Aceitação da telemedicina por médicos no Brasil: um olhar sob a lente da teoria institucional

Abstract

Telemedicine is characterized by being a set of different health services, which are performed at a distance, being a promising tool in social development, through expanded health care. However, there is still no consensus in the literature on the factors that influence the acceptance and diffusion of these practices. Thus, the objective of this study was to analyze the factors that influence the acceptance of telemedicine, more specifically, econsult, by physicians, and to understand how institutional factors and the institutional work practice by these professionals act in a way to spread or hamper the adoption of these practices. This work uses a single case study, with a qualitative approach; with data collection through semi-structured interviews, analysis of videos from public hearings, from digital platforms, in addition to various documents such as ordinances, laws and media reports, among others. Data analysis was performed in two cycles, using mixed coding methods. As a result of the research, 13 factors that influence the acceptance of telemedicine / econsult by physicians were initially identified. Eight of these factors had been previously identified in the literature, namely: Regulatory Factors, Degree of User’s literacy, Resistance to Change, Technological Infrastructure, Perception of Value, Organizational Characteristics and Financial Support. Five other acceptance factors, not found in the previous literature, emerged from the data collected in the Brazilian context: Corporatism, Possibilities of Specialties, Physical Examination in person, Mercantilization of Telemedicine, and the Previous Doctor-Patient Relationship. All of these factors were then discussed in the light of Institutional Theory and Institutional Work. Thereby, it was possible to verify that the Institutional Theory enables expanded views that relate these factors to each other and that reveal new relationships and similarities different from those already realized through theories of diffusion and acceptance of innovations, verified in the previous literature. Thus, the Culture / Cognitive, Normative and Regulatory Pillars are related to aspects that correspond to the basis of the relationship between factors, such as Ignorance, Structure and Regulation, respectively. Finally, the Institutional Work for maintaining the institution of face-to-face consultations was analyzed, and the Policing and Determination practices, already mentioned in the literature, were present in the researched context, but two new practices of institutional work were identified and are defined: Def research towards to the way in which certain professional classes influence the acceptance and diffusion of innovations and technologies through institutional work practices. For companies in the sector, it shows possibilities about the use and implementation of econsult. For society, on the other hand, it provides a better understanding of these practices, which can contribute to an expansion of health care assistance.