ABSTRACT
Objective: We aimed to explore the factors that influence medical students' intention to integrate dHealth technologies in their practice and analyze the influence of the COVID-19 pandemic on their perceptions and intention. Methods: We conducted a two-phased survey study at the University of Montreal's medical school in Canada. The study population consisted of 1367 medical students. The survey questionnaire was administered in two phases, that is, an initial survey (t0) in February 2020, before the Covid-19 pandemic, and a replication survey (t1) in January 2021, during the pandemic. Component-based structural equation modeling (SEM) was used to test seven research hypotheses. Results: A total of 184 students responded to the survey at t0 (13%), whereas 138 responded to the survey at t1 (10%). Findings reveal that students, especially those who are in their preclinical years, had little occasion to experiment with dHealth technologies during their degree. This lack of exposure may explain why a vast majority felt that dHealth should be integrated into medical education. Most respondents declared an intention to integrate dHealth, including AI-based tools, into their future medical practice. One of the most salient differences observed between t0 and t1 brings telemedicine to the forefront of medical education. SEM results confirm the explanatory power of the proposed research model. Conclusions: The present study unveils the specific dHealth technologies that could be integrated into existing medical curricula. Formal training would increase students' competencies with these technologies which, in turn, could ease their adoption and effective use in their practice.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. OBJECTIVE: This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? METHODS: A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. RESULTS: A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly "automated appointment confirmation and reminders" and "online appointment confirmation, modification, or cancellation by the patient." More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic's electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. CONCLUSIONS: The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions.