On digital intimacy: redefining provider-patient relationships in remote monitoring

Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care

Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a "digital-first" primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers' views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.

Digital geographies of care: Telehealth landscapes of addiction treatment during the COVID-19 pandemic

The COVID-19 pandemic has created new digital health care landscapes for the management of substance use and misuse. While telehealth was prohibited for addiction treatment prior to the pandemic, the severity of COVID-19 precipitated telehealth expansion for the delivery of individual and group-based treatment. Research has highlighted benefits and challenges of telehealth; however, little is known about the impacts of telehealth on the quality, use, and effectiveness of treatment. Fewer studies examine how these emerging digital geographies of care transform the spaces and landscapes of substance misuse. This article examines how telehealth affects landscapes of opioid use disorder care in Pennsylvania, West Virginia, and Kentucky during the COVID-19 pandemic. Our findings reveal that while telehealth extends access to treatment for opioid use disorder (OUD), it also creates new care inequities within and between providers and clientele that can undermine effective care and recovery.

Getting the most out of remote care: Co-developing a Toolkit to improve the delivery of remote kidney care appointments for underserved groups

BACKGROUND

Telephone and video appointments are still common post-pandemic, with an estimated 25%-50% of kidney appointments in the United Kingdom still conducted remotely. This is important as remote consultations may exacerbate pre-existing inequalities in those from underserved groups. Those from underserved groups are often not represented in health research and include those with learning disability, mental health needs, hearing/sight problems, young/older people, those from ethnic minority groups.

OBJECTIVES

The aim was to develop a Toolkit to improve the quality of remote kidney care appointments for people from different underserved groups.

DESIGN

A parallel mixed methods approach with semistructured interviews/focus groups and survey. We also conducted workshops to develop and validate the Toolkit.

PARTICIPANTS

Seventy-five renal staff members completed the survey and 21 patients participated in the interviews and focus groups. Patients (n = 11) and staff (n = 10) took part in the Toolkit development workshop, and patients (n = 13) took part in the Toolkit validation workshop.

RESULTS

Four themes from interviews/focus groups suggested areas in which remote appointments could be improved. Themes were quality of appointment, patient empowerment, patient-practitioner relationship and unique needs for underserved groups. Staff reported difficulty building rapport, confidentiality issues, confidence about diagnosis/advice given, technical difficulties and shared decision making.

CONCLUSION

This study is the first to explore experiences of remote appointments among both staff and those from underserved groups living with kidney disease in the United Kingdom. While remote appointments can be beneficial, our findings indicate that remote consultations need optimisation to meet the needs of patients. The project findings informed the development of a Toolkit which will be widely promoted and accessible in the United Kingdom during 2024.

Patients' perspectives on digital health tools

Objective

Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake.

Methods

A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively.

Results

Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology.

Conclusion

Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies.

Innovation

Participatory design approaches have the potential to support the creation of patient-centred digital health tools.

The illusion of immediacy: on the need for human synchronization in data-intensive medicine

Medical practice is increasingly shaped by big data sets and less by patient narratives. Data-intensive medicine promises to directly connect the patients with the clinic. Instead of medical examinations taking place at bedside and discrete moments, sensor-based technologies continuously monitor a certain body parameter and automatically transfer the data via a telemedical system. Based on a qualitative study of remote cardiac monitoring, I explore how the uncoupling of processes that used to happen in one place, changes the way diagnosis is made. Using ethnographic observations and semi-structured interviews with patients and tele-nurses of two university hospitals in Switzerland, I describe remote cardiac monitoring as a data network. The perception of being constantly connected to the hospital resulted in a reassuring effect among patients and healthcare professionals. Moreover, the notion of an automatically synchronized data network led patients to expect immediate feedback from the hospital as soon as an irregularity was detected. However, it obscured the fact that although the inserted sensor monitors the heart around the clock, the data is transmitted only once a day, and the tele-nurses only work during office hours, from Monday to Friday. I call this misperception "illusion of immediacy". It takes time to accurately correlate and interpret a recorded episode with other types of data, such as the last hospital visit, comorbidities, and/or the actual situation in which the recording was made. Accordingly, tele-nurses and cardiologists play a central and privileged role in the data network. The findings highlight the importance of synchronizing the different temporalities that coexist in the patient remote monitoring data network in order to generate meaningful knowledge that ultimately leads to a diagnosis.

Therapeutic Relational Connection in Telehealth: Concept Analysis

BACKGROUND

Therapeutic relational connection (TRC) in telehealth is a new concept that refers to the intentional use of relationship connection between health care providers and their patients as both parties work toward a therapeutic aim. It has been demonstrated that TRC positively affects patient-centered outcomes including adherence, self-management, and satisfaction with care. What is not known are best practices for establishing TRC during telehealth visits. The rapid emergence of telehealth during the COVID-19 pandemic has identified a number of challenges. These challenges include lack of human contact, distance creating mistrust, the inability to rely on nonverbal communication, and a sense of depersonalization. Training for health care providers in these interpersonal communication skills needed to establish TRC during telehealth visits is needed.

OBJECTIVE

This paper aims to explore the evolutionary concept of TRC in telehealth. The purpose of this paper is to provide a concept analysis of TRC during telehealth interactions between providers and patients through a comprehensive review of the existing published literature.

METHODS

Rodgers' evolutionary concept analysis method was used to guide this study. PubMed, Embase, PsycINFO, and CINAHL were used to search for relevant publications. An integrative review strategy aided by Rayyan software was used to identify a final sample of 13 papers for analysis.

RESULTS

The proposed definition of TRC in telehealth is the experience of a mutually responsive patient-provider relationship that is built on mutual respect and understanding and informed by cultural humility, presence, empathy, and the ability to effectively evaluate patient concerns to work toward a therapeutic aim. The key attributes of TRC in telehealth are the provider's ability to evaluate patient concerns, interpersonal communication, cultural humility, mutual trust and respect, presence, empathy, and building relationships. Clinical presence, proper environment, knowledge about the use of technology (both patient and provider), use of verbal and nonverbal communication, and knowledge about community and culture are important antecedents of TRC. Consequences of TRC include improved communication resulting in mutual respect and caring, adherence to follow-up recommendations, increased coping, collaborative decision-making, and satisfaction with care.

CONCLUSIONS

Telehealth visits necessitate alternative approaches to establishing TRC as compared to in-person clinic visits. With the rapid expansion of telehealth platforms and a heightened acceptance of the technology, there is a need to integrate knowledge and provide a clear conceptualization of TRC in telehealth as TRC has been demonstrated to result in positive patient-centered outcomes. Identifying the attributes and antecedents of TRC in telehealth allows us the opportunity to develop guidelines and educational interventions aimed at training health care providers in the skills needed to establish TRC during telehealth visits.

Can Online Patient-Provider Communication Improve Emotional Well-Being? Examining the Roles of Social Presence and Patient Empowerment

China has long been suffering from the problem of having health care that is expensive and difficult to access. Online patient-provider communication (OPPC) can offer a viable channel to increase access to care. However, through what underlying mechanisms OPPC can be associated with better health outcome is under-researched. To fill this research gap, this study investigated OPPC usage in China and identified psychological processes linking OPPC to emotional well-being. With two-wave panel surveys conducted in China, we found that mobile health app, social media, and health information service website were three common platforms for OPPC, followed by patient portal, whereas e-mail was used least frequently. Overall, OPPC did not have any direct effect on emotional well-being. Instead, OPPC first increased users' perceived social presence of providers in OPPC, which in turn triggered sense of patient empowerment, which finally enhanced emotional well-being.

Experiences of Women With Breast Cancer Using Telehealth: A Qualitative Systematic Review

Breast cancer is the most prevalent malignant neoplasm among women. Its treatment comprises different strategies. Telehealth can ensure continuity of care in distant locations. This study aimed to synthesize qualitative evidence of women's experiences with telehealth during the treatment and follow-up of breast cancer. We performed a qualitative systematic review and meta-synthesis. The databases included in the search were: Pubmed, EMBASE, CINAHAL, and Web of Science. The search combined the terms: breast cancer, telemedicine, telehealth, and qualitative study. The studies included were: qualitative design and mixed methods studies with qualitative components. The COREQ Checklist assisted in assessing the quality of included studies and an adaptation of thematic analysis for the qualitative meta-synthesis. We included twelve articles in the review. In the meta-synthesis, 3 themes emerged. (1) Structure: simple design and space to obtain information but in need of adjustments. (2) Usability: about the benefits and limitations of telehealth. (3) Interaction with health professionals. Telehealth is an accepted strategy for the clinical care of women with breast cancer. Patients identified the need for improvements in structure, usability, and interaction. PROTOCOL REGISTRATION: PROSPERO registration number CRD42021228326, registered 06/02/2021.

Photodiagnosis of genital herpes and warts: a sociomaterial perspective on users' experiences of online sexual health care

Online sexual health services potentially transform modes of engagement with service users. We report findings from an in-depth interview study with users of a photo-diagnosis service offered by an established UK-based online sexual health service (SH:24). Adopting a sociomaterial theoretical perspective, we analyse the interviews for descriptions of health care with and through the affordances offered by SH:24. We focus on how the interactions of service users and clinicians with nonhuman agents opened or closed off capacities for better health and wellbeing. Our findings explore navigating online and in-person service options; digitising bodies; temporal affordances; the tension between anonymous and personalised care; configuring digital privacy; and when automated care is not enough. We conclude that emerging practices of care within digital health services delivered by more-than-human collaborations reconfigure experiences of diagnosis and treatment and require detailed attention to understand how they create and close down opportunities to improve or maintain health.

Digital health: A sociomaterial approach

The notion of digital health often remains an empty signifier, employed strategically for a vast array of demands to attract investments and legitimise reforms. Rather scarce are attempts to develop digital health towards an analytic notion that provides avenues for understanding the ongoing transformations in health care. This article develops a sociomaterial approach to understanding digital health, showing how digitalisation affords practices of health and medicine to cope with and utilise the combined and interrelated challenges of increases in quantification (data-intensive medicine), varieties of connectivity (telemedicine), and unprecedented modes of instantaneous calculation (algorithmic medicine). This enables an engagement with questions about what forms of knowledge, relationships and control are produced through different manifestations of digital health. The paper then sets out, in detail, three innovative strategies that can guide explorations and negotiations into the type of care we want to achieve through digital transformation. These strategies embed Karen Barad's concept of agential cuts suggesting that responsible cuts towards the materialisation of digital health require participatory efforts that recognise the affordances and the generativity of technology developments. Through the sociomaterial approach presented in this article, we aim to lay the foundations to reorient and sensitise innovation and care processes in order to create new possibilities and value-centric approaches for promoting health in digital societies as opposed to promoting digital health per se.

'It's a different way to do medicine': Exploring the affordances of telehealth for hepatitis C healthcare

While the use of telehealth was common in hepatitis C healthcare in Australia in remote and regional areas prior to the COVID-19 pandemic, it has been used more broadly to improve access to hepatitis C heathcare during the pandemic. Despite its widespread uptake, little research has explored how telehealth shapes hepatitis C healthcare. In this article, we draw on the concept of affordances (Latour, 2002) and interviews with 25 healthcare practitioners to explore the emergent possibilities for hepatitis C care that take shape through telehealth. Despite suggestions that telehealth is comparable to in-person care, healthcare practitioners' accounts suggest that telehealth significantly changes the nature of their experience of providing healthcare for hepatitis C. According to these service practitioners, while it increased access to hepatitis C healthcare during the pandemic, it also afforded narrower, less personal healthcare encounters, with a focus on simple and singular issues, and reduced opportunities for communication and rapport. These affordances also discouraged the use of interpreters and by extension the inclusion of patients from non-English speaking backgrounds. However, the data collected also suggest that telehealth has the potential to afford more informal and relaxed healthcare environments and dispositions between healthcare practitioners and patients, potentially disrupting classic practitioner-patient power dynamics. In concluding, the article considers how telehealth models of care might better afford quality hepatitis C healthcare and care beyond COVID-19 pandemic conditions.

Influence of Parental Health Locus of Control on Behavior, Self-Management and Metabolic Control, in Pediatric Patients with Type 1 Diabetes

Background: Precision medicine in type 1 diabetes (T1D) treatment considers context and environmental data to subclassify patients. Parental Health Locus of Control PHLOC) could influence behavior, self-management, and metabolic control of children with T1D. Methods: No. 135 pediatric patients with T1D (No. 57 with HbA1c ≤ 7.0%, “optimal” group, and No. 78 with >7.0%, “sub-optimal” group) were enrolled in the study. History, anthropometric and diabetes management data were collected, as well as caregiver’s data about socioeconomic status (SES). The PHLOC scale questionnaire and a semi-structured interview were administered. Results: Access to technology was lower in the “sub-optimal” group and, in particular, in the ethnic minority subgroup, only 8% used them. In the “sub-optimal” group ethnic minority status was higher (24%), the caregiver had a lower SES and showed lower internal HLOC. Conclusions: New care models have to be implemented to ensure equity in diabetes care and precision treatment, particularly for ethnic minority groups, because SES and external PHLOC are still an important barrier to “optimal” diabetes control. In the “sub-optimal” group, we have to implement strategies aimed at increasing self-efficacy, while in the “optimal” one, a personalised approach should be considered to facilitate the shifting of responsibilities within the family, avoiding psychological distress.

Why do GPs rarely do video consultations? Qualitative study in UK

Background: Fewer than 1% of UK general practice consultations occur by video. Aim: To explain why video consultations are not more widely used in general practice. Design and setting: Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings 2019-2021. Methods: The dataset included interviews and focus groups with 121 participants from primary care (33 patients, 55 GPs, 11 other clinicians, 9 managers, 4 support staff, 4 national policymakers, 5 technology industry). Data were transcribed, coded thematically and then analysed using the Planning and Evaluating Remote Consultations (PERCS) Framework. Results: With few exceptions, video consultations were either never adopted or soon abandoned in general practice despite a strong policy push, short-term removal of regulatory and financial barriers and advances in functionality, dependability and usability of video technologies (though some products remained “fiddly” and unreliable). The relative advantage of video was perceived as minimal for most of the case load of general practice, since many presenting problems could be sorted adequately and safely by telephone and in-person assessment was considered necessary for the remainder. Some patients found video appointments convenient, appropriate and reassuring but others found therapeutic presence was only achieved in person. Video sometimes added value for out-of-hours and nursing home consultations and statutory functions (e.g. death certification). Conclusion: Efforts to introduce video consultations in general practice should focus on situations where this modality has a clear relative advantage (e.g. strong patient or clinician preference, remote localities, out-of-hours services, nursing homes).

Materiality and the mediating roles of eHealth: A qualitative study and comparison of three cases

Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance.

Power, paradox and pessimism: On the unintended consequences of digital health technologies in primary care

We consider what might be learned from the unintended, apparently unanticipated, consequences of the use of digital health (including alternatives to face to face consultations, electronic medical records, use of apps and online monitoring) in primary care. We chose a conceptual literature review method, to seek a higher order understanding of the nuanced patterning of unintended consequences of digital health technologies (for people, relationships, organisations and ways of working) which are rarely simply positive or negative. The approach is informed by realist review, which recognises that experiences and outcomes of interventions work (or fail) in different ways in particular contexts. We present three higher order themes to illuminate underpinning mechanisms for unintended consequences in digital health technologies in primary care. These themes are illustrated by case examples, with particular focus on those that have been little discussed in the literature. Following Merton's (1936) differentiation between consequences for the actor(s) and others, which are mediated through the culture and social structure, we discuss consequences that i) disrupt power relations between patients and health professionals or between different groups of health professions, ii) contribute to paradoxical outcomes and iii) result in a potentially corrosive sub-culture of pessimism about digital health. We conclude that when implementing or evaluating digital technologies in primary care, it is wise to consider the 'dark logic' of the intervention (Bonell et al., 2015). Attention to issues of power relations, the potential for paradoxical outcomes, and impacts on the expectations of staff in relation to digital innovation are particularly salient in relation to the dramatic changes in primary care delivery initiated during the Covid-19 pandemic. Fostering a sense of ownership and interest in monitoring the effects that matter to the organisation will likely help counter pessimism and renew interest in deploying those digital innovations that show promise.

The Association Between Patient Satisfaction and Mode of Visit (Telemedicine Versus In-Person) in a Large Orthopaedic Practice During the COVID-19 Pandemic Lockdown: A Retrospective Study

Background:

During the novel coronavirus disease 2019 (COVID-19) pandemic, telemedicine was rapidly adopted to provide continued, efficient, and safe medical care. Little is known about patient satisfaction with telemedicine in orthopedics or the factors associated with selection of telemedicine versus face-to-face care. Thus, we examined (1) the association between patient satisfaction and mode of visit (telemedicine versus in-person) and (2) predictors of patient satisfaction in a large orthopedic practice during the onset of the pandemic.

Methods:

We conducted a retrospective cohort study of in-person and telemedicine visits within a large, university-affiliated orthopaedic practice between March 2020 and April 2020 during the onset of the COVID-19 pandemic. Patients who completed a patient satisfaction survey were included. Demographic and other office visit (eg, type of provider and type of visit) data were collected. A Patient Satisfaction Aggregate (PSA, range 0 to 1) score was calculated by taking the average of five patient satisfaction questions. Linear regression was used to examine (1) the association between PSA score and mode of visit and (2) predictors of PSA score.

Results:

A total of 2,049 of 6,515 patient satisfaction surveys were completed and included for analysis, of which 748 had telemedicine visits and 1,301 had in-person visits. No association was found between PSA score and mode of visit with and without adjustment for duration of patient-physician relationship, appointment type (new versus follow-up), provider type (physician versus nonphysician), and provider subspecialty (β_unadjusted = 0.004 [SE = 0.01], P = 0.44; β_adjusted = 0.001 [SE = 0.01], P = 0.92). Predictors of increased PSA score were White race (P = 0.001), >1 year relationship with provider (P_{1-3 years} = 0.01, P_{3-5 years} = 0.04, and P_{5+ years} = 0.002), physician provider (P = 0.004), and foot/ankle provider (P = 0.04), whereas predictors of decreased PSA score were oncology provider (P = 0.02) and spine provider (P = 0.001).

Conclusion:

We found no association between PSA score and mode of visit. Predictors of PSA score included race, duration of patient-physician relationship, provider type, and provider subspecialty.

Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology

This paper brings together scholarship across sociology, media and communication, and human computer interaction to explore the intersection of digital health and the maternity care system. We draw on data (including interviews, focus groups, observations, and analyses of digital media content) from 19 studies involving over 400 women to explore women's experiences of using different forms of digital support such as the Internet, mobile technologies (apps and text messaging), social media, and remote monitoring devices in their reproductive journeys. We use a best fit approach to analysis, mapping our findings to the candidacy framework and notions of trajectory work to understand how women engage in digital health practices to negotiate boundaries between physiology and pathology and to enter dialogue with maternity services during conception, pregnancy and the postnatal period. We propose an integrated revised conceptual framework which explicates intersections between digital and care practices, and micro-level negotiations between women and professionals in the maternal health context. Our revised framework retains the dimensions of candidacy, but it introduces a precursor to the identification of candidacy in the form of 'understanding normality'. It identifies distinct forms of digital work (e.g. information work, navigation work, machine work) which operate across the candidacy dimensions that women (and partners at times) engage in to negotiate legitimacy when entering into encounters with the maternity care system. Operating conditions (norms around expert motherhood; neoliberal discourses around health optimisation, risk and responsibilisation) provide a broader macro-level context, influencing the micro-level dialogic processes between women and healthcare professionals. Our synthesis highlights digital mediation as a useful filter to understand care systems, distribution of lay/professional responsibilities, relational practices and the (dis)enablement of candidacy.

The prenatal triad: The importance of provider-patient communication with expectant fathers throughout the prenatal care process

Previous research has primarily focused on the relationship between providers and expectant mothers as a key element of quality prenatal care. Significantly less attention has been directed toward expectant fathers and the importance of their communication with prenatal care providers and involvement in the prenatal care process. Much of this limited existing literature emphasizes the health benefits including fathers would bring for mom and baby, but rarely is the potential benefit to fathers' health included in the conversation. This discussion aims to highlight the value of this line of research for both communication and medical researchers and consider potential avenues for studying and promoting father engagement in prenatal care.

Implementation of tele visit healthcare services triggered by the COVID-19 emergency: the Trentino Province experience

Aim

In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning.

Subject and methods

This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability.

Results

TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term.

Conclusion

Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning.

Platform encounters: A study of digitised patient follow-up in HIV care

Digital technologies are increasingly embedded in clinical encounters, reconfiguring the basis on which health care is delivered. Thereby, the delivery of care shifts from territorial locations in clinics and temporal modes of co-presence towards digital platforms. Drawing on a sociotechnical evaluation of digitised patient follow-up in HIV care, this paper argues that the forms of interactivity practised in platform encounters cannot be adequately understood through traditional interaction frameworks such as Erving Goffman's interaction order. To conceptualise the new informational space and temporal mode of 'response presence' within which platform encounters are conducted, the paper draws on theoretical advances made by Karin Knorr Cetina who further developed Goffman's interaction order to describe interactions augmented by 'scopic media'. A comprehensive framework is presented to elaborate the distinct qualities of interactions occurring in face-to-face, tele-interaction and platform encounters and to analyse their affordances based on doctor and patient experiences. This framework is intended to stimulate further research on how new interactional forms between doctors and patients will reconfigure roles and responsibilities as well as wider structures of digital society. Furthermore, it can also support practical guidance of when and how different forms of clinical encounters may be integrated in care pathways.