Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-Based Primary Care: Mixed Methods Study

Abstract

Background Owing to the shortage of medical professionals, as well as demographic and structural challenges, new care models have emerged to find innovative solutions to counter medical undersupply. Team-based primary care using medical delegation appears to be a promising approach to address these challenges; however, it demands efficient communication structures and mechanisms to reinsure patients and caregivers receive a delegated, treatment-related task. Digital health care technologies hold the potential to render these novel processes effective and demand driven. Objective The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. Methods We conducted a combination of 19 individual and group interviews with 12 GPs and 14 MAs, seeking to identify relevant technologies for delegation purposes as well as stakeholders’ perceptions of their effectiveness. Furthermore, a web-based survey was conducted asking the interviewees to order identified technologies based on their assessed applicability in multi-actor patient care. Interview data were analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize the survey data, leading to a triangulation of the results. Results Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed to improve the development and distribution of innovative technologies and to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultations, portable electrocardiograms, or telemedical stethoscopes, can counteract current challenges in primary care because of its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. Conclusions Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance of such innovative approaches increases with the tremendous need for differentiated and effective care, such as during the ongoing COVID-19 pandemic. For the successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role as mediators between GPs and patients, MAs are potentially able to counteract patients’ resistance toward using innovative technology and compensate for patients’ limited access to technology and care facilities.

Digital team coaching for workplace communication: longitudinal evaluation of recipients’ perceptions

“…Moreover, in this case, digital intervention relies on specific intervention techniques such as sociomapping and coaching, thus providing interesting insights into the further development of these techniques as intervention mechanisms in health-care organizations. The importance of these observations is amplified given the current changes within hospital environments, notably the consolidation of health-care processes across different departments and their digital transformation, alongside the consequences of the COVID-19 pandemic on health-care personnel and facilities in both rural and urban regions (Knop et al , 2021).…”

“…From this perspective, the scarcity of medical professionals, increasingly burdened with more complex and managerial responsibilities, has spurred the development of a broader organizational strategy. This strategy delegated traditional tasks to other team members, such as nurses and health-care assistants (Knop et al , 2021). Although the roles of general practitioners and nurses are converging in some areas, the success of this multiactor approach hinges on several factors, including effective communication among team members (Mohr et al , 2011).…”

A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery

“…• Some novel care models have evolved to address innovative solutions to tackle medical undersupply because of a shortage of human resources in healthcare (medical professionals, for example), as well as demographic and structural constraints. Medical delegation and team-based DHTs [29] appear to be a potential strategy to address these issues; however, this will require strong but smoother PHC communication structures and mechanisms to reassure that patients and caregivers are receiving a delegated task for a therapy-related duty. Thus, these evolutionary (if not revolutionary) processes could be made more productive and efficient by using DHTs.…”

A Systematic Scoping Review of Digital Health Technologies During COVID-19: A New Normal in Primary Health Care Delivery

“…Additionally, big data and other DHTs, such as check-in kiosks, emails, online patient portals, self-management home monitoring devices, and chatbots, were also noted. eHealth: telehealth, telemedecine, e-prescription, e-referral, e-Mental health, telepsychiatry, clinic-based telehealth, telehealth visits (18)(19)(20)(21)(22)(23)(24)(25)27,49,52,55) Devices: wearables, wearable health devices, portable electrocardiograms, telemedical stethoscopes, telemedical ECGs, remote monitoring devices, laboratory-on-a-chip' devices (26,27,37,(48)(49)(50)(51)(52)(53)60) Digital tracing (28,29) Testing, self-testing (self-screening) (30,31) Websites, Platforms, Trials Platform (25,(32)(33)(34)(35)(36) Monitoring Internet of Things (IoT) (39,55) Artificial intelligence (AI) (26,37,(48)(49)(50)(51)(52)(53)60) Big data (39,55) G...…”