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      Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study

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          Abstract

          Background

          Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients’ care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients’ use of mHealth apps that could impact their willingness to recommend the apps to patients.

          Objective

          The aim of this qualitative study is to investigate French GPs’ attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs’ perceptions and expectations of mHealth technologies.

          Methods

          A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis.

          Results

          Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients’ compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data).

          Conclusions

          A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs’ digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow.

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          Most cited references41

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          A Theoretical Extension of the Technology Acceptance Model: Four Longitudinal Field Studies

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            Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

            Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Contribution of primary care to health systems and health.

              Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                March 2021
                4 March 2021
                : 9
                : 3
                : e21795
                Affiliations
                [1 ] Aix Marseille University, INSERM, IRD, SESSTIM Marseille France
                [2 ] Institut Paoli-Calmettes CanBios UMR1252 Marseille France
                [3 ] Université Côte d’Azur, Rétines, Healthy, DERMG Nice France
                [4 ] Université Grenoble Alpes, Centre National de la Recherche Scientifique Sciences Po Grenoble, Pacte Grenoble France
                [5 ] Department of General Medicine Rouen University Hospital Rouen France
                [6 ] Department of Biomedical Informatics Rouen University Hospital Rouen France
                [7 ] INSERM, U1142, Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances en e-Santé (LIMICS) Sorbonne Université Paris France
                Author notes
                Corresponding Author: Aline Sarradon-Eck aline.sarradon@ 123456inserm.fr
                Author information
                https://orcid.org/0000-0002-6697-8058
                https://orcid.org/0000-0002-2203-9745
                https://orcid.org/0000-0002-0190-5835
                https://orcid.org/0000-0002-7355-4560
                https://orcid.org/0000-0002-4425-4163
                Article
                v9i3e21795
                10.2196/21795
                7974757
                33661123
                23fe7ad4-2df8-49a4-8922-22e7d7cbea19
                ©Aline Sarradon-Eck, Tiphanie Bouchez, Lola Auroy, Matthieu Schuers, David Darmon. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 04.03.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 25 June 2020
                : 22 September 2020
                : 10 November 2020
                : 8 January 2021
                Categories
                Original Paper
                Original Paper

                mobile applications,qualitative research,general practitioners,france,mobile phone

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