Table 1.

Interview results structured according to the Consolidated Framework for Implementation Research (CFIR) domains, categorized by e-health application.

Domains	E-Consultation	Online Ordering of Repeat Prescriptions	Video Consultations	Teleconsultations	Telemonitoring
Characteristics of the intervention	Most GP practices already made use of e-consultations before the COVID-19 pandemic Due to the outbreak, they used it more extensively during this period Particularly suitable for sending of photos of skin abnormalities, for simple questions from patients, and for sending test results to patients Not suitable for emerged clinical problems and elaborate, complex questions Photos sent by patients are generally clear enough to judge; patients generally have suitable questions Most GPs do not experience the e-consultation being more time efficient than face-to-face consultation	Most GP practices already made use of online services to request maintenance drugs before the COVID-19 pandemic Due to the outbreak, some used it more extensively, while in other practices this was already used extensively Generally, it is perceived suitable for any patient	Most GPs experimented with the use of video consultations during the COVID-19 pandemic Use has been reduced after the first wave, as face-to-face consultations are generally preferred by GPs (unless patients ask for video consultations) Generally, GPs report that it is only used for a minority of their patients, as in most cases there is no additional benefit in using video consultations over telephone calls or e-consultations	Most GP practices already made use of e-consultations before the COVID-19 pandemic; only a few used it for the first time Some GPs used teleconsulting more extensively during the COVID-19 pandemic, but this increase was only modest Teledermatology is the specialism for which it is used most frequently	GPs used telemonitoring more extensively due to the COVID-19 pandemic Blood pressure and saturation devices were either provided by the GP or patients were encouraged to purchase these themselves Patients forwarded their measures via e-mail or telephone None of the GPs have a direct connection with a device (no automatic sending of measures)
Target group of e-health application (inner setting; characteristics of individuals)	Generally, relatively young patients, who have digital skills and who work during the day, but also some older patients	Some GPs perceive that young patients use it more extensively than older patients Some GPs experience an increased use by elderly, probably because they are avoiding going to the practice during this period	Some GPs find it more suitable for young patients and patients with a higher obtained level of education, but most find it suitable for any patient with some technical skills (or with help) Nurse practitioner consultations are particularly mentioned by some GPs because consultations are often longer and more intensive with the more vulnerable and less mobile patients When the GP has not met the patient before, video consultations are preferred over telephone consultations It is particularly suitable for patients with psychological problems, as emotions and non-verbal communication can be observed Palliative care	Diverse Patients that receive care from multiple disciplines Patients that are new to a specialist	Patients that need regular blood pressure, glucose, or saturation monitoring and prefer not to come to the practice Patients that are able to take responsibility to perform the measures Used by GPs as well as nurse practitioners
Advantages (outer setting)	Flexibility of GPs to respond at any moment that is suitable to them Flexibility of patients to send their medical question or photo without having to cancel work or to wait on the telephone Leaves more room for urgent care E-consultation may replace the practice of evening visiting hours Variation in the care delivery modes Ability to save photos of skin abnormalities in the patient’s record	It saves time for assistants as they do not receive the medication boxes or telephone calls Pharmacists keep medication lists updated and GP only has to approve, which is less time consuming and less prone to errors than manual update It saves time for patients as they do not have to come to the practice or wait on the phone Patients find it easy to use	GPs obtain a better impression of how ill someone is by using video consultations (compared to telephone call or e-consultation) It is practical for the patients, as they do not have to travel to the practice Patients who need emergency care can be helped quicker if they do not live close to the emergency unit	Low key contact with specialists It is generally easier to plan a teleconsultation with specialists than reach them by phone It is beneficial for the specialist also that it can be planned Photos and test results can be attached It can be an alternative for the “meekijkconsult” (“watch consultation”) It prevents unnecessary referrals and consequently reduces waiting times It can save the patient a hospital visit	Patients’ state is being objectivized and monitored without having to come to the practice (especially an advantage when patients are more vulnerable to infection and less mobile)
Limitations (outer setting)	It can be inefficient when the questions go back and forth Low-threshold usage can lead to unnecessary consultations Administrative burden when not directly integrated with GP’s information system Respond time within 48 h can be a burden when it is directed to one specific GP who is on leave (need for gatekeeper) Not always clear whether a patient has received and read the response of the GP	Not many GPs report limitations Some experienced limitations in implementation, e.g., informing patients can be time consuming; the costs; working with different systems than the pharmacist can be an administrative burden	Practical limitations such as not having a camera Technical limitations such as connection, webcam, and audio limitations It has to be AVG-proof Some GPs as well as patients find it difficult to use Time consuming due to the need to perform extra steps such as sending invitations, having to log in, and having to explain to patients how it works, etc. It costs a lot of energy Most patients do not prefer video consultations, e.g., they feel unease The costs are not covered (except for the free test period)	Teleconsultation is an extra consultation for the GP, which costs more time than direct referral to a specialist Different disciplines work with different systems; in some cases this is not directly connected to GPs’ systems Some GPs experience technical problems or connection problems or find the application cumbersome Some GPs experience a barrier to using it for specialisms for the first time Some patients prefer a direct referral to a specialist	Some patients prefer face-to-face measurements in order to feel a sense of control Telemonitoring is not yet well-integrated with the GPs’ systems (administrative burden) Role for the patient to register their measures in the GPs’ system The costs of devices (for GPs or patients) Quality of (cheap) devices
Future use and incentives (process)	Most GPs intend to keep using e-consultations more extensively also after the pandemic because (1) since the pandemic there is more (positive) experiences among patients and (2) because of the OPEN program for facilitating online access to medical patient files. Use is reduced compared to the pandemic’s first peak, as people generally still prefer face-to-face visits Integration within all the GPs’ information systems would stimulate use E-consultation is perceived as a substitution but not a replacement for face-to-face consultations	Most GPs expect that it will be extensively used by patients also after the pandemic because (1) more patients have access to the patient portal, (also used for e-consultations, making online appointments, accessing medical files), (2) patients are actively encouraged to use it, and (3) it saves them time Working with only one system for all patients (i.e., pharmacists) would improve user-friendliness of use	Use is reduced compared to the pandemic’s first peak, as GPs as well as patients still prefer face-to-face visits Support for patients, e.g., via volunteer organization for elderly or via a social worker Support for implementation in GP practice by “healthcare group” Technical support for GPs Financial support by insurances Using it repeatedly is needed to adopt it as a routine (the “lockdown” period was too short to achieve a routine)	Most GPs expect that teleconsultations will be as extensively used as during pandemic, or more extensively Preparing patients by addressing the advantages	Integration with the GPs’ systems Reimbursement of the devices by the insurance When telemonitoring becomes automatic, responsibilities regarding when and how measures are monitored by the GP have to be well agreed-upon with the patient