Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study

BMC Medical Informatics and Decision Making

Research Article

P. Zanaboni¹  R. Wootton¹  J. P. Fortin²  H. Alami³  M. P. Gagnon⁴ 

[1] Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, 9038, Tromso, Norway;Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care. Laval University (CERSSPL-UL). CIUSSS-CN, Pavillon Landry-Poulin, 2525, chemin de la canardiere, G1J 0A4, Quebec, QC, Canada;Faculty of Medicine, Laval University Pavillon Ferdinand-Vandry, 1050, avenue de la Medecine, G1V 0A6, Quebec, QC, Canada;Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care. Laval University (CERSSPL-UL). CIUSSS-CN, Pavillon Landry-Poulin, 2525, chemin de la canardiere, G1J 0A4, Quebec, QC, Canada;Research Centre of the CHU de Quebec-Universite Laval, Hopital St-François d’Assise, Edifice D, 45, rue Leclerc, G1L 2G1, Quebec, QC, Canada;Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care. Laval University (CERSSPL-UL). CIUSSS-CN, Pavillon Landry-Poulin, 2525, chemin de la canardiere, G1J 0A4, Quebec, QC, Canada;Research Centre of the CHU de Quebec-Universite Laval, Hopital St-François d’Assise, Edifice D, 45, rue Leclerc, G1L 2G1, Quebec, QC, Canada;Faculty of Nursing Science, Laval University. Pavillon Ferdinand-Vandry, 1050, avenue de la Medecine, G1V 0A6, Quebec, QC, Canada;

关键词: Telemedicine;    Implementation;    Adoption;    Utilization;    Sustainability;    Scaling-up;    Health system;   

DOI  :  10.1186/s12911-017-0576-4

 received in 2017-08-09, accepted in 2017-12-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundNorway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway.MethodsWe used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data.ResultsTelemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified.ConclusionsThis study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems.

【 授权许可】

CC BY   
© The Author(s). 2017