Evaluation of Synchronous and Asynchronous Telemedical Applications in Primary Care in Rural Regions of Northern Germany-Results and Lessons Learned from a Pilot Study

Use of Video Consultation Between 2017 and 2020 in Outpatient Medical Care in Germany and Characteristics of Their User Groups: Analysis of Claims Data

BACKGROUND

Supplementing outpatient medical care with the use of video consultations could, among other benefits, improve access, especially in structurally disadvantaged areas.

OBJECTIVE

This claims data analysis, carried out as part of the German research project "Preference-based use of video consultation in urban and rural regions," aimed to analyze the use of video consultations and the characteristics of its user groups.

METHODS

Claims data from 3 Statutory Health Insurance Funds (SHIFs) and 4 Associations of Statutory Health Insurance Physicians (ASHIPs) from the period April 2017 to the end of 2020 were used. Data from a sample of about 6.1 million insured and 33,100 physicians and psychotherapists were analyzed. In addition to data on the use of video consultations, patient data on sociodemographic characteristics, diagnoses, and place of residence were included. To analyze the physicians' perspectives, specialty groups, demographic characteristics, and the type of practice location were also included. In consideration of the principles of data economy and the fact that data analysis represents merely a preliminary phase within the broader project, the SHIFs and ASHIPs transmitted aggregated data (cross-tabulations per subgroup analysis) to the evaluator. For this reason, the analyses were constrained to a comparison of video consultation users versus nonusers, differentiated according to the aforementioned subgroups. Furthermore, the association between place of residence or type of region of the practice location and the use of video consultation was examined. A significance level of P<.05 was set for chi-square tests.

RESULTS

From 2017 to 2019, almost no video consultations were used in outpatient care in the German health care system. Although this changed considerably in relative terms with the start of the COVID-19 pandemic (but still at a very low absolute level), there was also a clear decline in the use of video consultations as the number of infections flattened out. Physicians working in psychotherapy and psychological psychotherapists used video consultations with around 16% (44,808/282,530) of their treatment cases in the second quarter of 2020, followed by psychotherapists using video consultations for children (10,828/113,293, 10%). Although the absolute number of treatment cases with video consultations among general practitioners was very high compared with other specialist groups, their share of video consultations in all treatment cases was very low at 0.3% (29,600/9,837,118). Younger age groups and those located in urban areas used video consultations more frequently; this applies to both patients (age groups: χ27=9903.2, P<.001; region types: χ22=3746.2, P<.001) and service providers (age groups: χ23=11,338.2, P<.001; region types: χ22=8474.1, P<.001).

CONCLUSIONS

The current use of video consultations is below its potential in terms of scope and user groups. The widespread and lasting use of video consultations will only succeed if the potential user groups accept this form of service provision and recognize its advantages. Further analyses (both qualitative, such as focus group discussions, and quantitative, such as preference surveys) should therefore investigate the preferences of user groups for the use of video consultations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/50932.

Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.