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Abstract

Objectives

: To investigate the willingness of the general Hong Kong population to use teleconsultation in primary care and the factors affecting their decisions and to ascertain the medical problems for which people will consider using teleconsultation in primary care. The study was a cross-sectional territory-wide random population survey on adults recruited through a computer-assisted telephone interview system.

Outcome Measures

: Outcomes were the proportion of the general Hong Kong population indicating their willingness to use teleconsultation in primary care; the drivers and barriers affecting their willingness; and the medical problems in primary care for which people would consider using teleconsultation.

Results

: After applying population weighting, 51.6% of the study respondents were found to be willing to use teleconsultation in primary care. The main drivers were possessing the perception that teleconsultation would serve the majority of their health problems (odds ratio [OR] = 3.693, p < 0.001), provision of government subsidy (OR = 3.567, p < 0.001), and ownership of a computer/tablet (OR = 2.116, p < 0.001). A major barrier for people’s reluctance to use teleconsultation in primary care was having an education level of primary or below (OR = 0.388, p = 0.002). The majority of people had reasonable expectations on which medical conditions teleconsultation could be helpful but misunderstandings did exist.

Conclusion

: Our survey estimated that more than half of the general Hong Kong population was willing to use teleconsultation in primary care. Health care service providers and the government should address the drivers and barriers and clarify any misconceptions if teleconsultation is to be further developed in the Hong Kong primary care system.

Introduction

Telemedicine is defined by the World Health Organization as “the delivery of health care services where distance is a critical factor, by all health-care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries all in the interests of advancing the health of individuals and their communities.”¹ Teleconsultation, provision of remote clinical services to clients/patients, is one of the ways how telemedicine is being conducted.¹ Teleconsultations are most commonly conducted via telephone or video.² Due to the constraint in physical examination, teleconsultation plays only a minor role in most health care systems.^3,4

In Hong Kong, the development in teleconsultation was not a priority in the past due to the easy accessibility of health care services in this compact city. Few people had used teleconsultation, and the majority of the studies related to teleconsultation in Hong Kong mainly focused on its application in different clinical settings together with the health care provider’s perceptions and specific patient’s acceptance or experience.^5,6

Among the few local studies, Hui and Woo⁵ published a paper in 2002 on the feasibility, acceptability, and cost-effectiveness of using telemedicine (videoconferencing) in the public health care system to provide geriatric services to residents of nursing homes. In 2016, Kung et al.⁶ conducted an exploratory qualitative study of 30 patient’s views on medical e-consultation in a public primary care setting to assess perceived advantages and concerns of e-consultation. The most notable advantages of e-consultation expressed by the participants of that study were convenience, expected shorter waiting time, and removal of geographic barriers.

However, participants also expressed concerns such as technical difficulties with computer or internet access, lack of personal interaction leading to possibility of inaccuracy in doctor’s diagnoses, pitfalls in cyber security and safety, and issues of getting medications after the e-consultation. Nonetheless, people did express that they would consider using e-consultation if it was simple to use or help from family members or friends was available, especially when their presenting condition was mild or if the consultation only involved a simple follow-up. Participants also suggested that the government could play a role to enhance patient’s trust in e-consultation by setting up relevant operational regulations. The study provided us with insights toward the patients’ needs and concerns toward teleconsultation.

The COVID-19 pandemic changed the world drastically and prompted everyone to turn to teleconsultation service provision and research. During the pandemic, the number of teleconsultation visits in the United States increased by 50% in the first quarter of 2020 compared with the same period in 2019.⁷

When the pandemic hit Hong Kong in 2020, custom-made teleconsultation platforms first emerged in the private health care sector and attracted the younger generation to try this alternative mode of consultation.⁸ Two years later in July 2022, teleconsultation service exclusive for COVID-19 patient management was also available in the public sector.⁹

After 3 years of fighting against the pandemic, in May 2023, the World Health Organization declared COVID-19 was no longer a public health emergency of international concern but should be regarded as an established and ongoing health issue.¹⁰ Governments around the world began to review their public health policies and health care systems’ sustainability. Further developing teleconsultation seemed to be a solution to prepare for future epidemiological crises and to enhance health care accessibility. As primary health care researchers in Hong Kong, our question was “How ready is our general population to accept teleconsultation?”

During the pandemic, Hong Kong population’s smart phone coverage and people’s information technology literacy increased, as around 20,000 smart phones were provided to citizens of the lower socioeconomic class by charity bodies.¹¹ An online survey conducted by Lingnan University in Hong Kong in May 2020 during the pandemic revealed that among the 638 respondents aged 55 years or more, 61.3% were willing to use teleconsultation “when the relevant technology is fully developed.”¹² The fairly high receptiveness of teleconsultation among the senior citizens in this pilot survey suggested that teleconsultation might be a viable alternative to face-to-face consultations in our locality. However, how “mature” the technology would it then be considered by the public to be “fully developed” remained unanswered.

Another small-scale survey involving 109 participants conducted in Hong Kong in late 2020 among the elderly relatives (age ≥60 years) of a group of medical students revealed that provision of government subsidies for telemedicine services would be the strongest driver, and the only positive independent predictor toward the use of telemedicine both during a severe outbreak, as well as after the COVID-19 pandemic.¹³

Our study was the first large-scale population-wide survey to examine the knowledge, attitude, and main concerns of the Hong Kong general public toward using teleconsultation in primary care. We aimed to ascertain the population’s willingness to use teleconsultation and identify the drivers, barriers, and misconceptions behind. We hoped our study could provide insights to inform policy and guide further service development in the field.

Methods

STUDY DESIGN AND SETTING

Data were derived from a cross-sectional, territory-wide random population survey conducted via telephone interviews from October to November 2023. All Hong Kong residents of ≥18 years old with an ability to communicate through telephone by either Cantonese (the most common dialect used in the locality) or English were eligible to participate in the survey. Subjects were recruited through computer-assisted telephone interview system by a local professional public opinion survey center: the Center for Communication and Public Opinion Survey (CCPOS)¹⁴ of The Chinese University of Hong Kong. Participants were recruited through a mixed mode of fixed line telephones and mobile phones in order to obtain a random sample. Verbal consent was obtained from all participants included in the study.

The latest census statistics (July 2022) of Hong Kong¹⁵ was adopted in this study for weighting purposes to project the results to the general Hong Kong population. Since the target respondents in this survey were people aged 18 years or above (instead of aged 15 years or above in the report published by Census and Statistics Department¹⁵), the CCPOS had requested the Census and Statistics Department to provide this study with the corresponding data of age 18 or above to produce the weighted data appropriate for our study’s analyses. A similar weighting mechanism had been used by Bedford et al. in their study on the sleep quality of the general Hong Kong population.¹⁶

OUTCOME VARIABLES

The primary outcome in this study was the percentage of the general Hong Kong population indicating their willingness to use teleconsultation in primary care. The secondary outcomes were the demographical factors, people’s knowledge and attitudes toward teleconsultation as the drivers and barriers affecting their willingness, and the ascertainment of medical problems for which patients would seek help with teleconsultation in primary care.

DATA COLLECTION

Pilot testing on the flow of the study was conducted by the CCPOS with 22 subjects using the sampling method mentioned above. The questionnaire was generally well received. The final questionnaire used in the study proper was shown as “Supplementary Data S1.” The key question (Q7), “If teleconsultation is available with your family doctor or the general outpatient clinic, would you consider trying this mode?” was used to address the primary outcome of this study. Major demographical, health-service utilization, and clinical characteristics of the participants were also obtained together with their knowledge and attitudes toward teleconsultation. The participant’s opinions on whether they would use teleconsultation under different clinical scenarios were also collected.

STATISTICAL ANALYSES

For the sample size calculation, we took the conservative estimate of 61.3% from the online survey conducted by the Lingnan University in May 2020 among senior citizens who indicated their interests in using teleconsultation during the COVID-19 outbreak.¹² A sample size of 1,496 was required to construct a two-sided 95% exact Clopper–Pearson confidence interval for the proportion of population indicating their preference in using teleconsultation such that the width of the interval was no wider than 0.05.

Descriptive statistics namely frequencies and percentages of categorical variables were reported for the participant’s demographic and clinical characteristics and their knowledge and attitudes toward the various aspects of teleconsultation. In addition to the analysis at the original sample level, weighted sample data provided by the CCPOS as mentioned previously using random iterative method (RIM method)¹⁷ to project the result in general population level were also analyzed. Multivariable binary logistic regressions were used to assess the single and adjusted effects of sociodemographic factors, knowledge, attitudes, and clinical factors toward the likelihood of people’s willingness to use teleconsultation. Multicollinearity between predictor variables was examined by both correlation matrix and variance inflation factor (VIF). VIF <10 indicated the complete absence of multicollinearity. All tests of significance were two-tailed, and p < 0.05 was considered as statistically significant. Statistical analyses were performed using the Statistical Product and Service Solutions (SPSS).

Results

SUBJECT CHARACTERISTICS

Our study successfully recruited 1,507 subjects to complete the telephone interviews. Fig. 1 illustrates the subject recruitment flow. The overall response rate was 39%, which was similar to previous surveys conducted by the CCPOS.

Fig. 1.

Subject Flowchart.

Results of all demographic variables of the unweighted (original) and the weighted samples as provided by the CCPOS are listed in Table 1. In the weighted sample, most people reported to possess a smartphone (90.3%) or a computer/tablet (72.2%) with internet access. The majority (67.4%) of them did not require chronic follow-up in primary care. Table 2 describes the clinical characteristics of the minority of participants who required chronic follow-up.

Table 1.

Demographic Characteristics of the Participants (N = 1,507)

	UNWEIGHTED (THE ORIGINAL) SAMPLE (N = 1,507)		WEIGHTED SAMPLE (N = 1,507)
	FREQUENCY	PERCENTAGE (%)	FREQUENCY	PERCENTAGE (%)
GENDER
Female	774	51.4	797	52.9
Male	733	48.6	710	47.1
Age group
18–19	37	2.5	37	2.4
20–29	200	13.3	163	10.8
30–39	236	15.7	233	15.5
40–49	298	19.8	254	16.8
50–59	289	19.2	281	18.7
60–69	259	17.2	282	18.7
70–79	146	9.7	207	13.8
80 or above	32	2.1	40	2.6
Unanswered	10	0.7	10	0.7
Education Level
Never received any formal education/ pre-primary level	8	0.5	15	1.0
Primary level	106	7.0	181	12.0
Lower secondary level (S1-S3)	179	11.9	305	20.2
Higher secondary level (S4-S7)	425	28.2	449	29.8
Tertiary level: Nondegree bearer	137	9.1	95	6.3
Tertiary level: Bachelor degree or above	639	42.4	449	29.8
Unanswered	13	0.9	13	0.9
Occupation Status
Employer/ Manager/Administrative Personnel	163	10.8	123	8.2
Professional	177	11.7	124	8.3
Associate Professional	162	10.7	150	9.9
Clerical	166	11.0	146	9.7
Service provider/salesperson	114	7.6	130	8.6
Manual worker	112	7.4	145	9.6
Retiree	287	19.0	340	22.6
Home-maker	151	10.0	183	12.2
Student	85	5.6	70	4.6
Unemployed	62	4.1	69	4.6
Unanswered	28	1.9	27	1.8
Possession of a smartphone with internet access
No	97	6.4	142	9.5
Yes	1,407	93.4	1,362	90.3
Unanswered	3	0.2	3	0.2
Possession of a computer or tablet with internet access
No	295	19.6	413	27.4
Yes	1,206	80	1,088	72.2
Unanswered	6	0.4	6	0.4

Table 2.

Clinical Characteristics of the Participants (n = 1,507)

MEDICAL CONDITIONS REQUIRING FOLLOW-UP BY PRIMARY CARE DOCTORS	UNWEIGHTED (THE ORIGINAL) SAMPLE (N = 1,507)		WEIGHTED SAMPLE (N = 1,507)
	FREQUENCY	PERCENTAGE (%)	FREQUENCY	PERCENTAGE (%)
Hypertension	187	12.4	227	15.0
Diabetes mellitus	81	5.4	101	6.7
Hyperlipidemia	102	6.8	127	8.5
Gastrointestinal problem	9	0.6	10	0.7
Skin problem	12	0.8	12	0.8
Asthma or chronic obstructive pulmonary disease	4	0.3	5	0.3
Allergic rhinitis	4	0.3	4	0.3
Psychological problem	15	1.0	19	1.3
Joint(s) pain	20	1.3	30	2.0
Other chronic diseases	138	9.2	161	10.7

Table 3 illustrates the health care utilization characteristics of the participants. Most people (81.5%) could have access to their primary care service providers in less than 30 min in terms of physical distance. A small proportion of the participants (6.6%) required assistance to attend a primary care service point. Only 11.5% of the participants had prior experience in using teleconsultation as a patient. When we asked the key question, “If teleconsultation is available with your family doctor or the general outpatient clinic, would you consider trying this mode?” 51.6% of the participants replied “Yes”. Among those who are willing to try teleconsultation in primary care, >90% considered a charge of lower than or equal to face-to-face consultation as reasonable. Only 6.5% of these respondents accepted a higher charge.

Table 3.

Health Care Utilization Characteristics of the Participants (N = 1507)

	UNWEIGHTED (THE ORIGINAL) SAMPLE (N = 1,507)		WEIGHTED SAMPLE (N = 1,507)
	FREQUENCY	PERCENTAGE (%)	FREQUENCY	PERCENTAGE (%)
Habit of using public versus private primary care when feeling unwell
Public	431	28.6	490	32.5
Private	990	65.7	928	61.5
Similar for both	76	5.0	79	5.2
Unanswered	10	0.7	10	0.7
Frequency of primary care utilization per year
0 to 1	469	31.1	459	30.4
2 to 4	691	45.9	676	44.8
5 to 10	247	16.4	255	16.9
More than 10	91	6.0	107	7.1
Unanswered	9	0.6	11	0.7
Accessibility to primary care clinic
Within 15 min	627	41.6	615	40.8
15–30 min	597	39.6	613	40.7
31–60 min	214	14.2	200	13.3
More than 1 hour	62	4.1	72	4.8
Unanswered	7	0.5	6	0.4
Needs assistance to attend primary care service
No	1,412	93.7	1,400	92.9
Yes	87	5.8	99	6.6
Unanswered	8	0.5	8	0.5
Previous number of episodes of using teleconsultation as a patient
0	1,314	87.2	1334	88.5
1	133	8.8	121	8.0
2	40	2.7	35	2.3
3	9	0.6	8	0.5
4	3	0.2	2	0.2
5	2	0.1	2	0.1
6 or more	6	0.5	5	0.3
Willingness to be engaged in teleconsultation in primary care
No	665	44.1	715	47.5
Yes	829	55	778	51.6
Unanswered	13	0.9	13	0.9
Amount willing to be paid for teleconsultation (including medications and documents delivery) when compared with conventional face-to-face consultation?	n = 842		n = 792
Less than the normal charge of a face-to-face consultation	388	46.1	370	46.8
Same as the normal charge of a face-to-face consultation	391	46.4	358	45.3
Up to HKD50 more than the normal charge of a face-to-face consultation	14	1.7	14	1.8
Up to HKD100 more than the normal charge of a face-to-face consultation	27	3.2	24	3.1
Up to HKD200 when compared with the normal charge of a face-to-face consultation	4	0.5	4	0.5
More than HKD200 when compared with the normal charge of a face-to-face consultation	7	0.8	8	1.1
Unanswered	11	1.3	12	1.5

Table 4 lists out the participant’s decisions as to whether they would choose teleconsultation under various medical conditions. More than half of the participants in the weighted sample stated that they would consider using teleconsultation when they suffered from mild respiratory tract (60.6%) or gastrointestinal symptoms (53.2%) or for stable known chronic illnesses follow-up (65.9%). On the other hand, although being the minorities, significant proportions of the participants would consider using teleconsultations in medical emergencies such as acute chest pain (20.9%), shortness of breath (27.2%), suspected stroke (16.5%), or if they had thoughts of self-harm or harming others (32.8%).

Table 4.

Proportion of Participants Who Would or Would Not Consider Using Teleconsultation Service in Primary Care Under Different Clinical Scenarios (N = 1,507)

	UNWEIGHTED (THE ORIGINAL) SAMPLE (N = 1,507)			WEIGHTED SAMPLE (N = 1,507)
MEDICAL CONDITIONS	YES (%)	NO (%)	UNANSWERED (%)	YES (%)	NO (%)	UNANSWERED (%)
Acute chest pain	20.9	78.5	0.6	20.9	78.6	0.5
Difficulty breathing	28.4	70.5	1.1	27.2	71.8	1.0
Suspected stroke with difficulty in speaking or with weakness in an arm and a leg	16.4	82.7	0.9	16.5	82.4	1.1
Have thoughts of self-harm or harming others	34.7	62.4	2.9	32.8	63.7	3.5
Mild respiratory symptoms	63.8	35.8	0.4	60.6	39.0	0.4
Mild gastrointestinal symptoms such as diarrhea	57.3	42.6	0.1	53.2	46.6	0.2
Mild skin problems	40.1	59.3	0.6	38.8	60.4	0.8
Mild urinary problems	38.8	60.3	0.9	36.8	62.4	0.8
Mild depression or anxiety	49.3	49.7	1.0	46.4	52.5	1.1
Mild chronic joint pain	41.8	57.9	0.3	40.8	58.8	0.4
Stable known chronic illnesses follow-up	70.7	28.8	0.5	65.9	33.5	0.6

Less than one-third (30.5%) of the participants in the weighted sample knew that paid teleconsultation service was available in the private primary care sector in Hong Kong, and only 28.4% knew that drugs and documents such as sick leave certificate delivery was inclusive in the service. Only 20% of the weighted sample knew that patients must be physically present in Hong Kong when they receive teleconsultation services provided by doctors practicing in Hong Kong. Only 10.7% of the weighted sample knew that the Hong Kong Medical Council had issued Ethical Guidelines on the practice of telemedicine in Hong Kong¹⁸ to govern doctors’ practice.

The vast majority (74.3%) of the weighted sample agreed that government subsidy would attract them to use teleconsultation in primary care. Many of them (71.7%) agreed that teleconsultation could reduce their risks of getting cross infections in the clinic.

As for the concerns, 78.0% of the weighted sample worried about the accuracy of the doctor’s diagnosis in the absence of onsite physical examination. Half (50.7%) of the participants worried about patient information and health care record confidentiality issues. More than half (56.2%) of the participants worried about post-teleconsultation logistics such as drug and document delivery.

PREDICTORS ON THE WILLINGNESS OF TELECONSULTATION

Results of 13 (0.9%) and another 226 (15.0%) participants were excluded from this part of the analysis due to missing answers either to the key question on their willingness to use teleconsultation in primary care or to the predictor variables, respectively.

The results of multivariable logistic regression based on the unweighted samples are presented in Table 5. A statistically significant positive relationship was shown with a perception that teleconsultation would serve the majority of his/her health problems (OR = 3.693, p < 0.001), availability of government subsidy (OR = 3.567, p < 0.001), perception of teleconsultation could reduce one’s infection risk (OR = 1.831, p < 0.001), ownership of a computer/tablet with internet connection (OR = 2.116, p < 0.001), and in those who need assistance for accessing primary care services (OR = 1.838, p = 0.046). Statistically significant negative associations were shown with an educational level of primary or below (OR = 0.388, p = 0.002), not knowing that prescription and document delivery was inclusive in the teleconsultation services provided in Hong Kong (OR = 0.651, p = 0.014), and foreseeing problems in diagnosis accuracy (OR = 0.675, p = 0.040) or post-teleconsultation logistics (OR = 0.505, p < 0.001). Remarkably, those who knew that paid teleconsultation was available in the private sector tended not to use this mode of service (OR = 0.667, p = 0.013). From the responses of our participants to the open question on whether there were any other factors that would affect their willingness to use teleconsultation in primary care, we were satisfied that we had covered all the major domains of interest among the respondents.

Table 5.

The Association Between Willingness to Use Teleconsultation in Primary Care and the Participants’ Demographic Factors, Knowledge, and Attitudes by Multivariable Logistic Regression Model Based on the Unweighted Sample (n = 1,268)

	ODDS RATIOS	95% CI FOR ODDS RATIOS		P-VALUE
Gender
Female	0.755	0.566	1.008	0.057
Male	Ref	Ref	Ref	Ref
Age group
18–19	0.911	0.218	3.814	0.898
20–29	1.226	0.356	4.221	0.747
30–39	1.709	0.513	5.691	0.382
40–49	2.028	0.609	6.760	0.250
50–59	1.834	0.557	6.042	0.319
60–69	2.429	0.764	7.726	0.133
70–79	1.106	0.349	3.511	0.864
80 or above	Ref	Ref	Ref	Ref
Occupation status
White collars^a	1.454	0.645	3.278	0.366
Blue collars^b	1.370	0.601	3.121	0.454
Retirees	0.944	0.462	1.931	0.875
Homemakers	1.491	0.734	3.030	0.269
Students	1.072	0.536	2.146	0.843
Unemployed	Ref	Ref	Ref	Ref
Education level
Primary level or below^c	0.388	0.211	0.712	0.002^*
Lower secondary level	0.775	0.482	1.246	0.293
Higher secondary level	0.724	0.495	1.057	0.095
Tertiary education or above	Ref	Ref	Ref	Ref
Prior experience in using teleconsultation as a patient
No	0.907	0.592	1.390	0.654
Yes	Ref	Ref	Ref	Ref
Possession of a smartphone with internet connection
No	Ref	Ref	Ref	Ref
Yes	1.572	0.888	2.782	0.121
Possession of a computer or tablet with internet connection
No	Ref	Ref	Ref	Ref
Yes	2.116	1.432	3.128	<0.001^*
Habit of using public versus private primary health care service
Public	1.262	0.628	2.534	0.513
Private	1.049	0.535	2.058	0.888
Similar for both	Ref	Ref	Ref	Ref
Frequencies of primary health care service utilization per year
0 to 1	0.902	0.497	1.634	0.733
2 to 4	0.797	0.452	1.404	0.431
5 to 10	0.648	0.351	1.198	0.167
More than 10	Ref	Ref	Ref	Ref
Accessibility to the primary care clinic in terms of physical distance
Within 15 min	0.682	0.327	1.423	0.308
15–30 min	0.878	0.422	1.824	0.727
31–60 min	0.987	0.451	2.162	0.975
More than 1 h	Ref	Ref	Ref	Ref
Needs assistance to attend primary care services
No	Ref	Ref	Ref	Ref
Yes	1.838	1.010	3.344	0.046^*
Possession of knowledge in the availability of paid teleconsultation services in the private primary care sector in Hong Kong
No	Ref	Ref	Ref	Ref
Yes	0.667	0.484	0.917	0.013^*
Possession of the knowledge that drugs and documents delivery was inclusive in the teleconsultation services provided in Hong Kong
No	0.651	0.462	0.915	0.014^*
Yes	Ref	Ref	Ref	Ref
Possession of the knowledge that the patients must be physically present in Hong Kong to receive teleconsultation services provided by a doctor practicing in Hong Kong
No	1.173	0.823	1.673	0.377
Yes	Ref	Ref	Ref	Ref
Possession of the knowledge that ethical guidelines had been issued by the Hong Kong Medical Council to govern the telemedicine practice of doctors in Hong Kong
No	0.972	0.610	1.549	0.906
Yes	Ref	Ref	Ref	Ref
“Government subsidy (for example in terms of teleconsultation vouchers) will attract me to use teleconsultation.”
Disagree	Ref	Ref	Ref	Ref
Agree	3.567	2.480	5.131	<0.001^*
‘Teleconsultation would serve the majority of my health problems.’
Disagree	Ref	Ref	Ref	Ref
Agree	3.693	2.719	5.017	<0.001^*
“Teleconsultation would reduce my risk of getting an infection from the clinics.”
Disagree	Ref	Ref	Ref	Ref
Agree	1.831	1.316	2.547	<0.001^*
“Being unfamiliar with the operation of electronic devices would affect my willingness to use teleconsultation.”
Disagree	0.799	0.589	1.084	0.150
Agree	Ref	Ref	Ref	Ref
“There would be problems in the accuracy of the doctor’s diagnosis in teleconsultation.”
Disagree	Ref	Ref	Ref	Ref
Agree	0.675	0.463	0.982	0.040^*
“There would be problems in patient confidentiality and security of health care records in teleconsultation.”
Disagree	Ref	Ref	Ref	Ref
Agree	1.022	0.765	1.365	0.884
“There would be problems in the post-teleconsultation logistics.”
Disagree	Ref	Ref	Ref	Ref
Agree	0.505	0.376	0.679	<0.001^*

Tertiary education or above included participants who were nondegree bearers and those with a Bachelor degree or above.

significant at 5% level by multivariable logistic regression.

Thirteen respondents were excluded due to their missing answers for the question on their willingness to use teleconsultation in primary care.

226 respondents were excluded due to their missing answers in any of the predictor variables.

White collars were defined as participants who worked as employers, professionals, associate professionals, and clerical workers.

Blue collars were defined as participants who worked as service providers and manual workers.

Primary level or below included the participants with primary and pre-primary education levels.

Discussion

This was the first cross-sectional population survey on the topic of teleconsultation in primary care in Hong Kong. From the projection of our weighted sample, it was encouraging to see over half (51.6%) of the general Hong Kong population indicated their willingness to use teleconsultation in primary care.

Due to the easy accessibility of health care services in Hong Kong, the time to reach a primary care clinic did not associate with the willingness to use teleconsultation among Hong Kong citizens. However, the need of assistance to attend a primary care clinic in some people was clearly a strong pull-factor. “Convenience” was also a major driver to use teleconsultation, especially for those who thought teleconsultation could address most of their health problems. This was consistent with the results from the qualitative studies by Powell et al. for primary care patients in the United States.¹⁹ Moreover, avoiding getting infections from clinic attendance was also a strong reason for Hong Kong people to choose teleconsultation. This aligned with the findings in the study conducted by Baudier et al. among respondents from Europe and Asia.²⁰ Previous local studies and the current study all echoed that provision of government subsidy would be a significant facilitator to attract people to use teleconsultation. As the COVID-19 pandemic greatly increased the coverage of electronic device ownership among our local citizens, it might be a good time to consider further developing teleconsultation in primary care.

Barriers identified from our study toward choosing teleconsultation in primary care were low education level, having worries on the post-teleconsultation logistics (drug and document deliveries), and the accuracy of the doctor’s diagnosis in the absence of onsite physical examination. It is noteworthy that people who knew that teleconsultation was available in the private sector tended not to use the service. This shall be an area requiring further exploration in future.

In terms of expectations toward teleconsultation in primary care, most people were very reasonable and would consider using teleconsultations if they suffered from common mild illnesses or for follow-up of stable chronic diseases. However, it was alarming to see that although not many, some people did indicate that they would use teleconsultation if they had medical emergencies such as acute chest pain, and shortness of breath. We suspect that might be due to people’s assumption that teleconsultations implied a shorter waiting time to see the doctor. Anyhow, misunderstanding did exist in the population toward what were the suitable conditions to be handled by teleconsultation. More education to the general public regarding the proper use and limitations of teleconsultation is definitely needed (especially toward the less educated population, which was also proposed by Alboraie et al. in their study in Egypt²¹) to avoid delays in treatment and patients’ disappointments.

STRENGTHS

This was the first territory-wide cross-sectional survey to holistically examine the population’s willingness, knowledge, attitudes, and main concerns toward the use of teleconsultation in primary care in Hong Kong. The data were derived from a large representative sample with high data completion rate. As the survey was done by random telephone interviews, we believed it entailed a high generalizability across the population.

LIMITATIONS

As teleconsultation is only beginning to take hold in Hong Kong’s primary care system, and the majority (88.5%) of the respondents had no experience with the use of teleconsultation, most of the respondents’ replies were based on their hypothetical assumptions toward teleconsultation.

Moreover, as most of the teleconsultation services available in Hong Kong were offered through video instead of pure audio phone calls, the participants’ considerations were likely to be based on the video type of teleconsultation and hence the results may not be suitable for direct application in other parts of the world, especially if the use of audio phone calls is predominant.

IMPLICATION FOR FUTURE RESEARCHES

Although our study showed acceptability among Hong Kong people to use teleconsultation in primary care, we noted people who knew about the service being available in the private sector tended not to use it. It would be good to conduct further in-depth qualitative studies among those Hong Kong citizens who have used teleconsultation services in primary care to obtain their feedbacks in order to identify the underlying obstacles.

Conclusions

Our survey estimated that more than half of the general Hong Kong population were willing to use teleconsultation in primary care, and hence this modality of care should be further resourced. Facilitators and barriers to choose teleconsultations when receiving primary care services were clearly identified. The government and health care providers should address these factors to meet the public expectation while safeguarding the quality of the services provided. More resources should also be invested in public education regarding the proper use and the limitations of teleconsultations in primary care.

Footnotes

Acknowledgments

The authors thank Mr. Chan Kok Yin Eugene, our project’s research assistant, who made a significant contribution to the statistical analysis, results interpretation, and article drafting. Appreciation also goes to Dr Tang Ho Man Eric, senior research assistant, for his contribution and guidance in our statistical analysis.

Authors’ Contributions

E.T.Y.T., C.K.H.W., J.Y.C., D.D.W., and T.P.L. contributed to the study design. E.T.Y.T. coordinated the acquisition of data. E.T.Y.T. and C.K.H.W. contributed to data analysis, interpretation of results and writing of the article. J.Y.C., D.D.W., and T.P.L. contributed to interpretation of results and review of the article. All authors read and approved the final article.

Ethical Approval

Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) (Reference number UW 22-743).

Availability of Data and Materials

Our research data are available upon reasonable requests.

Disclosure Statement

No competing financial interests exist.

Funding Information

Health and Medical Research Fund, the Health Bureau, The Government of the Hong Kong Special Administrative Region (Project reference: 20212351). Kerry Group Kuok Foundation (Hong Kong) Limited supported the publication as an open access journal article.

Supplementary Material

Supplementary Data S1

References

The World Health Organization. Consolidated telemedicine implementation guide. 2022. Available from: https://iris.who.int/bitstream/handle/10665/364221/9789240059184-eng.pdf?sequence=1 [Last accessed: September 3, 2024 ].

NPS MedicineWise. General practice insights report July 2019–June 2020 including analyses related to the impact of COVID-19. Sydney; 2021. Available from: https://www.nps.org.au/assets/NPS/pdf/GPIR-Report-2019-20.pdf [Last accessed: February 22, 2024 ].

The World Medical Association. WMA statement on the ethics of telemedicine. 2020. Available from: https://www.wma.net/policies-post/wma-statement-on-the-ethics-of-telemedicine/ [Last accessed: February 22, 2024 ].

Craig

, Patterson

. Introduction to the practice of telemedicine. J Telemed Telecare, 2005; 11(1):3–9; doi: 10.1177/1357633X0501100102

Hui

, Woo

. Telehealth for older patients: The Hong Kong experience. J Telemed Telecare, 2002; 8(Suppl 3)(6):39–41.

Kung

, Wong

, Chen

. An exploratory qualitative study on patients’ views of medical e-consultation in a public primary care setting. Hong Kong Practitioner, 2016.

Koonin

, Hoots

, Tsang

, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January-March 2020. MMWR Morb Mortal Wkly Rep, 2020; 69(43):1595–1599; doi: 10.15585/mmwr.mm6943a3

Tsang

. The post COVID new normal: Rise of telemedicine. 2020. Available from: https://research.hktdc.com/en/article/NTkzOTE0MDg4 [Last accessed: March 11, 2024 ].

The Government of the Hong Kong Special Administrative Region. Press releases: LCQ19: Designated clinics and tele-consultation service under the hospital authority. 2023. Available from: https://www.info.gov.hk/gia/general/202302/15/P2023021500405.htm [Last accessed: February 22, 2024 ].

10.

World Health Organization. Statement on the fifteenth meeting of the IHR (2005) Emergency committee on the COVID-19 pandemic. 2023. Available from: https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic?adgroupsurvey=%7Badgroupsurvey%7D&gclid=EAIaIQobChMI4Ojtsdbe_gIVjQRyCh07igt4EAAYASACEgJ9pfD_BwE&fbclid=IwAR2M8EAyiSrAodhK9p-X582nHkP2AigpSX8pYIsLsPwqYh4SG26RGokGe7E [Last accessed: February 22, 2024 ].

11.

The Hong Kong Jockey Club. Jockey club supports distribution of 20,000 “LeaveHomeSafe” compatible smartphone to underprivileged elderly. 2021. Available from: https://corporate.hkjc.com/corporate/corporate-news/english/2021-12/news_2021122101007.aspx [Last accessed: March 11, 2024 ].

12.

Mok

KHJ

, Huang

. Perceptions on the COVID-19 epidemic of the elderly in Hong Kong. 2020. Available from: https://www.ln.edu.hk/research-and-impact/research-press-conferences/survey-findings-on-video-medical-consultation-for-elderly [Last accessed: February 22, 2024 ].

13.

Choi

MCY

, Chu

, Siu

, et al. Telemedicine acceptance by older adults in Hong Kong during a hypothetical severe outbreak and after the COVID-19 pandemic: A cross-sectional cohort survey. Hong Kong Med J, 2023; 29(5):412–420; doi: 10.12809/hkmj219747

14.

School of Journalism and Communication. The Chinese University of Hong Kong. Centre for communication and public opinion survey. 2020. Available from: https://ccpos.com.cuhk.edu.hk/ [Last accessed: April 4, 2024 ].

15.

Census and Statistics Department. Women and Men in Hong Kong Key Statistics, Hong Kong Special Administrative Region; 2022 HKSAR: Census and Statistics Department, 2022, p. 388.

16.

Bedford

, Tang

EHM

, Dong

, et al. Who reports insufficient and disturbed sleep? Results from a representative population-based health survey in Hong Kong. BMJ Open, 2022; 12(9):e058169; doi: 10.1136/bmjopen-2021-058169

17.

Question Pro. Random iterative method: What it is, importance & examples. Available from: https://www.questionpro.com/blog/random-iterative-method/ [Last accessed: February 22, 2024 ].

18.

The Medical Council of Hong Kong. Guidelines for all registered medical practitioners: The medical council of Hong Kong ethical guidelines on practice of telemedicine. Newsletter No. Issue 26. 2019. Available from: https://www.mchk.org.hk/files/newsletter-26th.pdf [Last accessed: April 6, 2024 ].

19.

Powell

, Henstenburg

, Cooper

, et al. Patient perceptions of telehealth primary care video visits. Ann Fam Med, 2017; 15(3):225–229; doi: 10.1370/afm.2095

20.

Baudier

, Kondrateva

, Ammi

, et al. Patients’ perceptions of teleconsultation during COVID-19: A cross-national study. Technol Forecast Soc Change, 2021; 163:120510; doi: 10.1016/j.techfore.2020.120510

21.

Alboraie

, Allam

, Youssef

, et al. Knowledge, applicability, and barriers of telemedicine in Egypt: A national survey. Int J Telemed Appl, 2021; 2021:5565652; doi: 10.1155/2021/5565652

Supplementary Material

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A Cross-Sectional Survey Exploring the Willingness of Hong Kong People to Use Teleconsultation in Primary Care During the COVID-19 Pandemic

Abstract

Objectives

Outcome Measures

Results

Conclusion

Introduction

Methods

STUDY DESIGN AND SETTING

OUTCOME VARIABLES

DATA COLLECTION

STATISTICAL ANALYSES

Results

SUBJECT CHARACTERISTICS

PREDICTORS ON THE WILLINGNESS OF TELECONSULTATION

Discussion

STRENGTHS

LIMITATIONS

IMPLICATION FOR FUTURE RESEARCHES

Conclusions

Footnotes

Acknowledgments

Authors’ Contributions

Ethical Approval

Availability of Data and Materials

Disclosure Statement

Funding Information

Supplementary Material

References

Supplementary Material