A Human-Organisation-Technology (HOT) perspective on patients’ experiences of a chat- and automated medical history-taking service in primary healthcare: qualitative study (Preprint)

BACKGROUND Worldwide, the use of e-consultations in healthcare is progressing fast. So far, studies on the advantages and disadvantages of e-consultations in the form of chat services for all enquiries in primary care have focused on the perspective of the healthcare professionals rather than the end-users (patients). OBJECTIVE To explore patients´ experiences of using a chat- and automated medical history-taking service in Swedish regular tax-based not-for-profit primary care. METHODS In this qualitative study, 25 individual interviews were conducted with patients in the catchment areas of five primary care centres (PCCs) in Sweden that tested a chat- and automated medical history-taking service for all kinds of patient enquiries. The semi-structured interviews were transcribed verbatim prior to content analysis, using inductive and deductive strategies, the latter including an unconstrained matrix of Human, Organisation and Technology (HOT) perspectives. RESULTS The service provided an easily managed way for patients to make written contact, which was considered beneficial for some patients and issues, but less suitable for others (like acute or more complex cases). The automated medical history-taking service was perceived as having potential, but still derived from what healthcare professionals need to know and how they address and communicate health and healthcare issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer, for example, but patients still expressed concern for people with less digital literacy. The opportunity for patients to take their time and reflect before answering questions from the healthcare professionals was found to be stress reducing and error preventing, and patients speculated that it might be the same for the healthcare professionals on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service let the patients take more control of the conversation and initiate a chat at any time at their own convenience, but it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant which would otherwise have been necessary if a telephone service had been used, saving patients both time and money. CONCLUSIONS Patients generally had a positive attitude towards e-consultations in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. While patients expect their PCC to offer a range of different means of communication, the HOT analysis revealed a need for a more extensive (end) user-experience design in the further development of the PCC chat service.