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The PCP's gatekeeper role in the era of telemedicine

In the last few years, more and more private actors have begun offering doctor’s appointments over video. If primary care physicians offer appointments over video as well, they’ll be able to secure their gatekeeper role in the digital age.


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The PCP has traditionally been the hub for both primary health care and specialist healthcare, acting as the filter that refers the patient to follow-up with specialists when needed.

If more and more patients choose to seek out private digital medical services instead of approaching their PCP when in need of a doctor, there will be a serious threat to the PCP's role. In our article in the Norwegian newspaper, Aftenposten, we point out how video doctors have created new challenges for PCP. But if PCPs make a habit of offering video appointments, they may pose even greater challenges to the fast-growing video-doctor market.

Over 30,000 video appointments per month in Sweden

Sweden doesn’t have regular PCPs but rather so-called health centers, which are controlled regionally. Because the Swedish telemedicine company, Kry, has an agreement with the public health service in Sweden, we have been able to request statistics on its use. September 2016 was the last month without any video consultations. Two years later, the figure had risen to 31,846 in the month of July 2018. This is a dramatic growth.

Sweden's largest patient group is under 35-years-old, with young children under 4-years-old. In Stockholm county, one-in-four doctor’s appointments with parents of children in this age group are made over video.

Why are parents of young children such eager users?

In Norway, parents of infants and young children report that they attempt to and prefer to speak with a doctor on the same day that their children get sick. They want to make sure that the sickness isn’t serious, and get advice on the best way to treat them.

If they can’t get an appointment with their PCP on the day-of, they’ll go to a private or public emergency room. The same has been found in research conducted through the Oslo ER system. Nearly half of patients had attempted to get an appointment with their family PCP before going to the ER, according to an article published by the Scandinavian Journal of Primary Health Care.

Both the researchers who conducted the survey through the Oslo ER system and the Medical Association’s (Legeforening) report about gatekeeper roles from 2017 emphasize that high availability is a necessary requisite for the PCP-as-gatekeeper system to work in practice.

A serious threat

There are many reasons to believe that the use of private video-doctor services will grow a lot in Norway when we compile the Swedish statistics and the study done through the Oslo ER system. Such a development would be a serious threat to the gatekeeper role of primary care physicians.

If younger generations don’t think that it’s useful or necessary to turn to a PCP but go straight to a private video-doctor instead, they run the risk of never building a relationship with their PCP.

Surveys conducted in Sweden by Dagens Medicin (Swedish medical periodical) suggest that video appointments offered by private “video doctors” (who never meet patients in person) have not contributed to greater efficiency in the healthcare system as there has not been a decrease in patients seeking out in-person doctor’s appointments. However, when PCPs offer video appointments, it works to alleviate the pressure on clinic hours because the PCP can decide who ought to come for an in-person appointment, and for whom a video appointment was enough.

When it comes to the Norwegian PCP system, we can ensure that patients meet the same doctor over video that they do at the office. This means that video appointments can help strengthen the gatekeeper role, rather than weaken it.

PCPs can offer video appointments

The necessary formalities that allow PCPs to offer video appointments are already taken care of in Norway, as well as in most countries that support telemedicine.

At the same time, PCPs are getting more and more patients, and they have limited time to try out new tools. Some PCPs have, nevertheless, gone ahead and found innovative ways to organize video appointments, like setting aside video-hours, among other things.

The goal must be to protect the PCP’s gatekeeper role in the digital era. We can’t simply sit back until the day that the patient population has understood, and expects, that digital services are offered only by private actors.

Video-doctors have challenged primary care physicians. If primary care physicians also offer appointments over video, they can overcome this challenge and secure their gatekeeper role in the digital era.

Anders Aspaas
Anders Aspaas
Head of Sales
anders@confrere.com
Phone number +47 984 24 471
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