JMIR Publications

ABSTRACT

Background:

Asynchronous text-based e-consultations have transformed how patients interact with their general practitioner (GP). While e-consultations can give patients increased access to GP care, concerns about increased workload for GPs are raised. It is unclear whether patients regard e-consultations as replacing other GP services or if they potentially generate an additional demand for GP care.

Objective:

This study aimed to explore: RQ1) For what purpose and with what expectations do patients initiate e-consultations? RQ2) If e-consultations had not been available, what alternative actions would the patient have taken? RQ3) How are the alternative actions associated with patient and e-consultation characteristics?

Methods:

A cross-sectional study was conducted via an online survey. The survey was sent to all users sending e-consultations in the official health portal Helsenorge from January - to February 2023. The survey was based on theoretical frameworks and research on digital health care. Data were analysed using descriptive statistics and multinomial logistic regression.

Results:

13,011 users answered the survey. The most common reason for initiating an e-consultation was to request a sick certificate (38%, 4940/13011). Almost 70% (8802/13011) of the respondents expected an answer within 24 hours, and 18% (4744/13011) anticipated being asked to attend a physical examination. If e-consultations had not been available, 46% (5917/13011) of the respondents would have booked a GP appointment, and 45% (5846/13011) would have called the front desk. Users who expected a quicker response (OR=1.64, 95% CI=1.46-1.85) and were less concerned about their health issues (OR=1.29, 95% CI=1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR=6.08, 95% CI=3.46-10.66) and a new health problem (OR=2.71, 95% CI=2.09-3.51) were more likely to choose this option. Additionally, 5% (609/13011) of the users would not have sought help had e-consultations been unavailable. Younger patients (OR=2.16, 95% CI=1.38-3.37) and those with a longer travel time to the GP office (OR=2.19, 95% CI=1.27-3.80) or a new health issue (OR=1.74, 95% CI=1.43-2.12) had higher odds for choosing the alternative of not seeking help.

Conclusions:

E-consultations were mainly used for convenience, as most users had good availability to GP services. Users expected a fast response to the e-consultation. E-consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Patients' concern for their medical problems also influenced their alternative actions. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess consultations’ effect on health outcomes and efficiency.