טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentChudner Irit
SubjectIntegration of Video-Consultations Into Primary Care:
Stakeholders' Preferences using a Discrete Choice
Experiment: Patients, Primary Care
Physicians and Policy Makers
DepartmentDepartment of Medicine
Supervisors CLINICAL PROFESSOR Khaled Karkabi
PROFESSOR EMERITUS Miriam Erez
Full Thesis textFull thesis text - English Version


Abstract

Video-consultation is a telemedicine technology in which medical information

is transmitted through visual interaction with image and voice between a patient and a

caregiver. This new possibility of providing health services regardless of the physical

location of the patient has significant potential for increased accessibility of primary

care to geographical and cultural peripheries and for overall improve of care. Despite being beneficial for Primary care settings, the adoption of Video-Consultations (VC) instead of traditional in-clinic consultations (I-CCs) is complex and slow. Understanding VC vs. ICC choice' related preferences of the three key stakeholder groups in primary care: Patients, Primary Care Physicians (PCPs) and Policy Makers (PMs), is crucial for achieving better implementation.

The first and the second study in this dissertation present Discrete Choice Experiment (DCE) was conducted to quantify preferences of key stakeholders. Discrete Choice Experiment (DCE) surveys with 12 choice tasks of two labeled alternatives (VC or I-CC) with four VC vs. ICC attributes most relevant to each stakeholder group was filled by 508 Patients, 264 PCPs and 138 PMs. Choice' attributes were, for both patients and PMs were: (1)-Time to next available appointment; (2)-Time in-line before consultation; (3)-Relationship to PCP; and (4)-Quality of consultation. For PCPs these were: (1)-Time in-line before consultation; (2)-Patient's self-management ability; (3)-Consultation purpose; (4)-Quality of consultation. Random effects logit model analysis was used to estimate stakeholders' preferences for attributes.

All experiment attributes were significantly important in choosing VC vs. ICC for patients and PCPs groups. Three out of four attributes were significantly important for PMs. Gaps and similarities were identified between stakeholders in attribute rank orders, trade-offs and probabilities of VC take up. PMs VC uptake were 86%, patients’ preferences suggested that 68% of ICC can be switched to VC and PCPs uptake rates were 30% in cases, where consultation purpose is to diagnose and giving treatment and 48% of consultations, where consultation purpose is follow up.

Our findings show key stakeholders' preferences for VC integration. Those preferences should be considered when VC systems are about to be used in primary care to optimize implementation process. Although there is a stronger preference for I-CC among PCPs and patients, alternative combinations of attribute levels can be used to compensate and reconfigure a more preferred VC service. Ththird stury in this dissertation focuses on the physician’s population and deals with the

question whether the intention to use video-consultations relates to how physicians

view their power, relative to other stakeholder groups in primary care. In this study,

primary care physicians’ perceived power gaps between them and patients and between them and managers were found to be a significant predictor to physicians’ intention to use video-consultations.

This cumulative dissertation presents the first empirical parallel preference elicitation among three key stakeholder groups referring to their preferences to use video-consultations in primary care. As video-consultation’ technologies are penetrating healthcare services, the evidence this study provides on stakeholders’ preferences and uptake of video-consultations, is important for better theoretical and practical implementation approaches.