Exploring general practitioners’ perceptions of e-Health: A qualitative study on the emergence, use, and acceptance of e-Health in primary care in the Netherlands

The Dutch primary care system faces challenges such as evolving care demands and staff shortages, which threaten its continuity and scope. The use of e-Health has been proposed as a strategy to address these challenges, but its adoption among general practitioners (GPs) remains limited. Therefore, this study aims to explore GPs’ perceptions of e-Health within the complex primary care system, using a combination of systems thinking (ST) and the Consolidated Framework of Implementation Research (CFIR). Through qualitative interviews with primary care providers, the study uncovered themes across CFIR domains, revealing complexities and interdependencies within the primary care system. Findings emerged from the outer setting domain, including evolving care demands, staff shortages, and shifting workforce dynamics, which shape the primary care landscape. Fragmentation and lack of coordination within the system hinder care coherence and collaboration, posing challenges for e-Health implementation. Regarding the inner setting, contextual factors, including practice type, location, and patient demographics, influence GPs' perceptions of e-Health suitability. The study reveals diverse views on the characteristics of e-Health, with both positive and negative perceptions highlighting its nuanced impact. While potential efficiency gains are recognized, concerns about increased workload due to communication inefficiency, technical issues, and inappropriate tool use are also acknowledged. Effective implementation of e-Health requires seamless integration into existing systems and patient education. Additionally, e-Health holds promise in empowering patients and enhancing care availability, but careful attention must be given to avoid exclusion of certain patient groups. This study recognizes e-Health’s potential in addressing primary care challenges, such as balancing care supply and demand. However, GPs commonly exhibit hesitancy towards changes that alter established working methods, thereby emphasizing the importance of the GP-patient connection and physical contact in delivering quality care. The findings underscore the need for a balanced approach that effectively integrates e-Health, while preserving the human connection, ensuring continuity of care, and leveraging its benefits effectively.