Constituting Factors of a Digitally Influenced Relationship between Patients and Primary Care Physicians in Rural Areas

In times of an ageing society and a rural exodus of primary care physicians, healthcare systems are facing major challenges. To maintain comprehensive care and an equitable access to healthcare services, today’s technological advancements represent a promising measure. Technologies empower patients by providing innovative tools such as sensors and applications for self-measurement, leading to selfinitiated interventions, while supporting physicians in handling rising demands through telemedicine and spatially detached solutions. These enhanced treatments come with patient and physician-sided challenges such as incorrect digital information provided to the patient, negatively affecting treatment quality and leading to high issue resolving efforts. In order to investigate the perspectives of rural physicians on treatment digitalization and effects of patient empowerment, we conducted a qualitative study using semi-structured interviews. Our findings show that patient activation, impacts on treatment process, patient differentiation, and patient-physicianinteraction are relevant factors in the physicians’ valuation and willingness to use health technologies.

[1]  Russell A. McCann,et al.  mHealth for mental health: Integrating smartphone technology in behavioral healthcare. , 2011 .

[2]  David Hartley,et al.  Rural health disparities, population health, and rural culture. , 2004, American journal of public health.

[3]  S. Meher,et al.  Awareness and attitudes to telemedicine among doctors and patients in India , 2009, Journal of telemedicine and telecare.

[4]  S. Scaife,et al.  Health literacy skills in rural and urban populations. , 2009, American journal of health behavior.

[5]  Mark E. Johnson,et al.  Barriers to healthcare as reported by rural and urban interprofessional providers , 2006, Journal of Interprofessional Care.

[6]  Mark E. Johnson,et al.  Rural–Urban Health Care Provider Disparities in Alaska and New Mexico , 2006, Administration and Policy in Mental Health and Mental Health Services Research.

[7]  J. Kvedar,et al.  Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. , 2014, Health affairs.

[8]  R. Hughes,et al.  Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care , 2001, Medical care research and review : MCRR.

[9]  E. M. Castro,et al.  Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. , 2016, Patient education and counseling.

[10]  Francisco del Pozo,et al.  Rural telemedicine for primary healthcare in developing countries , 2004, IEEE Technology and Society Magazine.

[11]  H. Thommasen,et al.  Mental health, job satisfaction, and intention to relocate. Opinions of physicians in rural British Columbia. , 2001, Canadian family physician Medecin de famille canadien.

[12]  M. Hojat,et al.  Patient perceptions of physician empathy, satisfaction with physician, interpersonal trust, and compliance , 2010, International Journal of Medical Education.

[13]  C. V. van Woerkum The Internet and primary care physicians: coping with different expectations. , 2003, The American journal of clinical nutrition.

[14]  Carolyn Petersen,et al.  Health information on the internet: quality issues and international initiatives. , 2002, JAMA.

[15]  G. Demiris,et al.  Technologies for an Aging Society: A Systematic Review of “Smart Home” Applications , 2008, Yearbook of Medical Informatics.

[16]  Marius Müller,et al.  Health at any Cost? Investigating Ethical Dimensions and Potential Conflicts of an Ambulatory Therapeutic Assistance System through Value Sensitive Design , 2018, ICIS.

[17]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[18]  Farah Ahmad,et al.  Are Physicians Ready for Patients With Internet-Based Health Information? , 2006, Journal of medical Internet research.

[19]  Andre Kushniruk,et al.  Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs , 2015, JMIR human factors.

[20]  E. Emanuel,et al.  Four models of the physician-patient relationship. , 1992, JAMA.

[21]  Steven Simske,et al.  Beyond quantified self: data for wellbeing , 2014, CHI Extended Abstracts.

[22]  H. Carel Phenomenology and its application in medicine , 2011, Theoretical medicine and bioethics.

[23]  N. Apt Ageing and the Changing Role of the Family and the Community: An African Perspective , 2002 .

[24]  Paul Jen-Hwa Hu,et al.  Investigating healthcare professionals' decisions to accept telemedicine technology: an empirical test of competing theories , 2002, Inf. Manag..

[25]  Brenda K. Wiederhold mHealth Sensors Can Promote Behavior Change and Reduce Healthcare Costs , 2015, Cyberpsychology Behav. Soc. Netw..

[26]  Robert L. Wears,et al.  Health information technology: fallacies and sober realities , 2010, J. Am. Medical Informatics Assoc..

[27]  Nikolaos G. Bourbakis,et al.  A Survey on Wearable Sensor-Based Systems for Health Monitoring and Prognosis , 2010, IEEE Transactions on Systems, Man, and Cybernetics, Part C (Applications and Reviews).

[28]  R. Rosenblatt,et al.  Physicians and rural America. , 2000, The Western journal of medicine.

[29]  Alan Wilson,et al.  Patient co-creation activities in healthcare service delivery at the micro level: The influence of online access to healthcare information , 2018 .

[30]  Yong Zhu,et al.  Flexible Technologies for Self-Powered Wearable Health and Environmental Sensing , 2015, Proceedings of the IEEE.

[31]  Hai Zhong The impact of population aging on income inequality in developing countries: Evidence from rural China , 2011 .

[32]  Björn Niehaves,et al.  Internet adoption by the elderly: employing IS technology acceptance theories for understanding the age-related digital divide , 2014, Eur. J. Inf. Syst..

[33]  Jon D. Elhai,et al.  Attitudes Toward Medical and Mental Health Care Delivered Via Telehealth Applications Among Rural and Urban Primary Care Patients , 2008, The Journal of nervous and mental disease.

[34]  Dean F. Sittig,et al.  Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use , 2011, Pediatrics.

[35]  Susan S. Woods,et al.  Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved. , 2008, Evidence report/technology assessment.

[36]  L. Philip,et al.  Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare , 2015, BMC Health Services Research.