Design Sustainability Goals for Digital Care Pathway for Epilepsy: A Healthcare Professionals’ Perspective
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Sehrish Khan, Pantea Keikhosrokiani, Johanna Uusimaa, Johanna Annunen, Jonna Komulainen-Ebrahim, Manria Polus, Paivi Vieria, Minna Isomursu
The healthcare systems across the world are transitioning towards sustainable development of digital health solutions such as digital care pathway (DCP) to meet the growing needs of healthcare services. DCP is a digital health solution to provide facilities like making online appointments, ease of access to connect with a healthcare professional (HCP), sharing symptoms and tracking progress of the disease. In this paper, a team of researchers and healthcare professionals (HCP) examine and propose the sustainability goals for Digital Care Pathway for Epilepsy (DCPE) project from the economic, social, and environmental perspectives. The project is a DCPE for children, adolescents, and adult patients with epilepsy. The research methodology is a single case study approach based on the DCPE in Northern Ostrobothnia Wellbeing County (Pohde), in Finland as a unit analysis. Furthermore, the data was collected using feedback from a co-design session with four HCPs all working as clinicians in epilepsy care at Oulu University Hospital. The analysis from the co-design session resulted in various factors to achieve sustainability goals like reduction in travel to hospital, cost efficient, time saving, ease of access to connect with HCPs, and lower CO2 emission. However, there are several challenges such as adaptation to the online treatment options, proper management, and scheduling of online appointments, and building trust in epilepsy patients for remote treatment. Despite the challenges, HCPs confirm that the DCPE can be useful for treating patients with epilepsy through remote consultation along with the traditional ways.
1 Introduction
Around 70 million people worldwide suffer from epilepsy which is a non-communicable neurological illness [1]. It affects nearly 60,000 Finns, out of which 5000 are children [2]. Since 2020, there is a web based digital tool of DCPE for all age groups of patients with epilepsy in the Wellbeing Services County of Northern Ostrobothnia (Pohde) at Oulu University Hospital (OUH). Furthermore, a similar mobile based service is developed for adult patients since December 2022. Furthermore, the mobile based version will be developed for children and adolescents patients with epilepsy in future [3]. Thus, a lot of research and study is required to improve the DCPE. The DCP is a digital health solution which enables a healthcare system to provide healthcare services to the patients from the comfort of their homes [4]. It allows the patients to communicate their concerns about their disease, receive care and treatment from clinicians in a streamlined, proactive, and patient-centric way [5].
The healthcare systems across the globe are overburdened to treat patients suffering from different diseases, especially chronic diseases which require long-term care [6]. The conventional patient-care model is getting overwhelmingly demanding, expensive and less sustainable in this era of booming digitization [7]. Moreover, with the effects left by pandemic of COVID-19, the outpatient care model or remote-treatment has begun to be seen as resource efficient in terms of cost and capacities of healthcare systems, and environment [8]. Thus, more and more healthcare systems are drawing attention towards this new mode of service delivery because of its promising features of sustainability [9]. It inspires and necessitates to innovate and deploy novel methods of delivering healthcare services. Furthermore, there is an ever-increasing drive to achieve sustainability goals for the healthcare system. To meet this challenge, advancements in Information Communication Technology ICT and digitalization of healthcare services offer promising solutions.
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When we design digital care pathways, one of the most important design goals is to make them sustainable. We want to design and develop digital solutions which do not increase the burden for the healthcare system, humans involved or our environment. In the past, sustainability was more associated to mitigating environmental hazards and reduce CO2 emissions [10]. The World Commission on Environment and Development [11] defines sustainability as “meeting the needs of the present without compromising the ability of future generation to meet their own needs” and “entails protection of the environment and natural resources as well as to provide social and economic welfare to the present and to subsequent generations” [12]. In healthcare sector, sustainability is further assessed through social, economic, and environmental dimensions [13, 14]. Therefore, digital healthcare services like digital care pathways are being developed worldwide to ensure sustainability of healthcare systems based on the three pillars. Transitioning to digital health solutions like DCPs has its own set of challenges for both the healthcare professionals (HCP) and patients.
In this paper, we examine research done in the context of DCPE for all age groups of patients with epilepsy in OUH.
The objective of this paper is to identify the sustainability design goals for DCPE. To achieve this, we conducted a case study on the DCPE project in collaboration with the HCPs. Based on the feedback from HCPs, we identified how the project achieves economic, social, and environmental sustainability goals. Therefore, an evidence-based study is conducted with the HCPs which can help to identify sustainability goals of DCPE.
This paper comprises of five sections. First the article discusses briefly the challenges faced by healthcare industry towards achieving the sustainability goals and reports some existing DCPs implemented around the world. Then, the methodology section describes the co-design approach followed by a team of researchers in collaboration with the HCPs on the developed template which discusses the sustainability goals for the DCPE. Afterwards, the feedback from the HCPs is given in the results and discussion section. Finally, the paper concludes with main findings on the HCP perspectives and briefly presents a future direction for further research on sustainability design goals for DCPE.
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2 Background
2.1 Sustainability Challenges in Healthcare Systems
The transition of healthcare systems towards sustainability offers multifold benefits for the economy, society, and ecology of this world. The major challenge of sustainability in healthcare systems is to deal with the complexity of operations within a healthcare system [9]. The challenge is further accentuated by the uncertainty and unpredictability of innovations and changes in ICT infrastructure [15]. In this paper, we define sustainability in healthcare system with three main pillars; economic, social and environmental [16]. These pillars are interdependent and mutually reinforcing.
Economic sustainability focuses on economy-friendly practices to maximize efficient usage of resources in terms of logistics and human resources. It promises to increase prosperity and security to the healthcare system, as well as other stakeholders like professionals, staff, and patients [10]. As the costs of the healthcare are rising globally [17], it is crucial from the adoption point of view to ensure that DCP are resource efficient.
The social sustainability focuses on providing equal access to healthcare facilities for all citizens, equity, empowerment, engagement, and participation [18]. The goal of the social sustainability pillar is to consider the impacts of the DCP on social stability and capacity and capability of individuals to equally take part and benefit from healthcare.
The environmental sustainability ensures that environment-friendly practices should be promoted to help minimize the challenges of hazardous Green House Gas (GHG emissions, and utilize energy resources which are already replenishing at a rapid rate [14]. Healthcare sector global climate footprint is 4,4% [19]. In addition, healthcare sector contributes to ecotoxicity [20] and pollution, as it uses and creates variety of toxic substances. All this also causes loss of biodiversity.
There are several challenging factors which need to be addressed for the successful transition of global healthcare systems towards sustainable healthcare systems. These involve rising requirement of healthcare facilities, raising employee turnover, reduction in the number of HCPs and caregivers, expensive healthcare facilities, lack of available resources, and the overall economic crises especially in developing countries adds more burden on healthcare systems’ capacities [7].
2.2 Digital Care Pathways
Digitalization in the healthcare industry offers promising alternatives like at-home or remote-treatment options [21]. The mobile applications empower the patients to self-monitor their symptoms, keep the track of their condition, share the health status with healthcare professionals, and receive treatment options while sitting at home [22]. The digitization of care pathways has multifold benefits for HCPs and patients and the overall healthcare systems [5]. Furthermore, DCPs have enabled healthcare systems to deliver more streamlined, proactive, cost-effective, and patient-centered care. Especially, patients suffering from chronic diseases like epilepsy can benefit from DCPs. According to Chronic Care Model (CCM), self-management can help the patients to get involved in better control of their symptoms and act as an equal partner along with professionals who monitor the healthcare needs of patients [23, 24].
The Health Village [3] portal is a digital health service developed by five Finnish university hospitals led by Helsinki University Hospital. My Path is a DCP tool on the Health Village website for patients to provide easy interaction with the HCPs and support their healthcare needs like self-management, guidance, appointment scheduling, and sharing health status remotely. Another model of DCP called as digital outpatient health solutions implemented in the United Kingdom (U.K.) discussed the benefits of DCP to increase the sustainability of healthcare systems and provide an evidence-base for clinicians and patients to adapt to this new model. Furthermore, ZEDOC by the Clinicians [5] provides a digital health solution platform which is developing its DCP [25] for various diseases like colorectal cancer, lung cancer, localized prostate cancer, hip and knee surgery, inflammatory arthritis, adult diabetes, cataract surgery, and general quality of life.
3 Method
In this paper a case study-based methodology is used [26, 27]. The study design is a single case of DCPE project for children, adolescents, and adult patients with epilepsy in Oulu University Hospital, Finland. We have studied DCPE to examine and explore the economic, social, and environmental sustainability goals for the project. The step-by-step methodology is illustrated in Fig. 1. We have collected qualitative data in collaboration with HCPS. We have used purposive sampling for this case study.
In the preparation phase, a group of three researchers prepared a table containing a list of factors which can contribute to achieve sustainability goals for economic, social, and environmental sustainability. The template shown in Table 1 was constructed through a literature [3‐6, 10, 18, 19] survey, where similar digital healthcare solutions and their sustainability elements were discussed. The purpose of the template was to provide triggers and material for the co-design process with the HCPs.
With the help of co-authors and researchers, the table was arranged to remove repeatability of the concepts and contents to ensure maximum clarity for further discussion with HCPs. Later, the final table was shared with the HCPs for the co-design session. The purpose of the session was to collaboratively define the guiding sustainability goals for DCPE. A co-design session with two researchers and four HCPs all working as clinicians in epilepsy care at OUH (one in Neuro center, Neurology and three in Paediatric Neurology Unit) was organized. The co-design session was organized through online Microsoft Teams. The session was recorded with the permission of HCPs and other participating researchers. The transcripts of the meeting were automatically transcribed in the Microsoft Teams and analyzed using the NVivo software.
The preliminary analysis of the data was done by a researcher leading the data collection. The preliminary results were documented and presented to HCPs participating in the co-design session and two researchers who participated in defining the data collection template. The analysis of results was collectively discussed and refined into their final format, which are the results presented in this paper. The research follows the ethical guidelines of our university. No patients were involved at this stage of the research.
Fig. 1.
Case study methodology step-by-step.
Table 1.
DCPE sustainability goals
Sustainability pillar
Goals
Economic
• To reduce the treatment burden of care
• To save time required for each face-to-face consultation
• To be resourceful and cost-efficient for both clinicians and patients by reducing the travel costs needed to visit hospital
• To reduce the energy expenditure associated with in-person visits to hospital
• To reduce the number of phone calls to hospitals
• To reduce the number of last-minute cancellations of scheduled appointments
Social
Healthcare Professional
• Lower workload will improve job satisfaction and better work-life balance
• HCPs can better utilize online consultation tools and provide personalized care to patients
Patient
• DCPE will improve patient experience and provide ease of access to consult with HCPs
• Patients’ adherence to treatment goes up
• Patients can track the progress of their condition
• Patients can learn and educate themselves through online available education resources in online portals
Environmental
• DCPE can be environmental-friendly by reducing the number of travels needed to hospital
• Less transportation or travel will help in reduction in CO2 emissions
• Lower number of visits will minimize the chances of spreading airborne pathogens in case of unprecedent incidences like COVID-19
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4 Results and Discussion
4.1 Economic Sustainability Goals
Based on the findings of this study, Fig. 2 shows six economic sustainability goals are identified which include (1) reduction in treatment burden, (2) reduced face-to-face consultation saves time, (3) resourceful and cost-efficient, (4) less energy expenditures due to lower hospital visits, (5) reduction in number of phone calls, and (6) reduction in last minute cancellation of appointment. In the forthcoming section, we further elaborate the feedback of HCPs about achieving these sustainability goals for the DCPE project.
Fig. 2.
Economic sustainability goals.
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Reduction in Treatment Burden of Care.
Currently, the care provider struggles with having enough resources to provide care for the patient population. Therefore, HCP defined the reduction of treatment burden for the healthcare provider to be one of the leading sustainability goals of the adoption and development of the DCPE. The clinicians hoped that DCPE would reduce and optimize the workload of HCP, and at the same time, would improve the quality of care. The HCPs believed that DCPE can help to reduce the treatment burden of care. Currently, the majority of appointments take place through traditional mode of delivery by visiting the hospitals in-person. This consumes a lot of time to examine each patient and time management becomes difficult for HCPs. Consequently, HCPs get burdened with excessive workload. In future, the treatment burden of care can be by reducing the number of unnecessary face-to-face consultations and providing the facility of online appointments as per the needs of a patient with epilepsy.
Time Saving for Clinicians, Patients and their Families.
Treatment of epilepsy is a long journey consuming a lot of time and energy of both the clinicians and patients. According to the HCPs, a web-based version of DCPE patients is currently in place for adolescents and children. The treatment to children is planned with the help of parents. However, DCPE in a mobile version can be designed in future to provide online treatment options for younger age groups as well as adolescents and adult patients. The clinicians believed that DCPE can have an impact on changing the operational processes and routines of clinicians. Through DCPE, appointments can be made easily, and clinicians can see more patients at the same time as compared to face-to-face appointments. Furthermore, after the initial face-to-face examination, some patients can be treated remotely for follow-up checkups. It is unnecessary to come for checkup in certain cases like when the disease is stable and patient is responding well to treatment, only video conferencing might be enough for such patients to do follow-up. Thus, DCPE can save time for clinicians which can be invested towards patients who require face-to-face appointments.
Resourceful and Cost-efficient.
Epilepsy is a chronic neurological disease, and it requires years of treatment. Sometimes, a major part of the life of a patient is spent receiving antiseizure medication (ASM). It is not only the patient who covers this journey alone, but the clinicians and caregivers of patients are along with him in this journey. A patient is most of the time accompanied by a caregiver, a parent, a family member, and in some cases any other person. From the parental and caregiver perspective, DCPE will be cost-efficient and save salary losses. According to the clinicians, DCPE will be cost-effective and save the economic losses incurred to patients who are working or caregivers or family members of patients who need to either compromise their professional routine or take a leave from job to care for patients. One HCP highlighted that in some cases, parental leave causes more loss because the compensation offered for such leaves is less in comparison to their salaries.
“It is more cost efficient to use the digital care pathway instead of being away from work or school.” – [HCP1].
Thus, it becomes profitable in terms of economic and financial terms to use a digital care pathway.
Reduction in Energy Expenditure.
The clinicians saw opportunities for saving energy costs due to lower number of travels to the clinic, thus reducing the energy needed for mobility. Fossils fuels are burnt to produce fuel for the vehicles to allow a patient to visit hospital for face-to-face checkup. Some patients with epilepsy require frequent in-person visits to hospital but some require less hospital visits. With the help of DCPE, an HCP can identify which patient can be provided remote treatment through online consultation or online follow-up. Furthermore, it is not only the patient or the person accompanying the patient who needs to travel to hospital, but doctors, nurses and other staff might also need to travel. This further increases the number of travels to and from hospital and results in excessive utilization of energy resources. Thus, it can save significant energy resources which can be helpful in achieving economic and environmental sustainability goals.
Reduction in Phone Calls.
DCPE provides features which allow two-way synchronous and asynchronous communication between the patients and/or their informal carers and HCP. Patients can use these services to reach out to the HCP and inform them about their health status or seek help when needed. There are many benefits of this service. Patients do not need to wait long for phone calls. Patients can send messages to get help at any time of the day. The costs associated with phone calls are also saved. However, asynchronous communication features also have their challenges. Patients sometimes expect quick replies which cannot always be provided. It is important to design asynchronous communication features so that the patients will have realistic expectations about the response times. Moreover, if text-based communication is used, the HCPs feel that sometimes it is difficult to make the other person understand your message correctlyy.
“There is a risk of taking wrong dosing if the patient misunderstood the changes made in ASM.”- [HCP2].
In this case, the patient should talk with the clinician in person to sort out their issue with regards to taking proper medication and treatment.
Reduction in Last-minute Cancellations of Appointments.
According to the HCPs, the incidence of absences from scheduled appointments needs to be considered too. It happens that the patient or the person who is accompanying the appointment cannot reach and fails to inform the clinicians beforehand about cancellation. In such cases, the time and resources of the HCP and hospitals are wasted. Thus, DCPE can be fruitful in minimizing the non-attendance of patients because it will decrease the travel related occurrences of absences from appointments.
4.2 Social Sustainability Goals
The social sustainability goals can be divided into two parts as shown in Fig. 3: (1) the first part discusses the HCP perspective, which include reduction in workload, better work life balance, provide personalized care; and (2) the second part involves the patient side that consists of adherence to treatment increases, easier for patients to share epilepsy related symptoms and track progress of disease, and educate through online available education resources in DCPE.
Fig. 3.
Social sustainability goals.
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Improvement in Work-life Balance.
DCPE helps the HCPs to quicken the working processes like booking appointments for patients, taking online consultations, and prescribing medication. According to the HCPs, clinicians face the burden of treatment in face-to-face consultation, and this sometimes can lead to over-work and imbalance in personal and professional lives. Thus, DCPs need to be implemented by assigning different timing slots to invest in the in-person and online appointments.
Provide Personalized Care to Patients.
The cases of patients with epilepsy vary significantly from each other. Each patient’s case is unique depending upon several factors like age, gender, severity of seizures, and history of disease. The HCPs have to work to understand and make the treatment plan for every patient. DCPE can be helpful because there is a seizure diary, information about type of epilepsy seizure, aetiology, and medication taken by patients which is recorded and saved in the online portal. When a new patient is diagnosed with epilepsy for treatment then they must go through initial face to face consultation, so that doctors can make a personalized treatment plan. A personalized treatment plan can help the patient feel empowered in their treatment journey and increases overall satisfaction.
Provide Ease of Access to Consult with HCPs.
DCPs like my Health village have been designed to provide people with ease of access to consult with the HCPs. The DCP of my Health Village, My Path is a DCP. Patients can access it easily by setting up a user account and providing information about their disease and ongoing treatment. Thus, DCPE will work similarly to provide ease of access to patients with epilepsy. Patients can benefit from DCPE by making a more systematic plan of treatment and taking an active role in their treatment through collaborative approach in communicating with the doctor.
Adherence to Treatment Increases.
The engagement of a patient in their treatment of epilepsy plays a significant role. The healthcare professionals believe that in-person visits are useful in building trust of patients and enhancing the patients’ involvement in their journey. In some cases, the patients get exhausted from frequent trips to hospitals. Patients can also get frustrated by the waiting time in (Outpatient Departments) OPDs. This reduces the efficiency of patients’ and care giver’s engagement in treatment. Therefore, it can help in increasing the self-efficacy and efficiency of a patient.
“The adherence to treatment in patients using DCPE has gone up.”-[HCP2].
Moreover, the history of previous check-ups helps the patient and clinician to assess and plan further treatment. This further enhances the adherence of patients to treat their disease by properly attending the online appointments from the comfort of their homes.
Patients Can Track the Progress of their Condition.
The presence of previous record of appointments, medications, health related parameters like glucose, blood pressure, weight, type of epileptic seizures; the frequency, time duration, and severity of such attacks can be seen in profile created for a patient with epilepsy after an initial checkup. Furthermore, in case of paediatric patients, seizures (occurrence and duration) can be seen in DCPE by clinicians. This information can be shared with the patient to keep track of their disease and monitor the progress of their condition.
Patients Can Learn and Educate Themselves through Available Education Resources in Online Portals.
According to the HCPs, education and awareness related to epilepsy can help the patient in self-care. Currently, there are different online sources of information like “Finnish Epilepsy Association”, “Health Village.” These provide useful resources about epilepsy for different age groups like children, adolescents, and adults, self-care advice, treatment plan, and peer-support options. Similarly, DCPE can provide educational and online resources to help patients in their journey.
4.3 Environmental Sustainability Goals
It was found that the project addresses three sustainability goals related to environmental sustainability: (1) reduces the travels needed to hospital, (2) reduction in the CO2 emissions, (3) and reduction in chances of spreading the airborne pathogens. These three goals are illustrated in Fig. 4. The HCPs perspective related to these goals are synthesized in the forthcoming subsections.
Fig. 4.
Environmental sustainability goals.
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Reduction in the Travels Needed to Hospital.
A bigger percentage of the population still visits hospitals in person for initial and follow-up visits. The HCPs prefer to conduct the initial evaluation of patients with epilepsy in person so that trust can be built, and a strong relationship is started for better communication between HCP and patient. Furthermore, in the initial evaluation, the clinician makes sure that they get all the required information and conducts all the required lab tests of patients.
However, when the follow-up visit becomes more routine, then it might not require an in-person visit. In this way, a greater number of unnecessary follow-up visits to and from hospitals can be avoided. This can reduce the carbon footprint as there is a reduced need to travel.
“Some of the patients living in the Northern Finland need to travel hundreds of kilometers to reach the clinic.”-[HCP1].
This can lead to negative consequences not only from a financial perspective but also from the environmental perspective.
Reduction in CO2 Emission.
Recently, there is an increased interest towards reducing healthcare activities related to carbon footprint across the globe. According to the HCPs, DCPE can certainly help in reducing the carbon footprint associated with travel to and from hospitals for clinical visits. Generally, it is believed that only patients need to travel to receive treatment. However, it is partially true, because there is a huge number of personnel in hospitals like nurses, doctors, lab specialists, and others, who are travelling for work. This sometimes accounts more for CO2 emission. An HCP expects that reduction in travels to hospital can benefit the healthcare personnel as well.
“I hope that in near future it would be possible for us doctors to work more from home, so we will have to travel less, at least not for the all the days to our workplace and back to home, so that it helps the environmental system because we will not be using all the facilities of hospital while working from home.”-[HCP3].
Minimize the Chances of Spreading Airborne Pathogens.
According to the healthcare experts, it is good to avoid spreading viral diseases by avoiding hospital visits when not needed. It is preferred and recommended to patients to stay at home and seek medical treatment remotely through phone calls when they are suffering from a viral illness. In the presence of DCPE, we can benefit from remote consultation or appointment through audio, and video calls according to the needs. It will surely have positive impacts on the whole environment and help the healthcare staff as well, who are equally at risk of getting affected through contact with any ill patient. One HCP mentioned that some patients suffer from rare genetic conditions and some autoimmune deficiency along with epilepsy, and we as HCP try to avoid frequent contact with them so that we do not spread viral illnesses.
“The lower number of visits to hospital will minimize chances for viral illnesses, as well as COVID-19, and spreading infections.”-[HCP2].
Therefore, DCPE can really bring a lot of positive impacts on reducing the spread of viral diseases.
4.4 Sustainability Challenges for Successful Implementation of Digital Care Pathway for Epilepsy
The HCPs believed that sustainable implementation of DCPE can be made sure after meeting the challenges involved in providing satisfactory services to patients with epilepsy. The challenges faced by the HCPs are different than the challenges faced by the patients.
Sustainability Challenges for HCPs.
According to the HCPs, the first challenge for them is the training required for managing the digital platforms for providing services like remote consultation through DCPE. Moreover, there is a risk of digital exclusion which can happen if a group of people do not have appropriate devices like laptop or a smart phone with working internet connection. In addition to this, there can be instances when patients are unable to access and use the digital tools or services of DCPE. Another challenge about effective communication was mentioned by an HCP which can help in proper guidelines during treatment.
“Sometimes patients expect the HCP to reply too fast because they want a quick result from the prescribed medicine, but it takes time for the medication to work.”
- [HCP2].
Therefore, it can be said that careful planning and proper rescheduling pose challenges for the HCPs in successful implementation of DCPE.
Sustainability Challenges for Patients.
According to the HCPs, it needs to be ensured that all the citizens are aware of the usefulness of DCPE and services like remote consultation. Particularly, the patients of epilepsy and their family members or persons involved with their treatment like friends, social workers etc. Patients can better adapt to this new mode of service after realizing its potential and advantages in their lives. Furthermore, it is important that all patients can access the digital tools and services of DCPE. For instance, it is crucial to have a laptop or PC or a smart phone to use the web or mobile application of DCPE. Besides, user satisfaction is crucial for maximizing the benefits for a patient. This can be done by implementing the principles of user centered design and verifying the developed prototypes through usability testing and user experience methods.
5 Conclusion
In this paper, we discussed and explored the sustainability goals of DCPE in collaboration with the HCPs. DCPE will offer various advantages which will contribute to the long-term goals of sustainable healthcare systems.
In terms of economic, social, and environmental factors, the project can support patients, their family members and friends, and caregivers like doctors and nurses. It is beneficial to all the stakeholders at different levels. This is done by minimizing the in-person travels needed to hospital and providing at home treatment. However, there are challenges involved in the successful implementation of a digital care pathway for smooth transitioning and delivery of online appointments. The HCPs can schedule, manage, and divide time for remote appointments and face-to-face visits as per the need of an epilepsy patient. Moreover, DCPE cannot replace every hospital visit, but it can help in reducing the unnecessary in-person visits to provide healthcare services through online portals for those with stable condition of epilepsy. Due to the nascent nature of DCPE, the HCPs perspective is highly crucial in successful and sustainable implementation of DCPE. Their firsthand experience, learning and insights will help guide the effective adoption and deployment of novel digital health solutions as well as shape its future development. Thus, we explored the subdimensions which can lead to sustainability of DCPE in collaboration with HCPs, so that an evidence-based study can help the HCPs, and patients in future.
In future, more research is required to study the sustainability goals of DCPE from an economic, social, and environmental perspective. Furthermore, we can study and examine the perspective of patients and their expectations from the sustainability perspective of DCPE. The patients can provide feedback on the usefulness and ease of use of online appointments after their first-hand experiences with DCPE. These developments and future studies can strongly support achieving the sustainability goals of DCPE.
Acknowledgments
The work has been supported by 6GESS – 6G Enabled Sustainable Society profiling program co-funded by Research Council Finland.
Disclosure of Interests
The authors have no competing interests pertaining to the content of this article to declare.
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