Strategic Considerations for Video Consultation Implementation in General Practice: Qualitative Study of...

Video consultations have become an established component of general practice and are increasingly promoted to improve access, efficiency, and health care sustainability. While previous research has primarily explored the perspectives of individual patients and health care professionals, less is known about how organizations involved in strategic video consultation implementation consider their benefits, challenges, and future role within health care systems.

This study aims to explore the experiences of organizational interest-holders involved in implementing video consultations in Danish general practice, focusing on the perceived strengths, weaknesses, opportunities, and threats related to their use.

A qualitative interview study was conducted with 17 representatives from 13 organizations involved in the development, support, regulation, governance, or strategic implementation of video consultations in Denmark. Purposive and snowball sampling identified participants from 4 different organizational groups: patient organizations, professional interest organizations, technology and digital health organizations, and public health authorities. Semistructured interviews were conducted between October and December 2023. Two researchers analyzed the transcripts using a 5-stage deductive-inductive framework analysis. Interest-holder theory defined whose role-informed perspectives were compared; the Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis framework structured the initial descriptive charting; and iterative comparisons across SWOT categories, organizational groups, and 5 analytical levels identified patterns of convergence, divergence, and tension.

Four overarching tensions, competing values, and dilemmas emerged across the organizational interest-holder groups: (1) improved access versus widening inequity, (2) efficiency versus relational and clinical quality and safety, (3) digital transformation versus implementation uncertainty, and (4) strategic governance versus target-driven digitalization. Participants recognized that video consultations may improve accessibility, convenience, and coordination of care while supporting broader digital transformation. However, concerns were raised regarding digital exclusion, limitations in relational and clinical assessment, uncertainty about appropriate use, cross-sector implementation challenges, and governance approaches that prioritize use targets over clinical value, quality, and patient safety.

Exploring the perspectives of organizational interest-holders suggested that implementing video consultations in general practice is not simply a matter of increasing technology uptake. Rather, it requires balancing competing priorities related to access and equity, efficiency and quality and safety, digital transformation and implementation uncertainty, and governance and professional autonomy. Sustainable implementation should promote equitable access, context-sensitive clinical use, interoperable digital infrastructure, and good governance. This should be based on research that assesses when video consultations add value, for whom, and according to which definitions of quality and safety, rather than prioritizing uptake alone.