Online contact with the doctor's office shortens the patient que
Fewer patients have to wait in the telephone queue and at the doctor's office, as more people book their consultation and renew their prescriptions online.
With the introduction of digital services via the portal Helsenorge.no, it is possible that the patients spend less time in telephone queue and the waiting room. For the patient, this means that they may experience less need to travel, and save time and money.
Together with colleagues, researcher Asbjørn Fagerlund at the Norwegian Centre for E-health Research has examined nine GPs' use of four digital services offered in the portal Helsenorge.no.
Fagerlund says that the staff at the doctor's office spend less time on administrative tasks, have shorter telephone queues and automatically document the communication with the patient.
«The doctors we have interviewed mostly reported that the digital dialogue with the patients works well. We also saw that children, elderly, the seriously ill and those who are unfamiliar with using technology still prefer to meet the physician physically,» he says.
Studied four digital health services
The researchers interviewed the GPs about four digital health services in primary care:
- Make an appointment with the GP
- Renew electronic prescription
- Start e-consultation
- Contact the doctor's office (non-clinical enquiries)
Not all general practitioners in Norway offer these services, but more and more do so. The researchers interviewed nine permanent GPs in Western Norway and Eastern Norway who had used the four services. The doctors were recruited and interviewed in the autumn of 2017, the data was analysed in the spring of 2018 and the research article was published in May 2019.
«When it came to the booking service, the GPs were happy. They experienced it as time-saving and that it gave them increased flexibility,» says Fagerlund.
He adds that the GPs also said some patients missed talking to a health secretary at the doctor's office, as they were accustomed to.
With electronic booking, the doctor may get less information about the subject the patient will address, and therefore does not know how long it will take. Some doctors said that an electronically booked appointment sometimes had to be extended to a double time slot, but this was not a frequent feedback.
Renew electronic prescription
About the digital service Renew prescription, the researchers observed that GPs organised their routines differently. In Norway, GPs are private practitioners that have established a contractual agreement with the municipality, and mostly run their practice as they see fit. Some of them made the health secretary sort out the electronic requests, while others received all the messages in their inbox. Some doctors pointed out that the messages could lead to more work.
«Perhaps a prescription renewal was not suitable to handle electronically, so the patient still had to travel to the doctor's office. It also appeared that the GPs schedule was still filled up with face-to-face consultations, and that they administered the electronic messages in between appointments, or outside ordinary working hours,» says Asbjørn Fagerlund.
According to the researchers, this is what often happens when new technology is introduced in an organisation. The operation at the office goes as before, and then the electronic messages arrive at the top.
The doctors also reported clear benefits for the patients as the need to travel or wait in telephone queue was reduced.
E-consultation is intended to supplement and sometimes replace the traditional face-to-face consultation. This is electronic communication between patient and GP, where the patient logs into Helsenorge.no and sends a written health question. The message arrives in an inbox and is then processed by the GP. The GP can answer in text, or if medically required set up the patient for a face-to-face consultation in the clinic. This service is the only one of the four where the patient must pay a deductible.
«When we did the study, the service was available for the GPs we interviewed, but not used by many patients. The doctors reported little demand, one to two per day. The patients had to be motivated by the doctors to use this service,» says Fagerlund.
Patients often sent inquiries about topics they had previously addressed in a physical consultation. Most doctors thought that the patients expressed themselves clearly. They also experienced situations where a face-to-face meeting would be better. The researchers were curious as to whether the patients were able to convey symptoms and ailments in text.
«Some doctors said patients expressed themselves more openly in writing and addressed things they wouldn't otherwise do. It could be about mental health or shameful issues. Many people who have tried this service are looking at the use of video consultation as a next step» says Fagerlund.
The doctors realized that they had to make routines for the new digital services. For example, if a doctor is absent, they must arrange so that the requests come to a substitute who can respond.
Less calls, automatic documentation
The digital service Contact the doctor's office is for text-based questions about administrative matters. For example, a patient can send a message and ask when the blood test results are clear.
In the study, the use of this service varied from a few to 20-30 inquiries per day. Doctors had to figure out how to get the service to fit into the practice. The biggest advantage was that it relieved the pressure on the doctor's phone. Another advantage was that the communication with the patient was automatically documented.
«It became clear what information was received from the patient and what had been sent out» says Fagerlund.
But there were also some misunderstandings.
«Sometimes the service was confused with e-consultation where people sent clinical questions about their health issues. But there was not much misuse. We need to find out why patients chose the wrong communication channel - what we see so far is that more and concise information is needed about all digital services, both to the doctors and the public.»
Not always suitable
In summary, the GPs in the study were positive to the four digital services. However, the GPs who participated volunteered to be among the first to implement the digital services in Helsenorge.no, and it is likely they were more positive to technology compared to the general GP population.
The benefits the doctors pointed out were improved patient accessibility, less calls, reduced queues at the doctor's waiting room, more precise and written documentation of the dialogue, and patients saving time and money. Not least those who had to travel far and lost their working income.
However, the researchers also noted that the digital services do not always suit everyone.
«They will not be as suitable for people with less digital competence, those who are not comfortable with using data and the internet. We have previously researched the elderly and technology use. Those who do not use online banking or electronic ticket booking, will perhaps also be reluctant to engage in digital dialogue with the doctor» Fagerlund says.
He emphasizes that the human dimension will always be important. For example, in the case of mental health problems, it will sometimes be best to meet face to face. This also applies to patients with serious illness. The feeling of security and care is something the patient is more likely to get in the face-to face human encounter.
Fagerlund says the study is based on the experiences of nine doctors.
«Some mentioned a reduction in queue in the waiting room and telephone, but others saw this as a possible future positive effect. As the services become available to more people, it will be important to measure the actual consequences of digital resident services, both for the operation in the doctor's office and how the patients experience it all.»
«An important point is that when a patient likes and uses the new digital services, there will also be shorter waiting times on the phone or waiting room for the older man who prefer to call the doctor’s office or meet in person. This means that the increased use digital services may also benefit those who do not want or can’t have a digital dialogue.»
Fagerlund A.J., Holm I.M. og Zanaboni P.: General practitioners’ perceptions towards the use of digital health services for citizens in primary care: a qualitative interview study. BMJ Open. May 2019