{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T09:13:53Z","timestamp":1774084433260,"version":"3.50.1"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007051","name":"Uppsala University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007051","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The use of remote services such as video consultations (VCs) has increased significantly in the wake of the COVID-19 pandemic. In Sweden, private healthcare providers offering VCs have grown substantially since 2016 and have been controversial. Few studies have focused on physicians\u2019 experiences providing care in this context. Our aim was to study physicians\u2019 experiences of VCs, focusing on the work environment, quality of care, and educational needs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twenty-two semi-structured interviews were performed with physicians working with VCs in Sweden, and analyzed through inductive content analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We identified five categories; flexibility, social work environment, impact on care and society, continuous learning and career development, and organizational support. Flexibility and accessibility were considered positive features of working digitally by giving physicians control over their time and workplace and increasing patients\u2019 timely access to healthcare. Regarding collegial contact and social activities in a digital context, the majority of the participants did not experience any significant difference compared to the physical context. Access to technical support services, educational support, and collegial support in decision-making, guidance, and consultations were described as well-functioning. Satisfied patients positively impacted the work environment, and participants felt that VCs have a positive socio-economic effect. Continuity of care was considered supported, but patients did not always prioritize this. Privacy risks were considered a challenge, as were poor development of clinical skills due to the low variation of patient cases. Working for an online healthcare provider was contributing to career advancements for junior clinicians.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Physicians appreciate the flexibility of the digital context and seem satisfied with a work environment where they have a high level of control, but few consider this a full-time career option. The pandemic year 2020 has led to a significant increase in the implementation of VCs in traditional care systems. How this affects the work environment and continuous education needs and career development remains to be seen.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-023-02337-7","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T13:02:58Z","timestamp":1697720578000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Escape to the future \u2013 a qualitative study of physicians\u2019 views on the work environment, education, and support in a digital context"],"prefix":"10.1186","volume":"23","author":[{"given":"Maria","family":"H\u00e4gglund","sequence":"first","affiliation":[]},{"given":"Anna Kristensson","family":"Ekwall","sequence":"additional","affiliation":[]},{"given":"Nadia","family":"Davoody","sequence":"additional","affiliation":[]},{"given":"Nasim","family":"Farrokhnia","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"issue":"4","key":"2337_CR1","doi-asserted-by":"publisher","first-page":"317","DOI":"10.3402\/ijch.v63i4.17748","volume":"63","author":"S Olsson","year":"2004","unstructured":"Olsson S, Jarlman O. A short overview of eHealth in Sweden. Int J Circumpolar Health. 2004;63(4):317\u201321.","journal-title":"Int J Circumpolar Health 01 Dec"},{"issue":"1suppl","key":"2337_CR2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1258\/1357633991932595","volume":"5","author":"LH Sj\u00f6gren","year":"1999","unstructured":"Sj\u00f6gren LH, Sandberg C, T\u00f6rnqvist H. Telemedicine in Sweden\u2014a diffusion study. J Telemedicine Telecare. 1999;5(1suppl):63\u20135.","journal-title":"J Telemedicine Telecare 01 mars"},{"issue":"10231","key":"2337_CR3","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1016\/S0140-6736(20)30818-7","volume":"395","author":"P Webster","year":"2020","unstructured":"Webster P. Virtual health care in the era of COVID-19. The Lancet. 2020;395(10231):1180\u20131.","journal-title":"The Lancet"},{"key":"2337_CR4","doi-asserted-by":"crossref","unstructured":"Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for covid-19. BMJ. 2020;368.","DOI":"10.1136\/bmj.m998"},{"key":"2337_CR5","doi-asserted-by":"crossref","unstructured":"Hashiguchi TCO. Bringing health care to the patient. OECD Health Working Papers No. 116. 2020;(116). https:\/\/dx.doi.org\/10.1787\/8e56ede7-en","DOI":"10.1787\/8e56ede7-en"},{"issue":"2","key":"2337_CR6","doi-asserted-by":"publisher","first-page":"e26433","DOI":"10.2196\/26433","volume":"23","author":"TM Johnsen","year":"2021","unstructured":"Johnsen TM, Norberg BL, Kristiansen E, Zanaboni P, Austad B, Krogh FH. et al. Suitability of video consultations during the COVID-19 pandemic lockdown: cross-sectonal survey among Norwegian general practitioners. J Med Internet Res. 2021;23(2):e26433.","journal-title":"J Med Internet Res"},{"issue":"1","key":"2337_CR7","doi-asserted-by":"publisher","first-page":"e23775","DOI":"10.2196\/23775","volume":"23","author":"HM James","year":"2021","unstructured":"James HM, Papoutsi C, Wherton J, Greenhalgh T, Shaw SE. Spread, scale-up, and sustainability of video consulting in health care: systematic review and synthesis guided by the NASSS framework. J Med Internet Res. 2021;23(1):e23775.","journal-title":"J Med Internet Res Januari"},{"issue":"1","key":"2337_CR8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s41233-020-00038-x","volume":"5","author":"\u00c3 Cajander","year":"2020","unstructured":"Cajander \u00c3, Larusdottir M, Hedstr\u00f6m G. The effects of automation of a patient-centric service in primary care on the work engagement and exhaustion of nurses. Qual User Experience. 2020;5(1):9.","journal-title":"Qual User Experience"},{"issue":"11","key":"2337_CR9","doi-asserted-by":"publisher","first-page":"e20032","DOI":"10.2196\/20032","volume":"22","author":"H Ding","year":"2020","unstructured":"Ding H, Chen SH, Edwards I, Jayasena R, Doecke J, Layland J. et al. Effects of different telemonitoring strategies on chronic Heart failure care: systematic review and subgroup meta-analysis. J Med Internet Res. 2020;22(11):e20032.","journal-title":"J Med Internet Res"},{"issue":"november","key":"2337_CR10","first-page":"1","volume":"116","author":"LM Elleg\u00e5rd","year":"2019","unstructured":"Elleg\u00e5rd LM, Kjellson G. N\u00e4tv\u00e5rdsanv\u00e4ndare i Sk\u00e5ne Kontaktade oftare v\u00e5rdcentral. L\u00e4kartidningen. 2019;116(november):1\u20135.","journal-title":"L\u00e4kartidningen"},{"issue":"2","key":"2337_CR11","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1080\/02813432.2021.1913904","volume":"39","author":"F Gabrielsson-J\u00e4rhult","year":"2021","unstructured":"Gabrielsson-J\u00e4rhult F, Kjellstr\u00f6m S, Josefsson KA. Telemedicine consultations with physicians in Swedish primary care: a mixed methods study of users\u2019 experiences and care patterns. Scandinavian J Prim Health Care. 2021;39(2):204\u201313.","journal-title":"Scandinavian J Prim Health Care 03 April"},{"issue":"3","key":"2337_CR12","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1093\/fampra\/cmw024","volume":"33","author":"C Liddy","year":"2016","unstructured":"Liddy C, Drosinis P, Keely E. Electronic consultation systems: worldwide prevalence and their impact on patient care\u2014a systematic review. Family Pract. 2016;33(3):274\u201385.","journal-title":"Family Pract 01 juni"},{"key":"2337_CR13","doi-asserted-by":"crossref","unstructured":"Nymberg VM, Bolmsj\u00f6 BB, Wolff M, Calling S, Gerward S, Sandberg M. \u2018Having to learn this so late in our lives?\u2019 Swedish elderly patients\u2019 beliefs, experiences, attitudes and expectations of e-health in primary health care. Scandinavian J Prim Health Care. 2019;37(1):41\u201352.","DOI":"10.1080\/02813432.2019.1570612"},{"key":"2337_CR14","unstructured":"Internetstiftelsen. Svenskarna och internet 2019. 2019. Accessed from: https:\/\/svenskarnaochinternet.se\/rapporter\/svenskarna-och-internet-2019\/"},{"issue":"8","key":"2337_CR15","doi-asserted-by":"publisher","first-page":"e36414","DOI":"10.2196\/36414","volume":"24","author":"J Longhini","year":"2022","unstructured":"Longhini J, Rossettini G, Palese A. Digital health competencies among health care professionals: systematic review. J Med Internet Res. 2022;24(8):e36414.","journal-title":"J Med Internet Res 18 Augusti"},{"issue":"5\u20136","key":"2337_CR16","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1111\/jocn.14710","volume":"28","author":"J Konttila","year":"2019","unstructured":"Konttila J, Siira H, Kyng\u00e4s H, Lahtinen M, Elo S, K\u00e4\u00e4ri\u00e4inen M. et al. Healthcare professionals\u2019 competence in digitalisation: a systematic review. J Clin Nurs. 2019;28(5\u20136):745\u201361.","journal-title":"J Clin Nurs"},{"issue":"2","key":"2337_CR17","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1002\/nop2.1184","volume":"9","author":"E Jarva","year":"2022","unstructured":"Jarva E, Oikarinen A, Andersson J, Tuomikoski AM, K\u00e4\u00e4ri\u00e4inen M, Meril\u00e4inen M. et al. Healthcare professionals\u2019 perceptions of digital health competence: a qualitative descriptive study. Nurs Open. 2022;9(2):1379\u201393.","journal-title":"Nurs Open"},{"key":"2337_CR18","doi-asserted-by":"crossref","unstructured":"Bosch J, Ludwig C, Fluch-Niebuhr J, Stoevesandt D. Empowerment for the digital transformation: results of a structured blended-learning on-the-job training for practicing physicians in Germany. Int J Environ Res Public Health. 2022;11(20):12991.","DOI":"10.3390\/ijerph192012991"},{"issue":"4","key":"2337_CR19","doi-asserted-by":"publisher","first-page":"e150","DOI":"10.2196\/jmir.9897","volume":"20","author":"T Greenhalgh","year":"2018","unstructured":"Greenhalgh T, Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S. et al. Real-world implementation of video outpatient consultations at macro, meso, and micro levels: mixed-method study. J Med Internet Res. 2018;20(4):e150.","journal-title":"J Med Internet Res April"},{"issue":"6","key":"2337_CR20","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u201357.","journal-title":"Int J Qual Health Care 01 Dec"},{"key":"2337_CR21","unstructured":"Inera. Nationell patient\u00f6versikt (NP\u00d6) [Internet]. 2017 [accessed 01 Jan 2017]. Available from: https:\/\/www.inera.se\/tjanster\/alla-tjanster-a-o\/npo---nationell-patientoversikt\/."},{"key":"2337_CR22","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.nedt.2003.10.001","volume":"24","author":"UH Graneheim","year":"2004","unstructured":"Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105\u201312.","journal-title":"Nurse Educ Today"},{"key":"2337_CR23","doi-asserted-by":"crossref","unstructured":"Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003;22(7425):1219\u201321.","DOI":"10.1136\/bmj.327.7425.1219"},{"issue":"4S","key":"2337_CR24","doi-asserted-by":"publisher","first-page":"367","DOI":"10.36076\/ppj.2020\/23\/S367","volume":"23","author":"S Shah","year":"2020","unstructured":"Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, m.fl. The Technological Impact of COVID-19 on the future of Education and Health Care Delivery. Pain Physician Augusti. 2020;23(4S):367\u201380.","journal-title":"Pain Physician Augusti"},{"key":"2337_CR25","unstructured":"V\u00e5rdanalys. V\u00e5rden ur befolkningens perspektiv 2020 En j\u00e4mf\u00f6relse mellan Sverige och tio andra l\u00e4nder. 2021."},{"key":"2337_CR26","volume-title":"Healthy work - stress, productivity, and the reconstruction of working life","author":"R Karasek","year":"1990","unstructured":"Karasek R, Theorell T. Healthy work - stress, productivity, and the reconstruction of working life. Middletown, DE, USA: Basic Books; 1990. 381 s."},{"key":"2337_CR27","doi-asserted-by":"crossref","unstructured":"Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q. 1979;13(2):285\u2013308.","DOI":"10.2307\/2392498"},{"issue":"10","key":"2337_CR28","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.2105\/AJPH.78.10.1336","volume":"78","author":"JV Johnson","year":"1988","unstructured":"Johnson JV, Hall EM. Job strain, work place social support, and Cardiovascular Disease: a cross-sectional study of a random sample of the Swedish working population. Am J Public Health. 1988;78(10):1336\u201342.","journal-title":"Am J Public Health"},{"key":"2337_CR29","unstructured":"Scandurra I, H\u00e4gglund M, Persson A, \u00c5hlfeldt RM. Disturbing or facilitating?\u2014On the usability of Swedish eHealth systems 2013. Stud Health Technol Inform. 2014;205:221\u20135."},{"key":"2337_CR30","doi-asserted-by":"crossref","unstructured":"Gagnon MP, Payne-Gagnon J, Breton E, Fortin JP, Khoury L, Dolovich L, et al. Adoption of electronic personal health records in Canada: perceptions of stakeholders. Int J Health Policy Manag. 2016;5(7):425\u201333.","DOI":"10.15171\/ijhpm.2016.36"},{"key":"2337_CR31","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.ijmedinf.2016.10.010","volume":"97","author":"J Kaipio","year":"2017","unstructured":"Kaipio J, L\u00e4\u00e4veri T, Hypp\u00f6nen H, Vainiom\u00e4ki S, Reponen J, Kushniruk A. m.fl. Usability problems do not heal by themselves: National survey on physicians\u2019 experiences with EHRs in Finland. Int J Med Informatics. 2017;97:266\u201381.","journal-title":"Int J Med Informatics"},{"issue":"2","key":"2337_CR32","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1093\/jamia\/ocy186","volume":"26","author":"S Bakken","year":"2019","unstructured":"Bakken S. Can informatics innovation help mitigate clinician burnout? J Am Med Inf Association. 2019;26(2):93\u20134.","journal-title":"J Am Med Inf Association 01 Februari"},{"key":"2337_CR33","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.apnr.2018.06.014","volume":"43","author":"DA Harris","year":"2018","unstructured":"Harris DA, Haskell J, Cooper E, Crouse N, Gardner R. Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Appl Nurs Research: ANR. 2018;43:36\u201341.","journal-title":"Appl Nurs Research: ANR"},{"issue":"2","key":"2337_CR34","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1093\/jamia\/ocy145","volume":"26","author":"RL Gardner","year":"2019","unstructured":"Gardner RL, Cooper E, Haskell J, Harris DA, Poplau S, Kroth PJ. et al. Physician stress and burnout: the impact of health information technology. J Am Med Inf Association. 2019;26(2):106\u201314.","journal-title":"J Am Med Inf Association"},{"issue":"4","key":"2337_CR35","doi-asserted-by":"publisher","first-page":"e054415","DOI":"10.1136\/bmjopen-2021-054415","volume":"12","author":"E Assing Hvidt","year":"2022","unstructured":"Assing Hvidt E, Christensen NP, Gr\u00f8nning A, Jepsen C, L\u00fcchau EC. What are patients\u2019 first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19. BMJ Open. 2022;12(4):e054415.","journal-title":"BMJ Open"},{"key":"2337_CR36","doi-asserted-by":"crossref","unstructured":"Bj\u00f6rndell C, Premberg \u00c5. Physicians\u2019 experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study. Scandinavian J Prim Health care. 2021;1\u201310.","DOI":"10.1080\/02813432.2021.1882082"},{"issue":"Suppl","key":"2337_CR37","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3122\/jabfm.2021.S1.200393","volume":"34","author":"J Volcy","year":"2021","unstructured":"Volcy J, Smith W, Mills K, Peterson A, Kene-Ewulu I, McNair M. Assessment of patient and provider satisfaction with the change to telehealth from In-Person visits at an academic Safety Net Institution during the COVID-19 pandemic. J Am Board Family Medicine. 2021;34(Suppl):71\u20136.","journal-title":"J Am Board Family Medicine"},{"issue":"1","key":"2337_CR38","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1186\/s12875-020-01321-8","volume":"21","author":"H Fernemark","year":"2020","unstructured":"Fernemark H, Skagerstr\u00f6m J, Seing I, Ericsson C, Nilsen P. Digital consultations in Swedish primary health care: a qualitative study of physicians\u2019 job control, demand and support. BMC Fam Pract. 2020;21(1):241.","journal-title":"BMC Fam Pract"},{"key":"2337_CR39","unstructured":"Cederberg J. Sharp increase in digital care (in Swedish, Kraftig \u00f6kning av digital v\u00e5rd). L\u00e4kartidningen."}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-023-02337-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-023-02337-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-023-02337-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T13:24:32Z","timestamp":1700573072000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-023-02337-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,19]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["2337"],"URL":"https:\/\/doi.org\/10.1186\/s12911-023-02337-7","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,19]]},"assertion":[{"value":"18 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval for the study was granted by the Swedish Ethical Review Authority (Dnr: 2018\/2318-31\/5). All study participants received written information about the study and signed an informed consent form. No other administrative permissions were required. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"During the design and data collection period, NF was employed by the online healthcare provider KRY AB, where the physicians participating in the study were recruited. NF therefore did not participate in the data collection, and joined the analysis work when a first round of coding had been completed. NF no longer works for the online healthcare provider. MH, ND and AKE declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"231"}}