
A mixed-methods study was conducted using clinical records of 18,473 patients receiving 39,239 online regular follow-up visit services at an internet hospital in 2021, as well as interviews with 7 physicians, 2 head nurses and 3 Administrative staffs. Quantitative analysis examined patient demographics, diagnoses, prescriptions, geographic distribution, physician characteristics, accessibility based on travel time/costs, and service hours. Qualitative analysis elucidated physician perspectives on ensuring quality of online healthcare.
Results:
Patients were predominantly middle-aged males with chronic diseases like viral hepatitis, located near the hospital. The vast majority were from Guangdong province where the hospital is based, especially concentrated in Guangzhou city. Online regular follow-up visit service reduced travel time by 1-9 hours and costs by 6-991 CNY depending on proximity, with greater savings for patients farther from the hospital. Consultation times were roughly equivalent between online and in-person. Physicians provided most online services during lunch breaks or after work hours from 12-14 and 19-23, indicating increased workload. The top departments providing online regular follow-up visit service were Infectious Diseases, Rheumatology, and Dermatology. The most commonly prescribed medications aligned with the prevalent chronic diagnoses. To ensure quality, physicians conduct initial in-person consultations to fully evaluate patients before allowing online regular follow-up visit. During online regular follow-up visit, they communicate with patients to assess conditions and determine if in-person care is warranted. They also periodically remind patients to come in-person for more comprehensive evaluations. However, they acknowledged online visits cannot fully replace face-to-face care.
Conclusions:
Telemedicine services such as online regular follow-up visit service provided by internet hospital must also adhere strictly to fundamental medical principles of diagnosis, prescription, and treatment. For chronic disease patients, online regular follow-up visit service improves accessibility and reduce cost, but cannot fully replace in-person evaluations. Physicians leverage various strategies to ensure quality of online care provision.
Citation
