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In this study, we examine how Danish general practitioners (GPs) and general practice staff have fitted their use of video consultation to align with their conceptualisations of good care. Political stakeholders are repeatedly encouraging the use of video consultation in the healthcare sector, discursively referring to optimised use of healthcare resources, increased efficiency and flexibility for and geographical equality among patients. By the end of 2024, it will be mandatory for GPs to offer video consultations to patients in Danish general practice. This raises important questions about the implications of video consultation on the care provided in general practice. Our data consists of 30 semi-structured interviews with GPs and 132 hours of fieldwork conducted across seven clinics from August 2021 to August 2022. We analysed the data following the principles of reflexive thematic analysis and inspired by an abductive approach. Drawing on Annemarie Mol's and Jeanette Pols' conceptualisations of care and fitting, we identified common rationalisations articulated and observed in practice that highlight how fitting video consultation into the care provided in a general practice setting can enable (1) optimised use of busy patients' time), (2) optimised use of clinician and clinic resources, (3) enhanced connection of 'harder to reach' patients and (4) better work experiences for GPs and staff. Our findings demonstrate the variety of video consultation use potentials, contributing to our understanding of the implications of video consultation on the provision of care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To delineate the characteristics of the work undertaken by general practitioners (GPs) and staff in implementing and utilising video consultation within their situated clinical contexts., Methods: The data material comprises 33 semi-structured interviews with GPs and staff and 132 hours of ethnographic fieldwork across seven clinics in Denmark. The data collection period spanned from June 2021 to August 2022. Reflexive thematic analysis was employed to analyse the data, drawing inspiration from the concept of invisible work as proposed by Susan Leigh Star and Anselm Strauss., Results: Four types of invisible work were identified through the analysis: (1) the work of introducing video consultations, (2) the work of stabilising video consultation use, (3) the work of coordinating users and systems, (4) the work of repair as a response to breakdowns., Conclusions: The video consultation changes the organisational structure and leads to a reconfiguration of professional roles and existing work practices. Moreover, implementing and using video consultations demands articulation, inclusion and affective work by GPs and staff, and this work includes allocating time to coordinate tasks, do workarounds and repair breakdowns., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

In this study, we discuss how email consultations in general practice operate as a temporal technology, transforming working conditions and power relations between general practitioners (GPs) and patients. We draw on empirical material from Denmark in the form of a set of semi-structured interviews with 53 patients and 15 GPs, including two focus group discussions with 17 GPs. Our theoretical point of departure stems primarily from media theorist Sarah Sharma's (2014) concept of power-chronography, which describes how power is embedded in temporal relations and everyday life and secondarily from sociologist, Judy Wajcman's (2015) concept of multiple temporal landscapes. Patients and GPs calibrate their own time and attune their mutual time according to their expectations and ideas about the other party's time. The patient and the GP can both be viewed as 'time workers' and the email consultation as a digital technology fostering the recalibration of one person's time to that of another, requiring significant labour. The email consultation rearranges the GP-patient boundaries and thereby the power relations. Health institutions ought to consider whose time and labour is being 'saved' with digital systems.

This study uses socio-cognitive theory on technological frames to understand how and why general practitioners in Denmark use or choose not to use video consultations. Video consultations play a vital role in the digitalisation of the Danish healthcare system. Whilst political decision-makers continuously push for increased use of video consultations, uptake accounts for less than 2% of all consultations. Research is needed that explores the actual circumstances and conditions of video consultation use. Our data corpus consists of 30 semi-structured interviews conducted from August 2021 to August 2022 with 27 Danish general practitioners. Interviews were analysed following reflexive thematic analysis. Our findings show that video consultations are interpreted as 1) compromising occupational values, 2) a crisis tool, 3) the future, and 4) a tool to improve work conditions. Video consultations are differently adopted across clinics due to different interpretations of the technology and its relative advantage in specific clinical contexts. We argue that the concept of technological frames offers a useful analytic perspective for elucidating and anticipating attitudes and actions towards a technology. It increases our understanding of the uptake and rejection of video consultations. This knowledge is valuable for clinicians and politicians working with technological innovation in general practice., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Video consultations enable a digital point of contact between the general practitioner and patient. With their medium-specific characteristics, video consultations may create novel conditions for the enactment of patient participation during consultations. Although numerous studies have explored patients' experiences of video consultations, research explicitly investigating patient participation within this new consultation setting remains sparse. This qualitative study explores how patients participate during interactions with their general practitioner by drawing on the affordances of video consultations., Methods: The data corpus comprises eight recorded video consultations (59 minutes and 19 seconds in total) between patients and their general practitioner, all subjected to reflexive thematic analysis yielding three themes illustrating concrete participatory use cases., Results: We find that video consultations provide an accessible format for patients otherwise unable to attend a physical consultation due to physical and mental barriers. Moreover, patients participate by drawing on resources situated in their spatial setting to settle health-related questions of doubt arising during the consultation. Lastly, we posit that patients enact participation by visually communicating their impromptu engagement in decision-making and reporting to their general practitioner by making use of the qualities of their smartphone during their consultation., Conclusions: Our findings illustrate how video consultations provide a communicative context in which patients may enact distinct forms of participation by drawing on its technologically contingent affordances during interactions with their general practitioner. More research is needed to explore the participatory opportunities of video consultations in telemedical healthcare services for different patient groups., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism., (©Elisabeth Assing Hvidt, Helen Atherton, Jelle Keuper, Eli Kristiansen, Elle Christine Lüchau, Børge Lønnebakke Norberg, Jost Steinhäuser, Johannes van den Heuvel, Lilian van Tuyl. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.05.2023.)

Background: Uncertainties are omnipresent in health care, but little is known about general practitioners' (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation., Objective: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations., Methods: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach., Results: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients., Conclusions: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs' working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships-not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology., (©Maja Nordtug, Elisabeth Assing Hvidt, Elle Christine Lüchau, Anette Grønning. Originally published in JMIR Formative Research (https://formative.jmir.org), 14.06.2022.)

Objective: To analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients., Methods: Using a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations., Results: Patients' use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology., Conclusions: Our findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients' hands., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: To explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19., Design: A qualitative design was employed, consisting of individual semi-structured interviews where participants were asked to retrospectively describe their experiences and reflections. Data were analysed using thematic analysis., Setting: Capital and Southern Regions of Denmark., Participants: 27 patients (17 women and 10 men) aged between 23 and 76 years who had used VC once or more during the COVID-19 pandemic participated. The data were collected from February to October 2020. We used a convenience sampling technique and sample size was based on the principle of information power., Results: Three overarching themes, each containing subthemes, were developed. Participants described pre-use reactions and concerns relating to VC as being 'better than nothing' given the COVID-19 circumstances, and preferred VC over a telephone consultation. Salient pre-use concerns related to whether the technology 'would work' and whether VC would influence consultation length and GP behaviour. Overall, participants reported positive experiences of VC use and communication attributing these mainly to 'knowing the GP' and 'feeling seen and heard'. Participants were interested in future VC use for many needs as a natural consequence of an increasingly digitalised society, not least due to COVID-19., Conclusions: Our findings contribute with knowledge about first-user experiences of VC against the background of COVID-19. Participants showed positive attitudes towards future use of VC as either a supplementary or alternative consultation form in general practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To analyse the reciprocal dynamics between patients' choice of place and how they experience video consultations (VCs) with the general practitioner., Methods: Qualitative, semi-structured interviews with 27 Danish patients were conducted over a period of 9 months, from February to October 2020. Interviews were analysed using thematic analysis. The analysis was guided by Nelly Oudshoorn's concept of technogeography of care., Results: The following three themes were identified in the data: VC-home dynamics: balancing boundaries; VC-workplace dynamics: logistical considerations; and VC-body image dynamics: on-screen exposure., Conclusions: Taking human geography and science and technology studies as our analytical point of departure, we used the concept of technogeography of care and demonstrated how the reciprocal dynamics between patients' choice of place and how they experience VC made boundaries fluid and complex between different contexts and places, such as the home, the workplace and the clinic. These boundaries were negotiated differently by the patients depending on their need for privacy, convenience and support. Additionally, VC reconfigured patients' and general practitioners' roles, increasing patients' responsibility in securing an appropriate health care setting., Competing Interests: Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)