Video consultation was urgently introduced in general practice in connection with the COVID-19 pandemic, where a rapid implementation ensured that Danes could continue to have access to their general practitioner. With the national lockdown in March 2020, the use of video consultations in general practice increased drastically and then declined significantly shortly after as society gradually reopened.
Today, a small proportion of the total number of consultations in general practice is made up of video consultations, and there is great variation in the scope and use of video consultation among general practitioners and practice staff.
There is a demand for research-based knowledge about video consultation and we need to shed light on questions such as: How does video consultation affect the diagnostic process? The quality of treatment? Patient satisfaction? The doctor-patient relationship? Social inequality? Organization in practice? Doctors’ well-being?
Project vCare aims to investigate and answer all these questions through six sub studies that make use of different research methods.
Results from the project will be disseminated to politicians, doctors and patients in order to ensure continued high quality in treatment in general practice and the best use of video consultation in future general practice.
The vCare project is supported by the Foundation for General Practice and Sygeforsikringen Danmark and will be carried out in the period 2020-2025.
The purpose of this project is to investigate changes in the consultation when it is on video or telephone. How are the doctor-patient relationship and the consultation affected? How do they understand each other, and is the handling of the patient’s and the doctor’s agendas different from face-to-face consultations?
We will record video consultations and afterwards interview the patients and general practitioners about their experience and their reflections on the communication. We hope to contribute with knowledge about changes in the consultation process, and which skills that are needed for a good doctor-patient relation when it is on video. This knowledge can contribute to understand how the communication can be customized, and what is won or lost, when the consultation is on screen.
1. How is the agenda setting conducted in video consultation in general practice?
2. What are good relational qualities in video consultations in general practice?
3. What are good relational qualities in telephone consultations?
PhD Student: Frida Kofod
Main supervisor: Associate professor Ann Dorrit Guassora, University of Copenhagen,
Co-supervisors: Associate professor Elisabeth Assing Hvidt, University of Southern Denmark and PhD Anne Beiter Arreskov, Region Hovedstaden.
The purpose of this project is to identify and understand the possibilities and challenges of implementing video consultations (VC) in order to achieve continuous and sustainable use of VC in general practice.
Organizational factors have been shown to play a significant role for successful implementation of VC, requiring a planned and coordinated approach that involves staff training, and coordination of responsible staff members. The introduction of VCs in general practice means that the working methods and routines are adapted to new practices created by new technologies. It is therefore important to investigate how adaptations to new working methods and technologies are made and how they impact the working life of healthcare professionals.
The study is divided into three levels representing
- the individual VC user (micro),
- the organizational aspect (meso) and
- the national context and wider influences on the implementation of VC (macro).
Empirically, the study is based on interviews with general practitioners, general practice staff and patients as well as observations in general practice and a collection and analysis of policy documents.
PhD student: Elle Christine Lüchau
Main supervisor: Associate Professor Elisabeth Assing Hvidt, Research Unit of General Practice, University of Southern Denmark
Co-supervisors: Professor Jens Søndergaard, Research Unit of General Practice, University of Southern Denmark, Associate Professor Finn Olesen, Aarhus University and Associate Professor Helen Atherton, University of Warwick
The overall aim of this project is to investigate the quality, satisfaction level and patient characteristics among users of video consultations in general practice.
Through a questionnaire sub study, we will investigate the experienced satisfaction level among users (patients) of video consultations in general practice and through a register-based study we will investigate the quality (prescribing and referral pattern) and differences in patient characteristics among patients who receive video talking therapy consultation compared to patients receiving physical talking therapy consultation. Results will be used to identify potential health inequalities in the use of video consultations in general practice.
A questionnaire will be developed, based on existing validated and non-validated questions. The questionnaire will be distributed to respondents in collaboration with “Min Læge App”.
The register-based sub study is an explorative sub study that includes all patients who have received talking therapy in general practice from 2017 to 2021. The dataset consists of health information, information on socioeconomic status and information on prescribing and referral patterns.
This PhD project generates knowledge about the advantages and disadvantages of the use of VC and whether some patients are more satisfied with the use of VC compared to other patients (reason for contact etc.). These results can contribute with knowledge to identify possible inequalities in the use of VC in general practice. Ultimately, this project can contribute with evidence-informed decision making- and implementation processes for using video consultations in general practice.
PhD student: Tessa Quirina Bang van Sas, Cand Scient Publ., PhD student.
Main supervisor: Elisabeth Assing Hvidt, Associate Professor, Research unit of general practice, University of Southern Denmark.
Co-supervisors: Jens Søndergaard, Professor, Head of Research Unit, Research Unit of general Practice, University of Southern Denmark, Jesper Bo Nielsen , Professor, Head of Department, Research Unit of General Practice, University of Southern Denmark, Linda Huibers, Senior researcher, MD, PhD, Research Unit of General practice, Aarhus University.
Project period: 01/09/2021-01/09/2024
This project investigates video consultations in the encounter between physician, patient, and technology in a context of patients who are vulnerable.
I will interview general practitioners with video consultation experience about their experiences with and reflections on the vulnerability of patients in the use of video consultation. This is done with an expectation of creating knowledge about relational vulnerability and for whom video consultations as a tool in general practice are beneficial.
This knowledge can contribute with an understanding of how vulnerability can manifest itself in the digital encounter between patients and the GPs. The following questions are raised:
• How is it assessed who is suitable for video consultations in general practice?
• How to vulnerable patients use video consultations in general practice?
• How does vulnerability manifest itself in video consultations in general practice?
Research Assistant: Johannes van den Heuvel
Main supervisor: Associate Professor Camilla Hoffmann Merrild, Center for General Practice, Aalborg University
Co-supervisors: Associate Professor Elisabeth Assing Hvidt , Research Unit for General Practice, University of Southern Denmark.
Clinical Professor Janus Laust Thomsen, Center for General Practice at Aalborg University
Project periode: 10/01/2022 - 10/01/2025
The aim of this project is to evaluate the use of video consultations in out of hours primary care.
Research within the field of video consultations in out of hours primary care is highly relevant. Video consultations has the potential to create better patient pathways due to more timely advise and reduction of travel and waiting time. For general practitioners, video consultations can decrease workload and costs, thereby contributing to sustaining high-quality out-of-hours primary care services and enhance patient satisfaction.
We plan a mixed methods study, combining a national register-based study, a regional survey among general practitioners and an interview-study among patients.
PhD student: Mette Amalie Nebsbjerg
Main supervisor: Morten Bondo Christensen, MD, Professor, PhD, Department of Public Health, Aarhus University and Research Unit for General Practice, Aarhus
Co-supervisor: Linda Huibers, senior researcher, PhD, Research Unit for General Practice, Aarhus
Elisabeth Assing Hvidt, Associate Professor, Research Unit of Genereal Practice, Odense
Project period: 01/05/2021 – 30/04/2024
The overall goal is to understand why, how and when video consultations in general practice work under which circumstances.
The three main objectives are: a) to explore how the local context interacts with different mechanisms and components to produce more or less effective video consultations (outcome), b) to define 'best practices' and inform about their implementation in relation to video consultations, and c) to generate transferable knowledge about opportunities and challenges in relation to upscaling and making video consultations a routine in general practice in Denmark.
We first plan to conduct a realistic scoping review to understand how complex interventions, such as video consultations, can generate different outcomes under different circumstances.
We will then perform a realistic evaluation to examine how the various mechanisms, such as changes in attitudes and behaviors in both physician and patient, are expressed in specific contexts.
We expect to provide decision-makers, doctors and patients with a thorough and balanced knowledge base and assessment of when, how and under which circumstances video consultations are best implemented, taking into account the unique organizational context that general practice in Denmark constitutes. The knowledge generated will guide decision makers to implement 'best practices' in video consulting.
PhD project: Ulrik Bak Kirk, Research Unit for General Practice, Aarhus University
Main supervisor: Professor Flemming Bro, Research Unit for General Practice, Aarhus University
Co-supervisors: Professor Helle Terkildsen Maindal, Section for Health Promotion and Health Care, Department of Public Health, Aarhus University and Adrian Rohrbasser, PhD, Center for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford University.
Project period: 01/06/2022 - 01/06/2028 (50%)
The project is based on the ongoing digital transformation of the healthcare system. The project focuses on what it means to "go to the doctor digitally " by investigating the use of video consultation as a form of consultation in general practice and in the regional community clinics in Region Zealand.
The project examines what the use of video consultations means for communication and the relationship between citizen and doctor, as well as how the digital transition can affect practice by changing routines, working methods and the interdisciplinary collaboration between, for example, doctor and nurse. The project focuses particularly on the regional community clinics in the outer areas of Region Zealand. In those areas, there is often a shortage of doctors, which has opened the way for digital solution models, where some doctors sit at a distance from both the citizen and the local clinic.
The project is a qualitative study which methodically makes use of interview, observation and video recordings of video consultations. Theoretically, the project is based on a mixture of dialogic communication theory inspired by Mikhail Bakhtin and 'Science and technology studies' (STS).
Associate professor,Michael Scheffmann-Petersen, PhD
Roskilde University Centre (RUC), Department of Communication and Arts and eHospital and Quality & Research, Det Nære Sundhedsvæsen, Region Zealand
E-mail:msche@regionsjaelland.dk