Published on in Vol 10 (2023)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/50740, first published .
Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians

Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians

Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians

Original Paper

1E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland

2Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland

3Primary Care Division, Geneva University Hospitals, Geneva, Switzerland

4Department of General Pediatrics at the Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland

5Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland

6Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland

7Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland

8Medical Directory, Geneva University Hospitals, Geneva, Switzerland

Corresponding Author:

Sanae Mazouri-Karker, MD

E-health and Telemedicine Division

Geneva University Hospitals

street Gabrielle Perret Gentil 6

Geneva, 1205

Switzerland

Phone: 41 22 379 59 40

Email: dr.mazouri@cmtb.ch


Background: While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic.

Objective: This study aims to evaluate patients’ and physicians’ self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic.

Methods: We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants’ sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations.

Results: A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60).

Conclusions: Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.

JMIR Hum Factors 2023;10:e50740

doi:10.2196/50740

Keywords



Telemedicine (TLM) designates the use of advanced communication technologies in health care settings to provide care at a distance. Remote communication can be synchronous (phone or video) or asynchronous (email or SMS text message).

A number of studies have evaluated patients’ and physicians’ satisfaction with different means of remote communication (phone, video, email, and SMS text messaging) [1-18]. However, most of these studies were conducted before the SARS-CoV-2 pandemic and in contexts where TLM was already well developed. In these studies, the advantages listed by patients were numerous and included easier, faster, and more efficient access to health care and the opportunity to include family members more easily in the consultation [9,13,15]. Disadvantages included concerns about data protection, depersonalized care [10,15], an absence of human contact [1], and the inability to carry out certain clinical investigations [17].

The COVID-19 pandemic disrupted many aspects of health care delivery and put pressure on health systems to rapidly adapt in order to respond to patients’ health care needs. In several countries, public health authorities relaxed existing regulations to promote and facilitate the use of TLM services as part of the response to this crisis [19-22]. In some countries, TLM use, especially videoconferencing, increased enormously during the initial phases of the pandemic because it reduced the exposure to COVID-19 (and other communicable diseases) of both frontline health professionals and vulnerable patients, improved triage and care pathways for COVID-19–positive patients, and helped reduce overcrowding in emergency departments [23-27]. However, while several studies have looked at TLM use during the height of the COVID-19 pandemic [28-32], little is known about TLM use beyond the initial phases of the COVID-19 pandemic and whether video consultations have become an accepted means of providing health care for patients and physicians.

While Switzerland has a relatively well-developed telehealth ecosystem, TLM is usually limited to providers such as health insurance companies offering teleconsultations before visiting a primary care physician [33,34]. During the early phases of the COVID-19 pandemic, the Swiss Medical Association encouraged the use of videoconferencing across the country and published a fact sheet to inform physicians of the technical possibilities for conducting secure TLM consultations, the legal bases governing TLM consultations and their pricing, and the risks associated with some of the most common videoconferencing tools [35]. In early 2020, the University Hospital of Geneva, Switzerland, created and disseminated a TLM-secured application initially developed for teleconsultations between hospital physicians and home care nurses. The application was made available to both institutional and private physicians to conduct secure video consultations with their patients [36].

The aim of this study was to explore patients’ and physicians’ self-reported use of and preferences for TLM in Geneva, Switzerland, after the COVID-19 pandemic restrictions were lifted. We were particularly interested in their views regarding the acceptability of different TLM formats, including video consultations, for specific clinical situations. Understanding postpandemic perceptions and practices will help to better inform future developments in telehealth care.


Design and Setting

We conducted a cross-sectional study in Geneva, Switzerland, between September 2021 and January 2022.

Participant Recruitment

Patients were recruited by research assistants in the waiting areas of 3 walk-in clinics (2 private and 1 at a public hospital), 4 primary care medical centers (3 private and 1 at a public hospital), and 1 public mental health outpatient medical center. All French-, Spanish-, Portuguese-, or English-speaking patients aged 18 years or older were invited to complete the web-based survey. Patients could complete the survey immediately on a tablet provided by a research assistant, on their smartphone, or at their convenience on their phones through a QR code posted on the Geneva University Hospitals website. Informed and written consent was obtained after explaining the study objectives. Patients received a CHF 10 (US $11) voucher for their participation.

To recruit physicians, email addresses were obtained from the Geneva University Hospital administration and the Geneva Medical Association. Email invitations were sent to all physicians (residents, chief residents, attendings, and heads of services) working in outpatient settings at the Geneva University Hospitals (n=2248) and all physicians working in private practices in Geneva (n=2715). Reminder emails were sent 2-4 weeks after the initial invitation.

Patients were recruited during September and October 2021, and physicians during December 2021 and January 2022.

Questionnaire Development

We constructed 2 versions (for patients and for physicians) of a 27-item, web-based questionnaire. Both questionnaires contained items that assessed the respondent’s sociodemographic characteristics, digital literacy, perceived changes in use of TLM since the COVID-19 pandemic (more often to less often to no use), general preferences for 5 different communication formats (face-to-face, phone, video, email, and SMS text message; ranking 1-5), and opinions regarding the acceptability of different TLM formats for specific clinical situations. In addition, physicians were asked about facilitators and barriers regarding phone and video (open-ended responses; Multimedia Appendix 1), while patients were asked about their perceptions of confidentiality and data security of phone and video consultations (Likert scale 1-5; 1=totally disagree and 5=totally agree).

In order to explore respondents’ opinions about the acceptability of different formats of TLM for different clinical situations, we defined five common health care situations experienced by patients (and physicians): (1) information transmission: receiving (or providing) test results; (2) medical advice: receiving (or providing) medical advice; (3) clinical follow-up: monitoring a chronic problem; (4) psychological support: receiving (or providing) support for mental health and psychosocial well-being; and (5) patient requests: requesting (or responding to a request for) a medical certificate or other document. For each situation, we asked respondents to indicate acceptable formats of TLM communication (yes or no).

The questionnaires were piloted with 10 patients and 10 primary-care physicians for clarity and comprehension and subsequently modified. The patient questionnaire was translated by native speakers into English, Portuguese, and Spanish (the 3 most common languages in Geneva, after French). The translated questionnaires were then back-translated by different native speakers to verify congruence.

We used the web-based survey software Qualtrics (Qualtrics) to create and administer both questionnaires [23]. Questionnaires contained a brief explanation of the study and a request for informed consent (a check box).

Analysis

Descriptive statistics were produced for patients’ and physicians’ preferences and opinions about the acceptability of different TLM formats. Patient and physician differences in opinions were analyzed using the chi-square test. Differences in patients’ opinions about phone versus video with regard to trust, confidentiality, perceived understanding of the health problem by their physician, and quality of care were analyzed using the McNemar test. A P value of ≤.05 was considered statistically significant for both tests. We conducted multivariate analyses using logistic regression to identify patients’ and physicians’ characteristics associated with the acceptability of phone and video in specific clinical contexts.

All statistical analyses were conducted using Stata Statistical Software (version 15; StataCorp) [37].

The responses to open-ended questions about physicians’ perceptions of barriers and facilitators to video and phone consultations were read by 4 investigators (PH, SMK, MDD, and NJP). Categories were identified, and a list of codes was developed, which PH then used to code all comments. Coding was checked by SMK, MDD, and NJP, and any discrepancy was resolved through discussion.

Ethical Considerations

The study was granted a waiver from ethical approval by the ethical committee of the Canton of Geneva (Article 2 of the Swiss Federal Act on Research involving Human Beings) because we collected no personal health information.


Participant Characteristics

Responses were obtained from 567 patients and 448 physicians (Tables 1 and 2). Patient response rate was 60% (567/940; reasons for refusal were not recorded). The response rate was 10% (225/2248) for hospital physicians and 8.5% (223/2715) for physicians in private practices.

Two-thirds of patients were aged 45 years or younger, and a majority had attended high school or vocational training. Less than a third of patients consulted more than 3-4 times per year. Most patients had internet access and used a computer or smartphone daily. Regarding TLM, they mainly reported using phone calls and, to a lesser extent, emails (Table 3).

Table 1. Patients’ demographics (n=567).
Sociodemographic dataPatients, n (%)
Age (years)

<30188 (33.1)

30-44181 (31.9)

45-64145 (25.6)

≥6553 (9.3)
Gender

Female309 (54.5)

Male254 (44.8)

Other4 (0.7)
Place of questionnaire fulfillment

Emergency settings383 (67.5)

Medical centers119 (21)

Social media65 (11.5)
Questionnaire filled in

French505 (89.1)

English33 (5.8)

Portuguese19 (3.3)

Spanish10 (1.8)
Working time

Full-time243 (42.9)

Part-time131 (23.1)

No work145 (25.6)

Retired48 (8.5)
Education

No school7 (1.2)

Compulsory school88 (15.5)

Vocational training155 (27.3)

High school259 (45.7)

Other58 (10.2)
Perceived health status

Excellent89 (15.7)

Very good195 (34.4)

Good226 (39.9)

Average44 (7.8)

Poor13 (2.3)
Frequency of medical consultation

1 time/year127 (22.4)

2 times/year117 (20.6)

3-4 times/year157 (27.7)

5-12 times/year107 (18.9)

>12 times/year59 (10.4)
Established care with a regular physician

Yes470 (82.9)
Duration of physician-patient relationship

<6 months35 (7.5)

6 months-2 years116 (24.7)

2-5 years198 (23)

>5 years210 (44.8)
Table 2. Physicians’ demographics (n=448).
Sociodemographic dataPhysicians, n (%)
Age (years)

<40135 (30.1)

40-50137 30.6)

>50176 (39.3)
Gender

Female230 (51.3)

Male216 (48.2)

Other2 (0.4)
Place of practice

Urban411 (91.7)

Suburban34 (7.6)

Rural3 (0.7)
Type of practice

Private practice225 (50.2)

Solo94 (21)

2-4 physicians80 (17.9)

Medical center51 (11.4)

Hospital or institution223 (49.8)
Working time

Full-time241 (53.8)

Part-time207 (46.2)
Working experience

<5 years47 (10.5)

5-10 years72 (16.1)

>10 years329 (73.4)
Specialty

General internal medicine179 (40)

Psychiatry97 (21.6)

Other172 (38.4)
Table 3. Participants’ access to and use of connected devices.
Digital use dataPatients, n (%)Physicians, n (%)
Access to the internet

Yes550 (97)446 (99.6)

No14 (2.5)1 (0.2)

Does not know3 (0.5)1 (0.2)
Frequency of internet use

Everyday520 (92.7)430 (97.3)

A few times a week23 (4.1)10 (2.3)

A few times a month12 (2.1)1 (0.2)

Less than 1 time per month4 (0.7)0 (0)

Never2 (0.3)1 (0.2)
Presence of connected tools

Computer457 (80.6)444 (99.1)

Smartphone510 (89.9)417 (93.1)

Pad246 (43.4)244 (54.5)

None5 (0.9)12 (2.7)

Other22 (3.9)3 (0.7)
Usage of connected devices

Phone calls476 (83.9)393 (87.7)

Video calls329 (58)293 (65.4)

Emails484 (85.4)434 (96.9)

Instant messaging481 (84.8)372 (83)

Work349 (61.5)389 (86.8)

Information seeking407 (71.8)429 (95.8)

Games223 (39.3)295 (65.8)

Other0 (0)0 (0)
Consultation format ever used

Telephone411 (72.5)N/Aa

Email193 (33)N/A

Video39 (6.9)N/A

Instant messaging73 (12.9)N/A

None97 (16.6)N/A

Other22 (3.9)N/A

aN/A: not applicable.

Most physicians were general internists and psychiatrists, worked in an urban setting, and had been working for more than 10 years (Table 2). Half of them worked in private practices. Most physicians reported using phone and email more often than video in their everyday life (Table 3).

Changes in TLM Use Since the COVID-19 Pandemic

About a third of patients and half of the physicians reported using the phone, email, and video more frequently in their everyday lives since the COVID-19 pandemic (Figures 1 and 2).

Figure 1. Patients' self-reported changes in telemedicine communication since the COVID-19 crisis.
Figure 2. Physicians' self-reported changes in telemedicine communication since the COVID-19 crisis.

Preferences for Future Communication and Acceptability of TLM Formats for Common Health Issues

Both physicians and patients ranked phone calls as the preferred TLM format after the COVID-19 pandemic (Figure 3) and considered it to be acceptable for most medical situations (Figure 4). Email was considered acceptable by both doctors and patients when requesting or providing documents. Video consultations were considered acceptable by both patients and physicians for psychological support.

Figure 3. Telemedicine preferences for future consultations (ranking presentation of the 2 first choices in percentage).
Figure 4. Perceptions of telemedicine acceptability for specific clinical situations (%). *P<.05 with a chi-square test, **P>.001 with a chi-square test.

Patients’ and Physicians’ Perceptions of Phone and Video Consultations

Patients trusted phone more than video for security and confidentiality reasons (n=411, 72.5% vs n=339, 59.8%; P<.001) and felt better able to communicate their needs through phone than by video (n=381, 67.2% vs n=336, 59.8%; P<.001). There were no differences between phone and video in terms of a physician’s ability to understand their health problem (n=320, 56.4% vs n=311, 54.9%; P=.41) or the quality of care provided (n=180, 31.7% vs n=189, 33.3%; P=.25).

Physicians thought both phone and video could facilitate access to care, contribute to time efficiency, and be used for consultations not requiring a physical examination (Table 4). Perceived barriers included a negative impact on the relationship and communication, technical difficulties, inadequate financial compensation, and unsuitability for patients who lack digital literacy with connected devices (eg, older people).

Table 4. Written comments of physicians regarding facilitators and barriers of phone and video.
CategoryExamples of physicians’ quotes
Facilitators

Expands access to care
  • For certain situations where travel is difficult, this allows for a consultation
  • COVID-19, illnesses that make it impossible to come to the practice (for the patient as well as for myself)

Time efficiency
  • Teleconsultation could be an ideal way to avoid wasting work hours

Usefulness for specific clinical contexts
  • Use it for consultations that do not require a physical examination (prescription, medical certificate, laboratory results, psychology, etc)
Barriers

Impact on relationships and communication
  • Loss of quality of the human relationship through the filter of a machine

Inability to conduct a clinical examination
  • Inability to examine patients through video
  • Clinical examination is essential most of the time

Technical difficulties
  • Poor sound and image quality

Limited compensation
  • Very limited reimbursement for telemedicine

Unsuitable situations
  • Not all elderly patients have access to the technology needed to perform video consultation
  • My patients are elderly and do not master smartphones or computers
  • For some patients, coming to the clinic is part of the therapeutic process (getting dressed or getting out of the house)

Patient and Physician Factors Associated With Acceptance of Phone and Video Consultations

Private use and previous use of video with physicians were associated with patients’ acceptance of video consultations for most clinical situations, while frequent consultations were associated with patients’ acceptance of phone consultations (Tables 5 and 6). For both patients and physicians, older age was negatively associated with acceptance of video. Physicians working in hospitals and psychiatrists and physicians with previous use of video in general were more likely to accept video than others.

Table 5. Patient-related factors associated with their acceptance of phone and video.
Patient-related factorsORa (95% CI)
Receiving and transmitting examination results

Phone


Survey filled at an emergency center0.55 (0.31-0.90)

Videoconference


Medical follow-up (2-5 years)0.32 (0.11-0.90)


Use of video calls in general3.16 (1.84-5.43)


Previous use of video calls with physician3.28 (1.40-7.70)
Receiving and giving advice for a simple medical problem

Videoconference


>65 years old0.03 (0.00-0.33)


Female0.63 (0.40-0.99)


Use of video calls in general2.03 (1.27-3.25)
Receiving and providing psychological support

Phone


Poor health status0.23 (0.070.78)


Consultations (>12 times/year)6.97 (2.12-22.92)


Survey filled at an emergency center2.34 (1.27-4.32)

Videoconference


>65 years old0.04 (0.00-0.39)


Very good health status2.18 (1.10-4.35)


Use of video calls in general2.00 (1.26-3.15)


Previous use of video calls with physician4.79 (1.34-17.13)
Requesting and providing a work or sickness certificate

Phone


Consultations (>12 times/year)3.91 (1.35-11.30)

Videoconference


Compulsory school0.23 (0.07-0.75)


Medical follow-up (2-5 years)0.34 (0.11-0.99)


Use of video calls in general4.00 (1.66-9.66)

aOR: odds ratio.

Table 6. Physician-related factors associated with their acceptance of phone and video.
Physician-related factorsORa (95% CI)
Receiving and transmitting exam results

Phone


Psychiatry discipline0.30 (0.09-0.99)

Videoconference


Hospital physician3.29 (1.90-5.71)


Use of video calls in general3.34 (2.91-5.54)


Psychiatry discipline2.69 (1.38-5.22)
Receiving and giving advice for a simple medical problem

Videoconference


Hospital physician3.97 (2.23-7.06)


Use of video calls in general3.08 (1.84-5.16)
Receiving and providing psychological support

Phone


Female0.47 (0.23-0.96)


Hospital physician0.21 (0.09-0.50)

Videoconference


>50 years old0.23 (0.08-0.66)


>10 years of working experience3.84 (1.05-11.57)


Hospital physician4.49 (2.30-8.77)


Use of video calls in general3.61 (2.07-6.29)


Psychiatric discipline10.79 (3.96-29.38)
Requesting and providing a work or sickness certificate

Phone


>50 years old0.39 (0.17-0.91)


Hospital physician0.51 (0.29-0.90)

Videoconference


>50 years old0.23 (0.08-0.66)


>10 years of working experience3.84 (1.05-11.57)


Hospital physician4.49 (2.30-8.77)


Use of video calls in general3.61 (2.07-6.29)


Psychiatric discipline10.79 (3.96-29.38)

aOR: odds ratio.


Overview

Our survey results suggest that since the COVID-19 pandemic, patients and physicians have used remote means of communication more often. Both stated a preference for the phone over other TLM formats, and patients expressed more trust in the phone than video for confidentiality and safety reasons. However, emails, SMS text messages, and video consultations were all considered acceptable, depending on the clinical situation or health request. Previous use of video calls was a key factor in patient and physician acceptance of video consultations.

The COVID-19 pandemic and perceived health risk were important factors for TLM and video acceptance [26,28] and boosted its use in several countries even after the end of the lockdown period [29]. Our data show that the COVID-19 pandemic changed physicians’ practices regarding phone and video as well as email beyond the first phases of the pandemic. However, similarly to other studies [30], both patients and physicians still preferred face-to-face consultations, with phone consultations being their second choice.

Synchronous TLM formats such as phone and video consultations differ from face-to-face consultations in that they deal with a lower number of problems and contain less exchange of information [31]. In addition, phone consultations do not allow access to visual examination and nonverbal communication [32]. However, video calls result in fewer medication errors, greater diagnostic accuracy, and improved decision-making accuracy when compared to phone consultation. Teleconsultations by phone or video appear to offer an effective alternative to face-to-face consultations in terms of patient satisfaction and costs in primary care and mental health services [38,39].

To our knowledge, little is known about patients’ preferences or acceptance of TLM regarding different health issues. Our findings showed that patients and physicians found phone consultations to be highly acceptable for most health issues (advice, follow-up, psychological support, and certificates) and trusted phone more than video for security and confidentiality reasons. Savira et al [30] showed in a discrete choice experiment that patients had no preference between face-to-face, phone, or video regarding issues such as repeat prescription or surgical follow-up but felt that TLM was not appropriate for more complex or sensitive issues or when a physical examination was required. However, another study showed that patients tended to consider phone to remain the preferred synchronous TLM format because of video limitations related to technology and privacy concerns [40]. In this study, both physicians and patients were more willing to accept video for psychological support. This finding is in line with several studies reporting that patients with mental health issues also consider video acceptable when they have a preestablished relationship with their therapist, when their issues are less complex, or when they encounter barriers to accessing their therapist’s office [39]. Similarly, psychotherapists also tend to value video consultations as a potential means to improve access to mental health care [41]. Such popularity may be explained by the fact that psychiatric follow-ups consist of long-term engagements with the same therapist for narrative clinical work rather than physical exams and show low levels of variation from a consultation sequence to another compared with consultations with primary care physicians.

While acceptance of SMS text messaging remains low for all clinical situations displayed in this study, emails are largely accepted for simple medical advice and the provision of documents. These findings are somewhat similar to previous studies showing that patients tended to use emails for clinical (medical and treatment) rather than administrative requests [42-44].

Several “pre-COVID-19” studies showed that patient factors associated with acceptance of TLM, particularly video, were regular use of video for calls, previous experience of video with their physician, younger age, and being male [45-51]. Patients also tended to be more accepting of phone and video for routine health issues, particularly when there was a preexisting relationship with their physician [18,30,31,52].

In this study, physicians’ acceptance of video was associated with working in a hospital or as a psychiatrist. It is possible that hospital physicians felt more institutional pressure to use videoconferencing or were more rapidly equipped to conduct such consultations. Another explanation may be that they felt they were expected to improve access to specialized care for some patients and to improve collaboration with family physicians during the COVID-19 pandemic [41]. Psychiatrists’ inclination to adopt video consultations to permit better access to mental care for their patients has already been reported [6].

Most studies assessing factors that could affect the intention of physicians found that physicians who perceived integrating telehealth in their clinical practice as part of their professional and social responsibilities and felt comfortable using TLM expressed a stronger intention to use this technology [3,46,49,53]. Additional predicting factors of intention to use TLM were the potential to reduce cost and a positive perception of medical information security and confidentiality [54,55]. Factors such as the development of user-friendly video platforms with improved interoperability between digital systems and the involvement of telehealth coordinators, together with adequate reimbursement of digital services, may also accelerate such a shift to TLM [34,56-59].

Limitations

The response rate was low for both physicians and patients. Participating physicians may have been more interested in and familiar with TLM than nonparticipants. Patient nonresponders may have included patients with low digital literacy (eg, older people). We also excluded patients who were unable to answer the questionnaire in 1 of the 4 languages available. This may have influenced our results, as both age and language ability are factors negatively associated with acceptance of TLM. Furthermore, we recruited patients mainly at emergency centers, which may have added an additional bias since patients consulting emergency centers may not be representative of the general patient population. Finally, this study was conducted in a single, primarily urban Swiss canton. Patients and physicians in other cantons or more rural areas may have different perceptions of the usefulness and acceptability of TLM.

Despite these limitations, our results offer some insight into the factors influencing postpandemic TLM-related practices and the opinions of patients and physicians.

Conclusion

Although Swiss physicians modified their TLM practices with higher self-reported use of TLM since the COVID-19 pandemic, use and acceptability of video remain rather low, except for mental health support [21], despite the relaxation of existing regulations and policies to promote and facilitate the use of video as well as improved access to secure videoconference platforms.

Practice Implications

Improved interoperability between digital systems and adequate reimbursement of digital services may accelerate a shift to video if both patients and physicians obtain higher guarantees regarding confidentiality and security issues and are better informed about the criteria and health conditions allowing adequate video. Although video seems to be highly acceptable and effective for individuals with mental illness and their therapists, there is a need for further studies to better define for which patients and in which medical situations video is safe and efficient.

Acknowledgments

The authors would like to thank all participating patients, physicians, and research assistants. This study would not have been possible without the support and funding of the Private Foundation of Geneva University Hospitals.

Conflicts of Interest

None declared.

Multimedia Appendix 1

Physicians questionnaire.

DOCX File , 33 KB

  1. Agha Z, Schapira RM, Laud PW, McNutt G, Roter DL. Patient satisfaction with physician-patient communication during telemedicine. Telemed J E Health. 2009;15(9):830-839. [CrossRef] [Medline]
  2. Donelan K, Barreto EA, Sossong S, Michael C, Estrada JJ, Cohen AB, et al. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019;25(1):40-44. [FREE Full text] [Medline]
  3. Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform. 2012;81(11):746-760. [FREE Full text] [CrossRef] [Medline]
  4. Gardner MR, Jenkins SM, O'Neil DA, Wood DL, Spurrier BR, Pruthi S. Perceptions of video-based appointments from the patient's home: a patient survey. Telemed J E Health. 2015;21(4):281-285. [FREE Full text] [CrossRef] [Medline]
  5. Gentry MT, Lapid MI, Clark MM, Rummans TA. Evidence for telehealth group-based treatment: a systematic review. J Telemed Telecare. 2019;25(6):327-342. [CrossRef] [Medline]
  6. Gentry MT, Puspitasari AJ, McKean AJ, Williams MD, Breitinger S, Geske JR, et al. Clinician satisfaction with rapid adoption and implementation of telehealth services during the COVID-19 pandemic. Telemed J E Health. 2021;27(12):1385-1392. [FREE Full text] [CrossRef] [Medline]
  7. Hall JA, Dornan MC. Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels. Soc Sci Med. 1988;27(6):637-644. [CrossRef] [Medline]
  8. Hu PJ, Chau PY. Physician acceptance of telemedicine technology: an empirical investigation. Top Health Inf Manage. 1999;19(4):20-35. [Medline]
  9. Johansson AM, Lindberg I, Söderberg S. Patients' experiences with specialist care via video consultation in primary healthcare in rural areas. Int J Telemed Appl. 2014;2014:143824. [FREE Full text] [CrossRef] [Medline]
  10. Kitamura C, Zurawel-Balaura L, Wong RKS. How effective is video consultation in clinical oncology? A systematic review. Curr Oncol. 2010;17(3):17-27. [FREE Full text] [CrossRef] [Medline]
  11. Lai CKY, Chung JCC, Leung NKL, Wong JCT, Mak DPS. A survey of older Hong Kong people's perceptions of telecommunication technologies and telecare devices. J Telemed Telecare. 2010;16(8):441-446. [CrossRef] [Medline]
  12. Lokkerbol J, Geomini A, van Voorthuijsen J, van Straten A, Tiemens B, Smit F, et al. A discrete-choice experiment to assess treatment modality preferences of patients with depression. J Med Econ. 2019;22(2):178-186. [FREE Full text] [CrossRef] [Medline]
  13. Matusitz J, Breen GM. Telemedicine: its effects on health communication. Health Commun. 2007;21(1):73-83. [CrossRef] [Medline]
  14. Pecina JL, North F. Early e-consultation face-to-face conversions. J Telemed Telecare. 2016;22(5):269-276. [CrossRef] [Medline]
  15. Powell RE, Henstenburg JM, Cooper G, Hollander JE, Rising KL. Patient perceptions of telehealth primary care video visits. Ann Fam Med. 2017;15(3):225-229. [FREE Full text] [CrossRef] [Medline]
  16. Reddy MP, Bindu CS. The lossless medical image compression for telemedicine applications with delimiter. J Adv Res Dynamical Control Syst. 2018;10(3):74-79. [FREE Full text]
  17. Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform. 2014;83(8):559-571. [FREE Full text] [CrossRef] [Medline]
  18. Welch BM, Harvey J, O'Connell NS, McElligott JT. Patient preferences for direct-to-consumer telemedicine services: a nationwide survey. BMC Health Serv Res. 2017;17(1):784. [FREE Full text] [CrossRef] [Medline]
  19. Fisk M, Livingstone A, Pit SW. Telehealth in the context of COVID-19: changing perspectives in Australia, the United Kingdom, and the United States. J Med Internet Res. 2020;22(6):e19264. [FREE Full text] [CrossRef] [Medline]
  20. Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR Public Health Surveill. 2020;6(2):e18810. [FREE Full text] [CrossRef] [Medline]
  21. Petrazzuoli F, Gokdemir O, Antonopoulou M, Blahova B, Mrduljaš-Đujić N, Dumitra G, et al. Patient consultations during SARS-CoV-2 pandemic: a mixed-method cross-sectional study in 16 European countries. Rural Remote Health. 2022;22(4):7196. [FREE Full text] [CrossRef] [Medline]
  22. Rockwell KL, Gilroy AS. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am J Manag Care. 2020;26(4):147-148. [FREE Full text] [CrossRef] [Medline]
  23. Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for COVID-19. BMJ. 2020;368:m998. [FREE Full text] [CrossRef] [Medline]
  24. John O. Video consultations for triage of patients with COVID-19. BMJ. 2020;369:m1583. [FREE Full text] [CrossRef] [Medline]
  25. Lam AY, Chan ECL, Quek CMX, Peng Y, Yeo SK, Chang RF, et al. Videoconsultation to overcome barriers during COVID-19. Ann Acad Med Singap. 2021;50(1):77-83. [FREE Full text] [CrossRef] [Medline]
  26. Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: evidence from the field. J Am Med Inform Assoc. 2020;27(7):1132-1135. [FREE Full text] [CrossRef] [Medline]
  27. Portnoy J, Waller M, Elliott T. Telemedicine in the era of COVID-19. J Allergy Clin Immunol Pract. 2020;8(5):1489-1491. [FREE Full text] [CrossRef] [Medline]
  28. Pereira FV, Tavares J, Oliveira T. Adoption of video consultations during the COVID-19 pandemic. Internet Interv. 2023;31:100602. [FREE Full text] [CrossRef] [Medline]
  29. Cormi C, Ohannessian R, Sanchez S. Motivations of French physicians to perform teleconsultations during COVID-19: a mixed-method study. Telemed J E Health. 2021;27(11):1299-1304. [CrossRef] [Medline]
  30. Savira F, Robinson S, Toll K, Spark L, Thomas E, Nesbitt J, et al. Consumer preferences for telehealth in Australia: a discrete choice experiment. PLoS One. 2023;18(3):e0283821. [FREE Full text] [CrossRef] [Medline]
  31. Hammersley V, Donaghy E, Parker R, McNeilly H, Atherton H, Bikker A, et al. Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care. Br J Gen Pract. 2019;69(686):e595-e604. [FREE Full text] [CrossRef] [Medline]
  32. McKinstry B, Watson P, Pinnock H, Heaney D, Sheikh A. Telephone consulting in primary care: a triangulated qualitative study of patients and providers. Br J Gen Pract. 2009;59(563):e209-e218. [FREE Full text] [CrossRef] [Medline]
  33. Nittari G, Savva D, Tomassoni D, Tayebati SK, Amenta F. Telemedicine in the COVID-19 era: a narrative review based on current evidence. Int J Environ Res Public Health. 2022;19(9):5101. [FREE Full text] [CrossRef] [Medline]
  34. Nittas V, von Wyl V. COVID-19 and telehealth: a window of opportunity and its challenges. Swiss Med Wkly. 2020;150:w20284. [FREE Full text] [CrossRef] [Medline]
  35. Factsheet F. Factsheet: Telemedizin während der COVID-19-Pandemie. 2021. URL: https://www.fmh.ch/files/pdf24/factsheet-telemedizin.pdf [accessed 2022-10-09]
  36. Vendeuvre LP, Lecygne C, Jeannot JG, Spahni S, Mazouri-Karker S. Telemedicine in the era of COVID-19: a revolution ? The experience of the University Hospitals of Geneva. Rev Med Suisse. 2020;16(706):1695-1698. [Medline]
  37. Stata statistical software. StataCorp. College Station, TX. StataCorp LLC; 2017. URL: https://www.stata.com/ [accessed 2023-09-16]
  38. Carrillo de Albornoz S, Sia KL, Harris A. The effectiveness of teleconsultations in primary care: systematic review. Fam Pract. 2022;39(1):168-182. [FREE Full text] [CrossRef] [Medline]
  39. Moeller AM, Christensen LF, Hansen JP, Andersen PT. Patients' acceptance of video consultations in the mental health services: a systematic review and synthesis of qualitative research. Digit Health. 2022;8:20552076221075148. [FREE Full text] [CrossRef] [Medline]
  40. Chatterton ML, Marangu E, Clancy EM, Mackay M, Gu E, Moylan S, et al. Telehealth service delivery in an Australian regional mental health service during COVID-19: a mixed methods analysis. Int J Ment Health Syst. 2022;16(1):43. [FREE Full text] [CrossRef] [Medline]
  41. Hoffmann M, Wensing M, Peters-Klimm F, Szecsenyi J, Hartmann M, Friederich HC, et al. Perspectives of psychotherapists and psychiatrists on mental health care integration within primary care via video consultations: qualitative preimplementation study. J Med Internet Res. 2020;22(6):e17569. [FREE Full text] [CrossRef] [Medline]
  42. Atherton H, Boylan AM, Eccles A, Fleming J, Goyder CR, Morris RL. Email consultations between patients and doctors in primary care: content analysis. J Med Internet Res. 2020;22(11):e18218. [FREE Full text] [CrossRef] [Medline]
  43. Mirsky JB, Tieu L, Lyles C, Sarkar U. A mixed-methods study of patient-provider e-mail content in a safety-net setting. J Health Commun. 2016;21(1):85-91. [FREE Full text] [CrossRef] [Medline]
  44. Shimada SL, Petrakis BA, Rothendler JA, Zirkle M, Zhao S, Feng H, et al. An analysis of patient-provider secure messaging at two veterans health administration medical centers: message content and resolution through secure messaging. J Am Med Inform Assoc. 2017;24(5):942-949. [FREE Full text] [CrossRef] [Medline]
  45. Anderson J, Walsh J, Anderson M, Burnley R. Patient satisfaction with remote consultations in a primary care setting. Cureus. 2021;13(9):e17814. [FREE Full text] [CrossRef] [Medline]
  46. Garavand A, Aslani N, Nadri H, Abedini S, Dehghan S. Acceptance of telemedicine technology among physicians: a systematic review. Inform Med Unlocked. 2022;30:100943. [FREE Full text] [CrossRef]
  47. Mueller M, Knop M, Niehaves B, Adarkwah CC. Investigating the acceptance of video consultation by patients in rural primary care: empirical comparison of preusers and actual users. JMIR Med Inform. 2020;8(10):e20813. [FREE Full text] [CrossRef] [Medline]
  48. Reed ME, Huang J, Graetz I, Lee C, Muelly E, Kennedy C, et al. Patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians. JAMA Netw Open. 2020;3(6):e205873. [FREE Full text] [CrossRef] [Medline]
  49. Shiferaw KB, Mengiste SA, Gullslett MK, Zeleke AA, Tilahun B, Tebeje T, et al. Healthcare providers' acceptance of telemedicine and preference of modalities during COVID-19 pandemics in a low-resource setting: an extended UTAUT model. PLoS One. 2021;16(4):e0250220. [FREE Full text] [CrossRef] [Medline]
  50. Sin DYE, Guo X, Yong DWW, Qiu TY, Moey PKS, Falk MR, et al. Assessment of willingness to tele-monitoring interventions in patients with type 2 diabetes and/or hypertension in the public primary healthcare setting. BMC Med Inform Decis Mak. 2020;20(1):11. [FREE Full text] [CrossRef] [Medline]
  51. Vendeuvre LP, Jeannot JG, Avigdor G, Mazouri-Karker S. Teleconsultation in practice. Rev Med Suisse. 2020;16(706):1706-1708. [Medline]
  52. Rush KL, Howlett L, Munro A, Burton L. Videoconference compared to telephone in healthcare delivery: a systematic review. Int J Med Inform. 2018;118:44-53. [FREE Full text] [CrossRef] [Medline]
  53. Gagnon MP, Godin G, Gagné C, Fortin JP, Lamothe L, Reinharz D, et al. An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians. Int J Med Inform. 2003;71(2-3):103-115. [CrossRef] [Medline]
  54. Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care. 2016;32(1-2):29-36. [CrossRef] [Medline]
  55. Babinet O, Bagnis CI. Et si la télésanté était une réponse aux déserts médicaux ? In: Babinet O, Bagnis CI, editors. Les Déserts Médicaux en Question(s). Rennes, France. Hygée Editions; 2021;147-163.
  56. Lieneck C, Herzog B, Krips R. Analysis of facilitators and barriers to the delivery of routine care during the COVID-19 global pandemic: a systematic review. Healthcare (Basel). 2021;9(5):528. [FREE Full text] [CrossRef] [Medline]
  57. Lieneck C, Weaver E, Maryon T. Outpatient telehealth implementation in the United States during the COVID-19 global pandemic: a systematic review. Medicina (Kaunas). 2021;57(5):462. [FREE Full text] [CrossRef] [Medline]
  58. Lynch J, Gay S. A survey of telehealth coordinators in Canada. J Telemed Telecare. 2012;18(4):231-234. [CrossRef] [Medline]
  59. Mazouri-Karker S, Vendeuvre LP, Sandoval J, Regard S, Braillard O, Guessous I, et al. Telemedicine at the heart of management of the COVID-19 crisis. Rev Med Suisse. 2020;16(706):1699-1702. [Medline]


OR: odds ratio
TLM: telemedicine


Edited by A Kushniruk; submitted 25.07.23; peer-reviewed by JG Jeannot, D Nguyen ; accepted 12.08.23; published 07.11.23.

Copyright

©Sanae Mazouri-Karker, Robin Lüchinger, Olivia Braillard, Nadia Bajwa, Sophia Achab, Patricia Hudelson, Melissa Dominicé Dao, Noelle Junod Perron. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 07.11.2023.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on https://humanfactors.jmir.org, as well as this copyright and license information must be included.