Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 17, 2019
Open Peer Review Period: Dec 20, 2019 - Feb 2, 2020
Date Accepted: Feb 22, 2020
(closed for review but you can still tweet)
Health system stakeholders’ perspective on the role of mHealth and its adoption in the Swiss health system: a qualitative study.
Digital Health solutions have a great potential to transform healthcare towards better clinical outcome and improved processes and access, amongst other benefits. Yet, adoption of mHealth solutions, i.e. for patient monitoring, has been rather slow in Switzerland. The reasons are complex and a better understanding is needed to leverage the full potential of mHealth.
This study aims at deepening the understanding of the role of mHealth and factors driving or restraining its adoption in the Swiss health system and providing feasible recommendations for action.
We conducted a qualitative survey using a maximum variation sample of a heterogenous group of stakeholders (N=50) in the Swiss healthcare system with a profound knowledge of digital and mobile health and medical device reimbursement. A semi-structured interview guide including open- and closed-ended questions was used to address questions around mHealth relevance and influence on the health system, the relevance of selected determinants for mHealth adoption as well as important influencing factors.
Overall, respondents thought that mHealth will have a beneficial impact on the Swiss health system but that its adoption would evolve slowly. We derived 23 key opportunities regarding patient and patient pathway, treatment of disease, and diseases and health conditions. A high consistency in answers among respondents was observed for ‘treatment of disease’. Providers of healthcare services mentioned a relatively wide range of topics. Stakeholders’ attitudes towards mHealth adoption along the relevance of 23 pre-selected determinants was relatively consistent. However, we obtained diverging attitudes regarding the influence of general trends, enablers and restraints in Switzerland. We derived 26 key themes influencing mHealth adoption. Relevant trends: ‘changing needs and expectations of patients’, ‘a rising need for efficient healthcare delivery’, ‘growing interest in improved outpatient care’, and ‘emerging technologies and progressing digitization’. Important enablers: ‘growing demand for new financing schemes and incentive concepts’, ‘rising demand for comprehensive information on and stronger body of evidence for mHealth use cases’, and ‘increasing need for easy to use alternate care approaches’. Challenging restraints: ‘rigidness of thinking and siloed actions of health system actors’, ‘complexity to change existing regulations and structures’, ‘little understanding of mHealth use and the role of clinicians’, and ‘risk of further polarization of the population’.
This study provides a comprehensive look at mHealth in the Swiss health system. It becomes apparent that strong governance is inevitable to foster a sustainable data strategy and to reconcile the different interests of stakeholders. The use of mHealth will add value but not necessarily reduce the burden on the system caused by emerging societal needs and changing disease prevalence. Health system actors need orientation and sensitization in terms of digitization. This study contributes to present additional ways to promote mHealth adoption in Switzerland.
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