Power Gaps among Stakeholders in Israel's Primary Care and the Role of Primary Care Physicians' Relative Power in Their Intention to Use Video-Consultations with Patients

Irit Chudner, Anat Drach-Zahavy, Hadass Goldblatt, Margalit Goldfracht, Khaled Karkabi

Research output: Contribution to journalArticlepeer-review


Introduction: Although some correlates of primary care physicians (PCPs) telemedicine adoption have been studied, little is known about whether the intention to use video-consultations (VCs) relates to how PCPs view their power, relative to other stakeholder groups in primary care. The aim of this study was (1) to describe PCPs', patients', and policy makers' (PMs) views of their power and (2) to explore how PCPs views of power are associated with their intention to use VC. Methods: A convergent parallel mixed-methods design was used. Interviews were conducted with five focus groups that comprised 42 patients; five focus groups with 52 PCPs; and 24 individual interviews with PMs. A total of 508 patients, 311 PCPs, and 141 PMs completed the questionnaire, assessing intention to use VC and stakeholders' relative power. The qualitative data were analyzed using the thematic method; survey data were analyzed using quantitative methods. Results: All stakeholder groups rated PCPs' power as significantly lower, relative to that of patients and managers. PCPs' intention to use telemedicine was found to be significantly related to perceived power gaps between them and patients (r =-0.24, p < 0.001) and between them and managers (r =-0.45, p < 0.001). Themes revealed in the analysis describing how PCPs' low power influences their intention to use VC were as follows: PCPs' low-impact telemedicine-related decisions, increased work overload, "big brother" control, and Health Maintenance Organization demands for telemedicine mandatory usage. Conclusions: To successfully adopt VC, efforts should be made to increase PCPs' relative power, by strengthening their involvement in decision-making procedures and by increasing PCPs' control over their work environment.

Original languageEnglish
Pages (from-to)190-204
Number of pages15
JournalTelemedicine Journal and e-Health
Issue number2
StatePublished - Feb 2020

Bibliographical note

Funding Information:
The authors thank all the study participants: PCPs, patients, and PMs. All authors contributed to the study design and to the data collection. I.C., H.K., A.D.Z., and H.G. conducted the analysis, interpreted the results, and reviewed the article. This study was part of a larger study, titled: ‘‘Family Medicine—Quo Vadis?’’ This aimed to examine the desirable directions for family medicine development over the next 10 years, in accordance with the changing work environment and telemedicine. Funding: The qualitative stage in the present study and the patients’ quantitative survey comprise part of a larger study entitled ‘‘Family Medicine—Quo Vadis?’’ This was funded by The Israel National Institute for Health Policy Research, grant no. 2020947. Its publication is not contingent on the sponsor’s approval. No funding was received for the PCPs’ and PMs’ surveys.

Publisher Copyright:
© Copyright 2020, Mary Ann Liebert, Inc., publishers 2020.


  • PCPs' relative power
  • intention to use telemedicine
  • primary care stakeholders
  • telemedicine
  • video-consultations

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management


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