Insights from high and low clinical users of telemedicine: a mixed-methods study of clinician workflows, sentiments,...

Teleconsultation is a valuable tool in healthcare, but systematic evaluation of workflow processes (comparing teleconsultation to in-person visits) and the nuanced experiences of high and low clinical users of teleconsultation services is lacking. Understanding if and where differences exist is important to improve adoption and optimise service delivery. Our study objectives are: (1) To compare the process and workflow of teleconsultations and in-person consultations, identifying and quantifying if and where differences arise. (2) To examine clinicians' experiences of teleconsultations, identifying barriers and enablers, and whether these differ between high and low providers.

We conducted a mixed-method study to explore workflow and clinician experiences with vCare (an outpatient chronic disease teleconsultation service run at Alexandra Hospital) versus in-person consultations. A time and motion study (n = 60 observations of individual consultations) quantified the task type and average duration for a teleconsultation and in-person visit. We also collected qualitative data (interviews and focus group discussions (n = 18)) from high and low-clinician users (physicians, nurses, and pharmacists) to understand clinical user experiences, barriers and enablers of vCare uptake. We defined low clinical users as clinicians who opted for vCare in less than <10 % of their monthly appointment time. Data were analysed using sentiment scoring and framework analysis, guided by the Consolidated Framework for Implementation Research (CFIR).

Teleconsultation time was shorter; 10 mins versus 15 min (mean difference 4 min 42 s, p < 0.001, confidence interval (CI) 2 min 25 s, 7 min), with less time spent on history taking (mean difference 58 s, p = 0.01, CI 12.9, 103.1) and patient discussion (mean difference 1 min 34 s, p = 0.03, CI 7.1, 180.3) compared to in-person consultations. High clinical vCare users expressed more positive sentiments towards teleconsultation than low clinical users (composite sentiment score 0.1860 versus 0.1225), particularly in the CFIR Implementation Process domain (high user: 0.276 and low user: -0.099). Regarding barriers and enablers, high and low clinical users aligned on several factors, including the impact of infrastructure quality, suitability of patients, costs, policy, and stakeholder buy-in. Unique uptake barriers from high clinical users included liability concerns, language barriers and health literacy. For low clinical users, the need for reminders, fatigue from teleconsultations, and challenges in providing emotional support were influencing factors.

Integrating quantitative and qualitative data revealed key process differences between tele- and in-person consultations, as well as variations in clinician experience among high and low clinical users of teleconsultation. Developing tailored strategies to support the distinct needs of different providers is necessary to improve teleconsultation practice and adoption.