The influences on physician attitudes toward the use of telemedicine for the delivery of patient care

The expectation of telemedicine as a health care delivery system that will address systemic problems confronting traditional health care delivery has largely been unrealized. For telemedicine to achieve the system change that is believed possible by its proponents, physicians must be willing to use it. In addition to commonly confronted user issues where technology is introduced such as mastering technical use of the technology itself, telemedicine requires a fundamental shift from local, familiar and traditional methods of patient referral and physician practice to distant, unfamiliar and new ways of practicing. These non-technological characteristics of telemedicine that may have a significant impact on physician attitudes toward the use of telemedicine for patient care must be studied with methodological rigour. The purpose of the teledermatology study is to explore the influence of innovation attributes as these have been defined by innovation diffusion theory, and social and organizational factors on physician attitudes toward use of telemedicine. Using three underserviced northern Ontario communities as case studies, in this practice-based study family physicians are interviewed before and after their participation in interactive continuing education teledermatology sessions where patients from their own practice have been referred and receive a dermatology consultation. Study results suggest that from the physician perspective, innovation attributes such as relative advantage and compatibility function as prerequisites to further consideration of telemedicine. The importance of trial use absent a commitment to ongoing telemedicine use is confirmed. Consistent with the uncertainty reduction process as described in theory, once physician knowledge of innovation attributes is satisfied, social and organizational and contextual factors appear to influence physician attitudes. A key finding of this study is the identification of 'value for time' as an influence on attitudes toward telemedicine. This suggests that exploration of the dimensions of 'value for time' from a physician perspective could be instructive to further understanding of telemedicine diffusion among family physicians for the delivery of patient care. Study findings also suggest that further investigation of the simultaneous use of telemedicine for the delivery of patient care and continuing education could elucidate the benefits of this model for the delivery of continuing education in medicine.

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