**4. Discussion**

This study aimed to explore the literature and determine the user experience of digital care visits from different healthcare professionals' points of view [62]. This study showed that healthcare professionals mostly had positive experiences with digital care visits. Many authors stated that healthcare professionals believe that digital care visits are advantageous for the professionals considering benefits such as remote work, efficiency, satisfaction with this type of consultation, and new perspectives in remote care. Clinicians particularly appreciated the ability to be flexible in terms of work hours, choosing the work environment, increased productivity and efficiency, as well as the ease of use of the technology. Similarly, when exploring patients' points of view, a systematic review has shown that the patients had overall high satisfaction with information sharing and consumer focus [6].

Many healthcare professionals agreed that digital care visits significantly increased the accessibility of health care services to patients who live in remote locations, are not able to travel to a health facility due to various reasons (limited or restricted mobility, social phobias, lack of resources, etc.,), or even those with responsibilities at home such as caring for young children or sick relatives. These findings align with other studies that explored the caregivers' and patients' points of view toward remote care [63,64]. A significant portion of studies declared clinicians found their patients became more confident in themselves, felt more at ease, and cooperated in their treatment better when they had the chance to stay in their home environment. Specifically, this was mentioned not only by mental health professionals, who rarely need to apply hands-on techniques in their treatment, but also by physical therapists who were teaching their patients exercise techniques and managed to achieve good outcomes [39,45,58,59]. Facilitators found in the literature were related to new perspectives and features of remote care, such as real-time video aspects that added visual information compared to consultations over the phone.

Health care professionals had mixed experiences with technical quality. Eight of the selected papers reported the quality as being good with no issues at all. In ten of the other studies, it was reported that clinicians experienced technical issues related to video/audio quality or connectivity issues from their or their patients' side [13,37,38,43,48,55,59,61].

The possibilities of digital care visits were rated positively among healthcare professionals. Physicians and therapists thought it was possible to consult, examine, diagnose, and treat patients via digital care visits. However, in almost half of the reviewed papers, healthcare professionals expressed that the lack of physical examination was at least somewhat problematic. Particularly, general practitioners and healthcare professionals who work with musculoskeletal disorders and oncologic patients found the inability to physically examine patients to be an obstacle in some cases [36,38,39,43,44,46,48,50,51,55,58,59,61]. Overall, there were mixed opinions on whether digital care visits could replace face-to-face visits. Health care professionals reported that digital care visits are suitable to assess some conditions, such as simpler skin conditions, mental health issues, and other conditions that did not require touch to assess as well as follow-up visits for chronically ill patients [38–40,46]. On the other hand, when the conditions were more complicated or the patient was new, clinicians reported that a physical visit would be more suitable [35,38,46,50,51]. Compared with another study, health personnel found both benefits and disadvantages of treating patients remotely. Some found it advantageous because the patients did not need to wait long to receive care; others expressed it was easier for them to write a referral rather than have a digital care visit [64].

The findings suggest that digital care visits are suitable for visits that involve treatment of rather simple conditions. Those that do not require a physical examination or do not involve sensitive conversations would be better managed in face-to-face visits. Naturally, selecting the right kind of patients for remote care would decrease the complexity of decision-making when a professional must rely on other senses and information collected without being physically present with a patient. This could be achieved by employing a triage system as suggested in two Swedish studies [13,37] and one American study [50]. By implementing a triage system that would filter the patients and direct them to the right type of care, limited medical resources could be utilized more efficiently. Other suggestions for improvement include training and educational materials, which could potentially improve healthcare professionals' experience in using digital care visits, as well as raise awareness among those who have not started to use it yet and encourage them to employ the technology [13,36,42,44,47,56]. Conversely, general practitioners from another study noted that even though reading manuals on how to use the technology were often helpful, they rarely found the time "to read and understand the instructions" due to tight scheduling [64].

Some healthcare professionals expressed digital care visits were not well integrated into their workflow. They felt unsure when prescribing medication to patients without knowing their health history [39]. Using separate video-conferencing tools, scheduling consultations, and coordinating remote care added to the workload [50], thus implementing the necessary tools into the EHR system could make the workflow smoother and allow healthcare professionals to access patients' health records, ensuring greater confidence for the clinicians and safety for the patient [37]. Another important aspect of remote consultations or remote work, in general, is fatigue that comes from communicating online and the feeling of isolation and loneliness from being unable to meet with peers. One study suggested that self-care should be promoted among healthcare professionals working remotely [46]. Online social activities for the healthcare teams such as communication channels, virtual social groups, peer support, and games or team challenges could be offered to healthcare professionals to provide them with an opportunity for casual and less formal communication with colleagues as a replacement for running into each other at the office [65]. This, in turn, could make them feel more connected to the team and less isolated.

Few of the studies in this review involved resident doctors or young professionals who do not have extensive work experience [50,51,53]. It was reported that they had more difficulties in using digital care visits. It was more complicated to assess and diagnose patients due to limited work experience [50,51,53], and therefore it is possible their experience with remote consultations was more negative. It is possible that clinicians with more in-person work experience would be a better fit for providing such services [39], and they would be more comfortable in such a setting. Alternatively, it could be beneficial if young professionals got mentorship or support from their more experienced peers whenever they needed to increase their confidence. Also, as mentioned in some of the reviewed articles, training and education on how to use the technology and provide remote health care would be beneficial [66].

It is worth mentioning that because of the COVID-19 pandemic, the adoption of digital care visits was extremely rapid, and many health organizations were unprepared for it. Health workers were pushed out of their comfort zones and forced to move to remote care abruptly without having the time to prepare or train for it properly, and many of the organizational changes had to be made suddenly to make the shift happen [45,46,54]. Therefore, the studies published during the pandemic were strongly influenced by these aspects, and healthcare professionals' experiences of using digital care visits were affected by the sudden shift as well as general stress and pressure caused by this unprecedented contagion. Many of the professionals have not used digital care visits prior to the pandemic, and the sudden change may have influenced their experiences more negatively. However, on the contrary, many stated an overall positive experience and would continue to use the technology to a smaller or larger extent in the post-pandemic future [35,38,41,44,45].

It is clear from the results that digital care visits will never fully replace in-person visits [67,68]. However, the studies showed that it is possible to provide health care services via digital care visits in cases that do not require a physical examination for the assessment, such as chronic disease management [40]. Patients with conditions such as diabetes who are consulted and monitored by healthcare professionals online may be able to manage their condition at home without the need for hospitalization, thus saving time and resources for both parties [68–70]. Almathami et al. performed a systematic literature review on "Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients' homes" in 2020 and found that the majority of their included studies (98 percent) proved the effectiveness of digital care visits in "improving patients' overall health conditions and in assessing patients' health conditions successfully" [71]. The same review found that more than a quarter of analyzed studies proved online consultations were as good as face-to-face visits [71]. However, digital care visits should not take over all in-person visits but act as a complement to the physical visits. It is important to note that the social interaction and physical presence facilitate better conditions for showing empathy and simply "being there" for the patient, which are essential parts of care and bear significant value to patients and professionals alike.
