Abstract
BackgroundIn recent years, telemedicine consultations have evolved as a new form of providing primary healthcare. Telemedicine options can provide benefits to patients in terms of access, reduced travel time and no risk of disease spreading. However, concerns have been raised that access is not equally distributed in the population, which could lead to increased inequality in health. The aim of this paper is to explore the determinants for use of direct-to-consumer (DTC) telemedicine consultations in a setting where telemedicine is included in the publicly funded healthcare system.MethodsTo investigate factors associated with the use of DTC telemedicine, a database was constructed by linking national and regional registries covering the entire population of Stockholm, Sweden (N = 2.3 million). Logistic regressions were applied to explore the determinants for utilization in 2018. As comparators, face-to-face physician consultations in primary healthcare were included in the study, as well as digi-physical physician consultations, i.e., telemedicine consultations offered by traditional primary healthcare providers also offering face-to-face visits, and telephone consultations by nurses.ResultsThe determinants for use of DTC telemedicine differed substantially from face-to-face visits but also to some extent from the other telemedicine options. For the DTC telemedicine consultations, the factors associated with higher probability of utilization were younger age, higher educational attainment, higher income and being born in Sweden. In contrast, the main determinants for use of face-to-face visits were higher age, lower educational background and being born outside of Sweden.ConclusionThe use of DTC telemedicine is determined by factors that are generally not associated with greater healthcare need and the distribution raises some concerns about the equity implications. Policy makers aiming to increase the level of telemedicine consultations in healthcare should consider measures to promote access for elderly and individuals born outside of Sweden to ensure that all groups have access to healthcare services according to their needs.
Highlights
In recent years, telemedicine consultations have evolved as a new form of providing primary healthcare
The Swedish government and the Swedish Association of Local Authorities and Regions have endorsed a common vision for eHealth stating that Sweden will be best in the world at using the opportunities offered by digitization and eHealth by 2025 [2]
Results from studies from both Swedish and international settings indicate that users of telemedicine are younger and female to a further extent than the population as a whole or in comparison to users of face-to-face consultations in primary healthcare [7,8,9,10,11,12,13]
Summary
Telemedicine consultations have evolved as a new form of providing primary healthcare. Telemedicine consultations, where healthcare personnel and patients are spatially separated and interact through video-link, telephone or electronic chat, have emerged as a new mode of providing primary healthcare in Sweden and internationally in recent years. The introduction of telemedicine in the Swedish healthcare system has been dominated by actors operating in parallel with traditional primary care. These direct-to-consumers (DTC) telemedicine providers have often acted as subcontractors to a primary healthcare centre in one region while offering their services directly to patients nationally. Following the popularity of the DTC telemedicine options, traditional primary healthcare providers have developed telemedicine alternatives, conceptualized as digi-physical healthcare
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