Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study
Abstract
:1. Introduction
“[T]he practice of medicine over a distance, in which interventions, diagnoses, therapeutic decisions, and subsequent treatment recommendations are based on patient data, documents and other information transmitted through telecommunication systems” [12].
2. Materials and Methods
2.1. Study Design
2.2. Expert Interviews
2.3. Patient Survey
2.4. Focus Groups
2.5. Qualitative Content Analysis
3. Results
3.1. Expert Interviews
3.1.1. Conceptualization of Telemedicine
“Telemedicine is comparable to the word digitalization. Everything and nothing. I think telemedicine starts where there is internet access. And I would understand telemedicine as using the technical conditions that we have as efficiently as possible for the benefit of all. And for me, telemedicine is not only the internet access in the medical practice, but also not necessarily the utmost... In other words, performing surgery between two hospitals via a monitor. It’s more about using platforms like internet consultations, especially nowadays. So that, the insured also have the opportunity to work with a technical system. In other words, that smartphones are used appropriately. That’s how I would actually define telemedicine—well, I think this is somehow wrong. Because telemedicine covers a whole lot of things. And I would say that if you put it very simply, you could actually start telemedicine with the electronic medical letter. This has nothing whatsoever to do with the patient himself, but people send things back and forth to each other without using paper. So I would actually say: Telemedicine is everything and nothing, but it definitely starts with the internet connection.” (Interview 17, Professional Stakeholder: Health insurance representative, Pos. 19)
3.1.2. Patients’ Perspectives
“No, I think it’s important. I have to have my doctor right in front of me and he has to have me. Otherwise, a lot of things get lost… for example the way we deal with and trust each other.” (Interview 14, Patient, Pos. 110)
“But I do think that telemedicine is a good thing. You live far away and then suddenly there’s something. For example, in my case here. I got a little thing with the skin. (…) By that it is possible to quickly ask someone competent. ‘My God, I actually have to go there tomorrow and now all the joints are swollen and so on’. The rheumatologist would know what to do. He can give you a quick hint: ‘Do this or that or this’. So you don’t have to go 30 km, wait four hours and then go back 30 km.” (Interview 4, Patient, Pos. 125)
“With [name of a video conference service] and the whole thing- Who of the old people up there in Mecklenburg [dense populated region in Germany] or so has the technical equipment? I always ask myself.” (Interview 4, Patient, Pos. 125)
“As I said, I see the issue that you can no longer control who gets hold of certain data and what they do with it. (...) Suddenly people find out things, who should not have access to this information. And that’s really just the tip of it, because you can’t imagine what could be done with such data there.” (Interview 2, Patient, Pos. 302)
3.1.3. Professional Stakeholders’ Perspectives
“Well, at the end of the day, I consider it as something supportive. It cannot replace the direct contact, the complete direct contact between doctor and patient, it neither can nor should. Because I think I also have to touch, I also have to see personally in front of me, without that it doesn’t work.” (Interview 10, Professional stakeholder: Rheumatologist, Pos. 93)
“It is a paradox, that patients who would be most affected by it [telemedicine], patients who live far away from the city, (...) still have white spots in their surroundings, for example areas, residential areas where ISDN is available. They don’t even have DSL 2000, they don’t have anything. And it doesn’t matter whether they want to or not, they simply can’t hold a video conference.” (Interview 22, Professional stakeholder: General practitioner, Pos. 40)
“And I can’t bill that at all in the S[ocial] H[ealth] I[nsurance] system, so it’s a hobby that I do. But I do have hobbies. Most of my colleagues have hobbies, they know what they can do in their free time. You can’t. You can’t do hobby activities at work. That is not possible. And that’s just telemedicine, unfortunately, that falls into it.” (Interview 28, Professional stakeholder: General Practitioner, Pos. 45)
3.2. Patient Survey
3.2.1. Technology Use in Health Care
3.2.2. Telemedicine
3.3. Focus Groups
“Discussant: Well, personal contact with the doctor is important. And not taking a picture and sending it somewhere. For me, personal contact is most important. Interviewer: And personal contact means you want to be in the same room with the doctor? Discussant: Yes.” (Focus group 2, Patient representative, Pos. 174)
“Then I also imagine an overload for the doctor. Because he now also has patients who he doesn’t know. That would be irresponsible, because he doesn’t see the whole person and so on. I don’t want to imagine that at all. So at the very most, if you are under a doctor’s care and he knows you, you may then also ask a question by phone or by video or by telemedicine. For a doctor who has never seen me or so, I would not actually agree with that. (Focus group 2, Patient representative, Pos. 178)
“I’m interested in the organizational side of things. When I make a phone call now, where do I actually end up? Is it a doctor who has office hours there, who only does telemedicine? Because when I arrive at my doctor’s office, he doesn’t have any time, he has to see his patients. He can’t focus on me. I do not see it.” (Focus group 2, Patient representative, Pos. 116)
“Perhaps telemedicine can then be seen more or less as a digital safety or support network, so to speak. We as physicians are more or less automatically notified of potential problems thus we can react as promptly as possible in the consultation.” (Focus group 1, Rheumatologists Pos. 40)
“We are all open-minded, but nevertheless the doctors have no time for it... to practice telemedicine in addition to their normal office hours. It only works if retired doctors are brought on board again. So from there, the topic of time savings, I think you have to carefully consider for whom this is a time saving.” (Focus group 1, Rheumatologists, Pos. 26)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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# | Date | Role/Profession | Age | Gender | TM User 1 |
---|---|---|---|---|---|
1 | 28 November 2017 | Rheumatologist | 49 | F | Yes |
2 | 5 December 2017 | Patient | 51 | F | No |
3 | 31 January 2018 | Patient | 58 | F | No |
4 | 8 February 2018 | Patient | 81 | F | No |
5 | 8 February 2018 | General practitioner | 70 | F | No |
6 | 22 February 2018 | Rheumatologist | 69 | M | Yes |
7 | 7 March 2018 | Digital health developer | 47 | F | N/A |
8 | 8 March 2018 | Rheumatologist | 45 | F | Yes |
9 | 23 March 2018 | Rheumatologist | 47 | M | Yes |
10 | 28 March 2018 | Digital health developer | 51 | F | N/A |
11 | 9 April 2018 | General Practitioner | 43 | F | Yes |
12 | 19 April 2018 | Digital health developer | 50 | F | N/A |
13 | 23 April 2018 | Patient | 76 | F | No |
14 | 23 April 2018 | Rheumatologist | 52 | F | No |
15 | 15 November 2018 | General practitioner | 37 | M | Yes |
16 | 21 February 2019 | Statutory health insurance representative | 45 | F | N/A |
17 | 18 March 2019 | Digital health developer | 30 | M | N/A |
18 | 9 May 2019 | Patient | 52 | F | Yes |
19 | 9 May 2019 | Statutory health insurance representative | 32 | F | N/A |
20 | 27 June 2019 | Representatives of regional association of statutory health insurance physicians | 53 | M | N/A |
21 | 2 July 2019 | General practitioner | 41 | M | Yes |
22 | 4 July 2019 | Digital health developer | 66 | M | N/A |
23 | 11 July 2019 | Representatives of regional association of statutory health insurance physicians | 35 | F | N/A |
24 | 11 July 2019 | Digital health developer | 65 | F | N/A |
25 | 17 July 2019 | Rheumatology assistant | 51 | F | Yes |
26 | 18 July 2019 | Rheumatologist | 34 | M | Yes |
27 | 18 July 2019 | General practitioner | 32 | F | Yes |
Total | |
---|---|
“Would you like your rheumatologist to offer you telemedicine services?” | 663 |
Yes | 139 (21.0%) |
No | 286 (43.1%) |
I do not know | 238 (35.9%) |
“Would you like your rheumatologist to give you recommendations on digital services?” | 661 |
Yes | 320 (48.4%) |
No | 211 (31.9%) |
I do not know | 130 (19.7%) |
“Would you be willing to pay privately for telemedicine services?” | 675 |
Yes | 25 (3.7%) |
No | 518 (76.7%) |
I do not know | 132 (19.6%) |
“Do you document your health status?” | 662 |
Yes, via paper | 158 (23.9%) |
Yes, digitally | 59 (8.8%) |
No | 445 (67.2%) |
Opportunities | Barriers | ||
---|---|---|---|
Qualitative Interviews | Patient |
|
|
Professional Stakeholder |
|
| |
Survey Data | Patient |
|
|
Focus Groups | Patient |
|
|
Physician |
|
|
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Muehlensiepen, F.; Knitza, J.; Marquardt, W.; May, S.; Krusche, M.; Hueber, A.; Schwarz, J.; Vuillerme, N.; Heinze, M.; Welcker, M. Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study. Int. J. Environ. Res. Public Health 2021, 18, 13127. https://doi.org/10.3390/ijerph182413127
Muehlensiepen F, Knitza J, Marquardt W, May S, Krusche M, Hueber A, Schwarz J, Vuillerme N, Heinze M, Welcker M. Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study. International Journal of Environmental Research and Public Health. 2021; 18(24):13127. https://doi.org/10.3390/ijerph182413127
Chicago/Turabian StyleMuehlensiepen, Felix, Johannes Knitza, Wenke Marquardt, Susann May, Martin Krusche, Axel Hueber, Julian Schwarz, Nicolas Vuillerme, Martin Heinze, and Martin Welcker. 2021. "Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study" International Journal of Environmental Research and Public Health 18, no. 24: 13127. https://doi.org/10.3390/ijerph182413127
APA StyleMuehlensiepen, F., Knitza, J., Marquardt, W., May, S., Krusche, M., Hueber, A., Schwarz, J., Vuillerme, N., Heinze, M., & Welcker, M. (2021). Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study. International Journal of Environmental Research and Public Health, 18(24), 13127. https://doi.org/10.3390/ijerph182413127