Teleconsultation and joint consultation across primary-secondary care in a Dutch urbanised area: an exploratory qualitative study of healthcare professionals' experiences of implementation barriers and facilitators.

Abstract

This study explored healthcare professionals' experiences with (asynchronous) teleconsultations and (synchronous) joint consultations in primary and secondary care as well as perceived implementation barriers and facilitators to their use in clinical practice. An implementation-focused qualitative study employing semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). A systematic examination of implementation barriers and facilitators using deductive and inductive approaches, followed by thematic analysis that identified patterns, developed conceptual categories and synthesised these into overarching themes and thematic areas. Teleconsultation and joint consultation used to support collaboration and continuity of care between general practitioners and medical specialists in a Dutch urbanised area. 37 participants were interviewed between August 2021 and October 2022, including 14 general practitioners and 23 medical specialists. Four thematic areas were identified: (1) intervention, (2) interprofessional collaboration, (3) perceived patient perspective and (4) prerequisites for implementation and sustainability. Teleconsultations were highly valued by healthcare professionals, as they enhanced the quality, efficiency and flexibility of their work and improved access to care and the overall care experience for patients. Joint consultations were particularly appreciated for their interactive nature, which strengthened interprofessional relationships and supported their educational value while facilitating delivery of the right care in the right place. However, next to these facilitators several challenges were identified. Specifically, teleconsultations were hindered by variation in use, unclear expectations, a lack of dialogue and limited IT interoperability. Furthermore, scaling up joint consultations was deemed challenging due to volume requirements, time inefficiencies and organisational constraints. Teleconsultation and joint consultation were valued by healthcare professionals as tools that support continuity and quality of care. While serving distinct purposes, their combined use strengthened collaboration between general practitioners and medical specialists. However, sustainable implementation was hindered by organisational, technical, financial and governance-related barriers, as well as limited interoperability and lack of shared clinical ownership. Addressing these barriers is essential to enable scalable and routine use of digital interprofessional consultation models.