Shift in determinants of remote care use from sociodemographic characteristics to health need factors during the course of the COVID-19 pandemic. A follow-up study
This study utilized the Delphi method and the Iceberg Model to construct and validate a scientifically sound, reliable, and clinically applicable evaluation index system comprising 8 primary, 26 secondary, and 88 tertiary indicators for assessing the interdisciplinary core competencies of nurses in digestive disease specialty centers.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a pandemic forces the world to stay apart, the way people connect with their doctors must change. In the Netherlands, as in many places, the sudden need to avoid physical contact during the early days of the COVID-19 crisis pushed general practitioners to rely heavily on remote care. This term covers any medical advice given without a face-to-face meeting, such as phone calls, video chats, or emails. Before the virus arrived, these methods were already growing in popularity, but the lockdowns made them the primary lifeline for patients. For those living in poorer neighborhoods, where chronic illnesses are more common and access to technology can be harder, this shift presented a unique challenge. Researchers have long known that a person's background—like their income, education, or where they come from—often shapes how they use health services. However, it remained unclear whether these background factors would continue to dictate who used remote care once the strict lockdowns began to ease, or if the actual health needs of the patient would become the deciding factor. Understanding this shift is vital because if remote care becomes the standard, it must work for everyone, not just those who are already comfortable with digital tools.
A team of researchers from Erasmus University Rotterdam and Erasmus MC set out to track this evolution over the course of the pandemic. They focused on patients in disadvantaged neighborhoods in Rotterdam, a group that often faces barriers to healthcare. The study followed these patients at two specific moments: first, during the height of the initial lockdown in 2020, and again one year later in 2021, when restrictions had relaxed and vaccination rates had risen. The researchers asked the same group of people about how they contacted their doctors, what their health was like, and how they felt about using technology for medical advice. They looked at whether factors like age, gender, or having a chronic disease influenced whether a patient chose a phone call over a visit to the clinic.
In the beginning, during the strict lockdown, the pattern of who used remote care was driven by basic demographics. Women were much more likely to use remote services than men, and younger people used them more often than those over fifty. This likely reflected the reality that women often manage family health needs and that older adults might have less experience with digital tools. At this stage, the pandemic rules were so strict that remote care was often the only option, so the usual barriers of money or digital skills mattered less than who was simply willing and able to pick up the phone.
However, the story changed a year later. When the strict measures were lifted and patients could once again walk into a doctor's office, the reasons for choosing remote care shifted dramatically. The influence of age and gender faded away. Instead, the decision to use remote care became tightly linked to a patient's specific health needs and their ability to navigate the system. The study found that patients with chronic diseases were less likely to use remote care, preferring to see their doctor in person. This suggests that when people have complex, long-term health issues, they value the physical presence of a caregiver more than the convenience of a call. Conversely, those without chronic conditions were more likely to stick with remote options.
The researchers also discovered that financial struggles and a lack of digital skills became significant barriers to remote care in the second year. Patients who had money troubles or who found it difficult to use the internet were less likely to use remote services, even when they were available. Interestingly, patients with a migration background were more likely to use remote care than those without, a pattern the researchers linked to higher overall usage of primary care services in that community. Perhaps most telling was the change in attitude. At the start of the pandemic, most patients felt positive or neutral about remote care. By the second year, that optimism had faded, with a larger portion of the group expressing negative feelings toward it. This shift was particularly strong among patients with chronic diseases and those from migrant backgrounds, who seemed to feel that the remote option did not meet their needs as well as a personal visit.
The study concludes that while remote care is a powerful tool, it is not a one-size-fits-all solution. The factors that determine who uses it are not static; they evolve as the crisis changes. In the early days, the rules of the pandemic dictated the method of contact. Later, as those rules loosened, the patient's own health situation and their socioeconomic reality took the lead. For doctors and policymakers, this means that simply offering remote care is not enough. To ensure fair access, they must recognize that patients with chronic illnesses, financial difficulties, or lower digital skills may need different support to get the care they require. The pandemic accelerated the move toward digital health, but this research shows that without careful attention to these human factors, the shift could leave the most vulnerable patients behind.
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