Health professionals intend to continue using digital consultations after the pandemic

In 2015, as part of the personal health portfolio known as La Meva Salut (My Health), eConsulta was included for all residents of Catalonia and their primary care professionals. A study by the Universitat Oberta de Catalunya (UOC) and the Government of Catalonia's Catalan Institute of Health (ICS) shows that professionals are very willing to continue using this service in a post-COVID-19 context. In the analysis, which has been published as open access in the Journal of Medical Internet Research, the research team assessed the implementation of the system among users and healthcare professionals and its current usefulness.

The importance of eConsulta during the pandemic

eConsulta is an asynchronous remote consultation tool, in other words, a digital communication tool that does not require the parties to be present or to interact in real time. It enables members of the public to send queries to their primary care doctor or nurse at any time and from any device and to receive an answer within a maximum of 48 hours on business days. The tool allows the parties involved to send attachments, such as photographs and other documents, which can then be added to the patient's medical record if so decided by the healthcare professional.

Although eConsulta is intended to be used in addition to face-to-face care, its use has increased very significantly during the pandemic, helping the health system respond to the high pressure it has been under. "Telemedicine has become a necessary clinical practice to safely provide care to COVID-19 patients and to continue offering routine primary care consultations," said Francesc Saigí, a researcher of the ICT interdisciplinary research group (i2TIC) and member of the Faculty of Health Sciences who collaborates with the Universitat Oberta de Catalunya's eHealth Center.

The use of eConsulta has been gradually extended to the whole of the primary care network, and the tool has been used by over 92% of teams. "It has recently started to be introduced in public hospitals," added Saigí. This suggests that the pandemic has fostered its implementation, since use of the tool began to increase when COVID-19 measures and restrictions were being put in place. "In spite of having a lower rate of use than face-to-face consultations up to March 2020, with eConsulta accounting for only 0.9% of all consultations, the COVID-19 pandemic has encouraged its implementation – and continues to do so – at an unprecedented rate and with an unprecedented impact, causing its use to triple," said the researcher.

The main finding of the study is that the majority of healthcare professionals are satisfied with the use of this tool and plan to include it in their practices beyond the pandemic. The researchers noted that its perceived benefits, added to environmental pressure, are decisive factors in the willingness and intention to use eConsulta. However, they also detected some resistance to its continued use once the pandemic is over, particularly among certain groups, such as nurses. In spite of this, the positive experiences of medical and nursing staff make them more likely to continue to use it after the pandemic. "It's worth taking advantage of the momentum caused by the current crisis to put into practice at least some of the solutions proposed in the scientific literature," said Saigí.

How have healthcare professionals used eConsulta during this time?

In order for telemedicine to become fully consolidated as part of routine healthcare, it needs to be accepted by both users and healthcare professionals. The reasons why any given group adopts a specific technological tool to a greater or lesser extent can be explained by a variety of factors. Of these, social factors are considered the most complex. "Our research confirms that people's perception of usefulness is the factor with the greatest impact on their willingness to use eConsulta," said Saigí. "Specifically," he continued, "when deciding to use the tool after COVID-19, healthcare professionals at the Catalan Institute of Health (ICS) place great relevance on the way the tool has improved their relationship with patients and increased the efficiency of their work, as well as on the benefits they believe they have derived from it".

He explained that, after these two perceived effects, the factor with the most significant impact on practitioners' intention to continue using eConsulta after COVID-19 is the environmental pressure directly or indirectly exerted on them by colleagues, patients or the institution itself. "We've found that having easy access to the tool makes patients ask health professionals to use it. Similarly, practitioners' intention to use the tool is also influenced by colleagues' positive opinion or the fact that they actually use it. Finally, another significant reason for adopting eConsulta is the health institution's commitment to implementing it."

Another variable that encourages its use is the perceived ease of use in its implementation. "This also supports a positive impact on people's attitude towards using the tool. Specifically, some professionals' attitude and intention to use eConsulta improves with the belief that it won't require any effort, particularly in the case of doctors," said the researcher. In line with previous studies, GPs who have previous experience with other e-health technologies are more enthusiastic and optimistic than those who have never used them before. "But it's worth highlighting the low impact of this factor compared to its benefits and environmental pressure," he noted.

According to Saigí, this could be due either to the government's widespread implementation of the tool or to the accelerated digital transformation of the healthcare sector as a result of COVID-19. "In any case, the experience of using technological tools is another variable that is directly and significantly correlated to the intention to use eConsulta after the pandemic. And this result shows the importance of developing staff members' competencies to adopt sustainable e-health solutions."

eConsulta and the way to the future of telemedicine

Even if its use has become standard practice to some extent, the implementation of telemedicine still has a long way to go. Professional e-health and telemedicine practice has resulted in significant changes to professionals' work. Hence the need for more, and more in-depth, scientific literature on this subject. "The results of this study are critical for e-health policy planners, as the tool's success will depend to a great extent on whether it's promoted by health professionals," he confirmed. According to the researcher, in order for eConsulta to become established in the long term, the work of medical and nursing professionals should be reviewed to ensure the value they provide is more efficient and of better quality.

One of the main challenges facing eConsulta is patient demand. "There's little point in having active professionals who are ready for the digital transformation if the people causing the demand for services are still choosing face-to-face care. That's why it's important to continue moving forward in educating the public about the strengths of these e-healthcare tools while working on their weaknesses, particularly the potential care inequalities that may result from their use," he explained.

Recommendations for a "perfect" eConsulta system

"In order to create a perfect eConsulta system," explained Saigí, "we must first modify the tasks to be carried out by professionals in order to make its use more valuable. We must also increase patient demand for e-healthcare. And finally, we must establish complementary relationships between uses, tasks and patient demand." Fortunately, we seem to already be making inroads towards more widespread e-health in society. The expert agreed that "the standard use of eConsulta will undoubtedly have significant benefits for the healthcare system. According to the literature, the adoption and use of telemedicine are linked to efficiency and competitiveness, enabling us to address the challenges faced by healthcare systems as a result of socio-economic changes."

These demands include healthcare, an ageing population, higher mobility among citizens, the need to handle large amounts of information and the provision of better healthcare. In Saigí's opinion, "all this is in the context of limited budgets and containment of costs." Furthermore, a number of studies show that telemedicine reduces low-added-value face-to-face visits, providing evidence of the efficiency of interventions based on the healthcare provider's perspective. This also suggests that telemedicine enables providers to focus their face-to-face care on those patients who require physical contact, avoiding the unnecessary waste of resources, which adds value to the implementation of eConsulta. "It could lead to shorter waiting lists and optimized care services. In summary, these benefits would be the result of the empowerment of the part of the population that actively uses eConsulta."

The UOC is committed to the e-health strategic pillar. As part of this initiative, it has created the eHealth Center, a research centre with the mission of promoting interdisciplinary and cross-cutting e-health research.

This UOC research supports Sustainable Development Goal (SDG) 3, to ensure healthy lives and promote well-being for all at all ages.

 

Reference article:

Saigí-Rubió F, Vidal-Alaball J, Torrent-Sellens J, Jiménez-Zarco A, López Segui F, Carrasco Hernandez M, Alzaga Reig X, Bonet Simó JM, Abizanda González M, Piera-Jimenez J, Solans O. (2021). Determinants of Catalan Public Primary Care Professionals' Intention to Use Digital Clinical Consultations (eConsulta) in the Post–COVID-19 Context: Mixed Methods Study Journal of Medical Internet Research, 23, (6), 28944. https://doi.org/10.2196/28944

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