This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway.
This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic.
A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests.
In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting.
Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.
The digitalization of medical consultations in general practice (family medicine) has in many countries received increasing interest in recent years, with a particular focus on video consultations (VCs) [
Prepandemic research on VCs in general practice has mostly been characterized by small studies on selected patient groups [
In the context of face-to-face consultations, continuity of care [
Before the COVID-19 pandemic, around 3% of all GP consultations in Norway were performed digitally [
During the first phase of the lockdown in mid-March 2020, many GP offices restricted physical access and triaged all contacts via telephone or online communication. Almost 60% (171,169/299,148) of all GP consultations in Norway were performed digitally from March 16 to March 22 (
Most GP offices still offered face-to-face consultations for urgent issues. However, digital consultations were conducted even in situations where a physical examination would have been deemed necessary before the COVID-19 lockdown, such as acute abdominal pain or chest pain. At the time of data collection, the main technical solution for VCs in Norway was an external video application not integrated with the GP’s electronic patient record systems. However, the patients’ medical record was available to the GPs during the VCs.
The Norwegian health care system is based on the principles of universal access, decentralization, and continuity of care [
In association with the COVID-19 pandemic, recommendations regarding the use of VCs by GPs and their patients have been issued based on clinical expertise and relevant evidence [
Ideally, the large-scale implementation of VCs should have been rigorously monitored by detailed research on both GPs and patients. Due to the pressing circumstances of the lockdown, such systematic evaluation was not deemed feasible. However, conducting a large-scale survey of GPs’ experiences with the use of VCs during the lockdown was achievable and can contribute to filling important knowledge gaps.
The overall aim of this survey was to explore how GPs in Norway perceived the suitability of VCs compared to ordinary face-to-face consultations during the COVID-19 lockdown. In addition to addressing the suitability of VCs across a wide range of health problems (reasons for contact), we were also interested in knowing whether continuity of care (ie, prior knowledge of the patient/problem) had an impact on GPs’ perceptions of VC suitability.
A prospective nationwide online cross-sectional survey was conducted among GPs in Norway during the COVID-19 pandemic lockdown (April 14-May 3, 2020). The survey was addressed to all GPs registered in Norway. Basic demographic characteristics of the GPs and their practices were collected. Each GP also indicated the number of consultations and other activities conducted during the day when the survey was taken.
A central part of the survey addressed GPs’ experiences with VCs before and during the pandemic. Each GP was asked to evaluate up to 10 consecutive (or otherwise unselected) VCs during the COVID-19 lockdown, preferably conducted during the same day. The evaluation of each VC included 13 questions that covered the GPs’ prior knowledge of the patient (relational continuity), whether the reason for contact was a new problem or a follow-up (episodic continuity), the total number of presented problems, the nature of the main problem (as perceived by the GP), the perceived suitability of VC compared to an envisaged face-to-face consultation for the main problem, and actions (one or more) taken by the GP during/after the VC. The GP’s perception of the patient’s satisfaction with the VC, the technical quality of each VC, and their willingness to use VC in a similar situation after the COVID-19 pandemic were also recorded. Finally, the GPs were asked to estimate the overall proportion of VCs they personally envisaged in their practice in a “normalized” future, in light of their accumulated experience with the medium.
Questions were multiple choice with 2-11 alternative answers, depending on the topic. Questions concerning users’ experiences were scored on a 3-point or 4-point Likert scale. Regarding patients’ reasons for contact, a total of 78 alternatives were offered. This list was informed by the International Classification of Primary Care, second edition (ICPC-2), but was less detailed. Regarding actions taken during or after each VC, 16 alternatives were offered. We consulted the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) to develop the survey and report its results [
To obtain access to GPs’ updated contact emails on very short notice, the research team collaborated with Norwegian Health Informatics, a web-based portal that hosts an online clinical decision support product (NEL), to which approximately 98% of all Norwegian GPs subscribe [
Results were summarized by descriptive statistics, diagrams, and chi-square tests with 95% CIs. Background data from this survey were compared to available information on all GPs in Norway. The associations between suitability of VCs and relational continuity, episodic continuity, and the nature of the patients’ main problems were explored by diagrams, tables, and chi-square tests. The defined significance level was .05.
Before further analysis was performed, the 78 alternative reasons for contact were merged into 27 more overarching categories (eg, knee, hip, shoulder, and back problems were merged into “musculoskeletal issues”). We also merged “better” and “same” into one category regarding suitability. Data were analyzed in IBM Statistical Package for the Social Sciences (SPSS; Version 26.0, IBM Corp).
Ethical considerations were included in all phases of the survey. Participating GPs were informed that participation was voluntary and anonymous. We did not elicit sensitive information or demographic characteristics that could reveal the identity of the GPs. For the evaluated VCs, we did not elicit patients’ age, sex, specific diagnoses, or other sensitive or person-related information. Distribution of the survey to GPs’ email addresses was handled by an independent party (Norwegian Health Informatics). No linkage key was established, and participants’ IP numbers were not accessible to any party. Further approvals were thereby not required, according to Norwegian health research legislation, verified by the Norwegian Centre for Research Data (NSD).
A total of 1237 GPs participated in the survey, representing 26% (1237/4822) of the total GP population in Norway [
On average, each GP conducted 20 consultations during the surveyed working day. Of these, 6.9 (34.5%) were face-to-face consultations, 5.3 (26.5%) were VCs, 3.3 (16.5%) were text-based e-consultations, and 4.5 (22.5%) were telephone consultations. Of the 855 participants, 74 (9%) had no face-to-face consultations on the study day. Most of the respondents (80%; 687/855) did not have any experience with the use of VCs before the COVID-19 pandemic.
Characteristics of the 855 general practitioners who evaluated one or more video consultations.
Characteristics of the general practitioners (N=855) | Participants, n (%) | |
|
||
|
Female | 480 (56.2) |
|
Male | 368 (43.0) |
|
No answer | 7 (0.8) |
|
||
|
0-5 | 174 (20.3) |
|
6-10 | 189 (22.1) |
|
11-20 | 287 (33.6) |
|
>20 | 205 (24.0) |
|
||
|
<10,000 | 130 (15.2) |
|
10,000-50,000 | 295 (34.5) |
|
50,000-100,000 | 143 (16.7) |
|
100,000-500,000 | 217 (25.4) |
|
>500,000 | 70 (8.2) |
|
||
|
None | 687 (80.3) |
|
Limited (1-50 video consultations) | 123 (14.4) |
|
Relatively good (>50 video consultations) | 45 (5.3) |
On average, each GP provided an evaluation of 3.8 VCs. The final data set included 3484 unique VCs between GPs and patients (
In most VCs (79%; 2760/3484), the GP knew the patient well beforehand, while the GPs described only 8% (276/3484) of the patients as previously unknown. More than half of the consultations (55%; 1921/3481) were a follow-up of a previous problem. On average, 1.9 (median 2.0) problems/issues were discussed during each consultation. Half of the VCs (51%; 1766/3476) were considered to have similar or even better suitability to assess the main reason for contact compared to face-to-face consultations. For 15% (514/3476) of the VCs, the GPs expressed concern that they might not have detected potential signs of serious illness. The lack of opportunity to physically examine the patient was reported as a “major loss” or “some loss” in 25% (884/3475) and 36% (1232/3475) of the VCs, respectively. In 85% (2967/3475) of cases, the GPs perceived that the patient was satisfied with the VC. The technical quality was considered good in 90% (3118/3475) of the VCs. Half of the GPs (1704/3475) considered it realistic to handle a similar issue by VC after the COVID-19 pandemic.
Characteristics of the 3484 recorded video consultations. Missing answers (ranging from 0-9 general practitioners per question) are not displayed.
Characteristics of the video consultations (N=3484) | Values, n (%) | |
|
||
|
Very good | 1788 (51.3) |
|
Good | 972 (27.9) |
|
Some | 448 (12.9) |
|
None | 276 (7.9) |
|
||
|
New problem | 1560 (44.8) |
|
Follow-up | 1921 (55.1) |
|
||
|
1 | 1471 (42.2) |
|
2-4 | 1930 (55.4) |
|
>4 | 75 (2.2) |
|
||
|
Better or same | 1766 (50.7) |
|
Worse | 1709 (49.1) |
|
||
|
Better or same | 1767 (50.7) |
|
Worse | 1709 (49.1) |
|
||
|
No loss | 1359 (39.0) |
|
Some loss | 1232 (35.4) |
|
Major loss | 884 (25.4) |
|
||
|
Not worried | 2009 (57.7) |
|
Neutral | 953 (27.3) |
|
Worried | 514 (15.0) |
|
||
|
Very satisfactory | 988 (28.4) |
|
Satisfactory | 1979 (56.8) |
|
Unsatisfactory | 368 (10.6) |
|
Do not know | 140 (4.0) |
|
||
|
Very satisfactory | 1433 (41.1) |
|
Satisfactory | 1685 (48.4) |
|
Unsatisfactory | 273 (7.8) |
|
Video consultation terminated due to technical problems | 84 (2.4) |
|
||
|
Yes | 1704 (48.9) |
|
Do not know | 768 (22.0) |
|
No | 1003 (28.8) |
The association between GPs’ perceptions of the suitability of VCs and their previous knowledge of their patients (relational continuity) is presented in
In
In
Association between relational continuity (previous knowledge of the patient) and general practitioners' perceived suitability of video consultations compared to an envisaged face-to-face consultation for the same issue (95% CIs are illustrated by lines). GP: general practitioner; VC: video consultation.
Association between episodic continuity (new problem or follow-up of previously defined problem) and general practitioners' perceived suitability of the video consultations, compared to envisaged face-to-face consultations for the same problem (95% CIs are illustrated by lines). VC: video consultation.
Video consultations perceived by the GPs as equally or better suited compared to an envisaged face-to-face consultation, shown as combinations of pre-existing knowledge of the patient (relational continuity) and the main reason for contact (episodic continuity).
Main reason for contact | Pre-existing knowledge of patient | |||
Very good/good (n=2754) | Some/none (n=721) | |||
Number of video consultations, n/N | Proportion, % (95% CI) | Number of video consultations, n/N | Proportion, % (95% CI) | |
New problem (n=1556) | 389/1035 | 38 (35-41) | 155/521 | 30 (26-34) |
Follow-up (n=1919) | 1070/1719 | 62 (60-65) | 95/200 | 48 (41-54) |
GPs considered VCs to be equally or better suited for several reasons for contact, compared to envisaged face-to-face consultations (
General practitioners' perceived suitability of video consultations compared to an envisaged face-to-face consultation for the same issue, according to the nature of the main problem/reason for contact. The contact reasons are presented in decreasing frequency (n) from top to bottom, and 95% CIs are illustrated by lines. VC: video consultation.
Furthermore, for each main reason for contact, the perceived suitability of VCs differed according to episodic continuity of care (
Suitability of video consultations compared to face-to-face consultations, association with main reason for contact (new problem/follow up), and the 20 most common issues/presented problems, N=3350.
Issue/presented problem | Main reason for contact | |||||||
New problem (n=1484) | Follow-up (n=1866) | |||||||
Better or same (n=529) | Worse (n=955) | Better or same (n=1140) | Worse (n=726) | |||||
Contacts, n/N | Proportion, % (95% CI) | Contacts, n/N | Proportion, % (95% CI) | Contacts, n/N | Proportion, % (95% CI) | Contacts, n/N | Proportion, % (95% CI) | |
Mental illness/life stress | 67/105 | 64 (54-73)a | 38/105 | 36 (28-46)a | 442/579 | 76 (73-80)a | 137/579 | 24 (20-27)a |
Musculoskeletal problems | 33/183 | 18 (13-24)a | 150/183 | 82 (76-87)a | 154/286 | 54 (48-60) | 132/286 | 46 (40-52) |
Suspicion of COVID-19 or COVID-19–related | 99/222 | 45 (38-51) | 123/222 | 55 (49-62) | 46/94 | 49 (39-59) | 48/94 | 51 (41-61) |
Skin disorders | 69/234 | 30 (24-36)a | 165/234 | 71 (64-76)a | 29/66 | 44 (32-56) | 37/66 | 56 (44-68) |
Children | 52/173 | 30 (24-37)a | 121/173 | 70 (63-76)a | 41/74 | 55 (44-66) | 33/74 | 45 (34-56) |
Lung | 27/96 | 28 (20-38)a | 69/96 | 72 (62-80)a | 26/87 | 30 (21-40)a | 61/87 | 70 (60-79)a |
Administrative issues | 45/57 | 79 (67-88)a | 12/57 | 21 (12-33)a | 62/80 | 78 (68-86)a | 18/80 | 23 (14-33)a |
Gynecology and pregnancy | 24/50 | 48 (35-62) | 26/50 | 52 (38-65) | 39/74 | 53 (41-64) | 35/74 | 47 (36-59) |
Infection | 25/84 | 30 (21-40)a | 59/84 | 70 (60-79)a | 10/32 | 31 (17-48) | 22/32 | 69 (52-83) |
Endocrinology | 6/15 | 40 (19-65) | 9/15 | 60 (35-81) | 54/99 | 55 (45-64) | 45/99 | 46 (36-55) |
Cardiovascular | 2/37 | 19 (9-34)a | 30/37 | 81 (66-91)a | 32/72 | 44 (33-56) | 40/72 | 56 (44-67) |
Complex issues and disorders | 10/20 | 50 (29-71) | 10/20 | 50 (29-71) | 65/86 | 76 (66-84)a | 21/86 | 24 (16-34)a |
Gastrointestinal | 12/47 | 26 (15-39)a | 35/47 | 75 (61-85)a | 20/50 | 40 (27-54) | 30/50 | 60 (46-73) |
ENT (ear, nose, and throat) | 23/68 | 34 (23-46)a | 45/68 | 66 (54-77)a | 12/22 | 55 (34-74) | 10/22 | 46 (26-66) |
Neurology | 4/20 | 20 (7-41)a | 16/20 | 80 (59-93)a | 39/51 | 77 (64-86)a | 12/51 | 24 (14-36)a |
Cancer follow-up | 2/3 | 67 (18-96) | 1/3 | 33 (4-82) | 28/41 | 68 (53-81)a | 13/41 | 32 (19-47)a |
Eye | 12/36 | 33 (20-50)a | 24/36 | 67 (51-80)a | 1/4 | 25 (3-72) | 3/4 | 75 (28-97) |
Urology | 9/22 | 41 (23-62) | 13/22 | 59 (39-78) | 5/15 | 33 (14-58) | 10/15 | 67 (42-86) |
Headache | 1/8 | 13 (1-45)a | 7/8 | 88 (55-99)a | 13/25 | 52 (33-71) | 12/25 | 48 (30-67) |
Intoxication and addiction | 2/4 | 50 (12-88)a | 2/4 | 50 (12-88)a | 22/29 | 76 (58-89)a | 7/29 | 24 (12-42)a |
aNonoverlapping CIs.
A total of 7647 actions were registered by the GP during/after the VCs (
VCs were deemed to be less suitable in situations where a physical follow-up was subsequently planned (ie, a face-to-face consultation in the near future, referrals to medical imaging, laboratory examinations, and hospitalizations;
Action taken during/after the 3484 evaluated video consultations. Several actions could be registered for each video consultation.a
Type of actions taken during/after the video consultation (N=7647) | Count, n | % |
Comprehensive advice and guidance | 1646 | 47 |
Planning a new video consultation or text-based e-consultation | 1197 | 34 |
Prolongation of sick leave certificate | 791 | 23 |
Planning of face-to-face consultation some time ahead | 486 | 14 |
Prescription of new medication | 429 | 12 |
Referral to laboratory testing | 425 | 12 |
Renewal of established medication | 408 | 12 |
Referral to other medical specialists (nonacute) | 395 | 11 |
New sick leave certificate | 391 | 11 |
No new appointment made; contact doctor if needed | 390 | 11 |
Planning of face-to-face consultation in near future | 388 | 11 |
Various other actions | 268 | 8 |
Prescription of antibiotics | 145 | 4 |
Referral to medical imaging | 119 | 3 |
Prescription of sedatives or hypnotics (addictive drugs) | 90 | 3 |
Hospitalization or acute referral | 79 | 2 |
aIn total, 8 evaluated video consultations did not have a registered action.
Associations between general practitioners' perceived suitability of video consultations and actions taken during/after the consultation. The actions taken are sorted by general practitioners' perceived suitability (better or same) of the video consultation in question, displayed in decreasing order. 95% CIs are illustrated by lines. VC: video consultation.
Based on their accumulated experience with VCs, participating GPs estimated that on average, 19% of all their consultations (median 20%) could be conducted via video in a normalized, nonpandemic future. Further analyses showed that this estimate was not associated with the GP’s geographic context, previous experience with VCs, age, or gender.
This online, cross-sectional survey conducted among GPs in Norway during the COVID-19 pandemic lockdown provides new knowledge about GPs’ experiences with large-scale uptake of VCs within the context of an established national primary health care system. Data collection took place in a phase of the lockdown when infection rates had peaked and most GPs had adapted their working practices, including implementation of VCs, to the pandemic circumstances.
Overall, VCs were perceived as equally or even more suitable than face-to-face consultations in about half of the 3484 evaluated cases. VCs appeared significantly more appropriate in the context of an established doctor-patient relationship and in relation to a previously defined reason for contact. GPs expressed concern about immediate patient safety (ie, the risk of missing signs of serious disease) in 15% (514/3476) of the evaluated cases.
Most of the survey was developed around the perceived suitability of VCs in general practice, compared to ordinary face-to-face consultations. It was therefore essential to ensure that the participating GPs had a shared understanding of the concept of suitability. Face validity of the term was assessed when the survey was pilot tested and was found to be satisfactory. Moreover, GPs were instructed to evaluate the suitability of VCs without emphasis on the evident gain of reducing the risk of viral contamination. Furthermore, the analysis of the association between perceived suitability and actions taken in the VCs contributed to the validation of the suitability concept. Consultations categorized with low suitability for VCs often had an “unfinished” character, thus requiring further clinical investigations and/or referrals that could have been more effectively managed in an ordinary face-to-face consultation (
A central finding in this survey was a strong and consistent association between both relational and episodic continuity of care and GPs’ perceptions of the suitability of VCs (
The predefined list of medical issues used to categorize the main contact reason (presented problem) for each evaluated VC was developed for the purpose of this survey to provide a clinically relevant overview while being general enough to safeguard patient anonymity. We acknowledge that the opportunity to categorize only one (perceived by the GP as the main) reason for contact underrates the clinical complexity of the evaluated VCs, as many of them dealt with two or more health problems (
Moreover, under the given circumstances, we found that VCs were suitable for a variety of mental health problems, along with other chronic or complex issues such as chronic pain, tiredness, sleeping problems, follow-up of established cancer treatment, and administrative purposes (
Contacts related to skin problems, pediatric issues, and acute and potentially severe health problems (such as abdominal pain, chest pain, and respiratory difficulties) were found to be the least suitable for VCs. Real-time video might be a feasible alternative to face-to-face and store-and-forward (asynchronous) consultations for selected skin issues [
Our material included only 23 cases where the main problem was categorized as “geriatric,” and the majority of these cases were classified with low suitability for VC. This aligns well with previous concerns that VCs may not be suitable for use by frail, older patients [
Our study participants constitute approximately 26% (1237/4822) of all registered GPs in Norway. Their demographic characteristics are well representative of the GP population in Norway, with the exception of a slightly higher representation of younger doctors [
Before deciding to participate in the survey, invited GPs were informed that VCs would be a central topic, but not a prerequisite for participation. This may nonetheless have attracted GPs with a positive attitude toward digital solutions. As mentioned in the introduction, many GPs who acquired VC equipment in relation to the pandemic lockdown hardly used it in practice. As previously argued, the implementation of VCs is not mainly a simple question of equipment installation, but a complex process of integrating a new consultation modality into established working routines [
On average, each participating GP performed five VCs on the day of the survey, while typically evaluating three of these. The survey instructed the GPs not to purposefully select particular types of VCs for evaluation. Although we cannot rule out possible selection bias, it is unlikely that GPs would deliberately restrict their contribution to specific cases. The risk of substantial confirmation bias is therefore considered low.
However, other important selection mechanisms may have influenced our VC material. The study was undertaken in a lockdown period when patients were typically recommended to consult their GPs digitally or by phone before a physical consultation could be considered. In some GP offices, patients could book a VC directly through an online booking system. Beyond this, there were no formal guidelines on how to select patients for VCs. Irrespective of variations in booking systems, many GP offices would arrange physical consultations for selected urgent health problems. Nevertheless, our material includes numerous cases that would normally be considered poorly suited for VC (eg, acute abdomen and chest pain). This aligns well with the fact that participating GPs relatively often reported that they missed the opportunity to perform a physical examination (61% of cases) or expressed concern that they might have misjudged the severity of the presented health problem (15% of cases). Our results cannot be generalized to the use of VCs under nonpandemic circumstances, but we believe they have substantial external validity.
The COVID-19 pandemic has led to a crisis for many people and organizations worldwide. At the same time, it has offered opportunities to rethink what is important in general practice and really put new consultation modalities to the test [
In our study, GPs experienced technical difficulties in 10% of the consultations, somewhat less than a comparable study performed in New York City in March 2020, where technical problems were reported in 13% of consultations [
Comparison of clinical practice during lockdown with practice-as-usual reveals numerous discrepancies, both obvious and subtle [
Our study of VCs performed in Norwegian general practice during the pandemic lockdown indicates a future role for VCs in future, nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning. In accordance with existing literature and guidance, GPs’ perceived suitability of VCs varied considerably across reasons for contact and presented health problems. The findings cannot be directly generalized beyond the specific context of the pandemic lockdown, but nevertheless provide interesting results regarding the performance of VCs for different reasons for contact and clinical conditions. The results indicate that GPs still consider the physical examination a crucial element of many consultations to enhance both diagnostic accuracy and quality of care in a wider sense. Reflecting on the accumulated experience with VCs, most participating GPs envisaged conducting 20% of their consultations by video in a future, nonpandemic setting.
Consultations with general practitioners in Norway during the COVID-19 lockdown. The shaded period corresponds to the period of the data collection. April 6-12, 2020, was the Easter holiday week. Data obtained from Norwegian general practitioners' reimbursement claims and The Norwegian Directorate of eHealth.
Digital consultations with general practitioners in Norway during the COVID-19 lockdown. The shaded period corresponds to the period of data collection. April 6-12, 2020, was the Easter holiday week. Data from Norwegian general practitioners' reimbursement claims and The Norwegian Directorate of eHealth.
general practitioner
video consultation
After the survey was conducted, TMJ and BLN held part-time positions at the Norwegian Centre for E-health Research in Tromsø, Norway. FLO 2.0 (a GP-driven, nonprofit organization dedicated to the sustainable development of Norwegian general practice) covered the license to Netigate.
Norwegian Health Informatics made a crucial contribution with the dispatch of the survey through their subscriber email list and website. The Norwegian Directorate of eHealth and Confrere provided background data on video consultations.
TMJ and NLB developed the survey together with LG, FHK, and BA. EK and PZ subsequently joined the team and contributed substantially to data analysis, interpretation of results, and writing, together with the rest of the authors.
The authors declare no conflicts of interests. The commercial actors who distributed the survey (Norwegian Health Informatics) and contributed information on the use of VCs in Norway in spring 2020 (Confrere) were at no point involved in the design of the survey or data analysis.