Physician Online Care in Telehealth: Drivers of Follow-Up Services and Economic Outcomes of Medical Support

Abstract

The rapid expansion of telehealth technologies has transformed healthcare delivery by increasing access to care and enabling more continuous patient monitoring. However, the success of virtual healthcare systems hinges largely on the active engagement of physicians, who serve as the primary providers of medical care on telehealth platforms.
Given that online consultations remain the most prevalent form of telehealth service delivery, prior research has predominantly focused on physicians’ reactive engagements (e.g., responding to patients’ online inquiries). Yet as telehealth services evolve and mature, physicians’ roles in these systems may also expand. Current helping literature distinguishes between reactive helping and proactive helping, suggesting that physician engagement in telehealth could have both reactive and proactive dimensions. This thesis investigates physician engagement in telehealth from two complementary perspectives: reactive engagement in online consultations and proactive engagement in online follow-up services. By adopting this dual lens, the thesis contributes to the telehealth literature by offering a more comprehensive framework for understanding physician engagement in virtual care settings.
Study 1 focuses on the reactive engagement of physicians in online consultations, exploring how physicians’ emotional and informational support in online consultations impact patient satisfaction in online health communities (OHCs). Using text-mining techniques, this study quantifies support within physicians’ reply texts and compares their short- and long-term effects. The findings reveal that both emotional and informational support positively impact patient satisfaction, with informational support showing a stronger and more enduring effect. The study also uncovers a complementary relationship between emotional and informational support, and highlights the negative moderating role of medical jargon on the effectiveness of informational support. Methodologically, the study applies the concept of information entropy in the measurement of informational support and introduces a novel sentence-based sentiment analysis approach to measure emotional support.
Study 2 focuses on the proactive engagement of physicians in online follow-ups, examining how patient features impact physicians’ follow-up decisions on mental telehealth platforms. Guided by the Elaboration Likelihood Model (ELM), this study differentiates patient features into central route factors (e.g., patient clinical features) and peripheral route factors (e.g., patient online behavioral cues). Using a multimethod approach that integrates regression analysis and fuzzy-set Qualitative Comparative Analysis (fsQCA), the findings show that both central and peripheral cues affect physicians' decision-making, with physician ability significantly moderating these effects. The study also reveals stage-specific drivers for the decision to initiate follow-up and to offer re-follow-ups, and identifies interactions between central and peripheral cues, thus extending the dual-route assumptions of the ELM.
Together, these studies contribute to the understanding of physician engagement in telehealth and provide actionable insights for optimizing digital healthcare delivery. First, this thesis introduces a holistic perspective that considers both reactive and proactive dimensions of physician engagement, exploring how physicians respond to patient-initiated consultations (reactive engagement) and how they initiate follow-ups (proactive engagement). This dual perspective broadens current research, which has predominantly focused on reactive physician engagement in telehealth.
Second, the thesis demonstrates how multimethod designs can cope with the complexities inherent in telehealth settings, such as the unstructured data in online consultations (study 1) and the complex decision-making of physicians in offering follow-ups (study 2). This research design showcases the value of combining multiple techniques in digital health studies and responds to long-standing calls for methodological pluralism in the literature.
Third, this thesis offers novel theoretical insights into physician engagement in telehealth. Study 1 explores the differences and relationships between emotional and informational support in a physician-driven online health community, supplementing prior findings from a patient-driven platform. Study 2 develops a dual-route decision-making model of physicians that integrates both patient clinical features and online behaviors in telehealth, revealing essential differences in physician decision-making processes between online and offline medical settings.
Finally, this thesis offers practical insights for enhancing digital healthcare delivery. For instance, study 1 suggests that combining emotional and informational support improves patient satisfaction, highlighting the need for platforms to guide physicians to integrate both forms of support in their replies. It also highlights the negative effect of excessive medical jargon, recommending features like automated explanations to improve communication clarity. Study 2 shows that physicians’ follow-up decisions are influenced by both the clinical conditions and online behaviors of patients. Accordingly, platforms can integrate diverse patient data—potentially through AI-generated risk scores—into dashboards to aid decision-making and targeted care.

Date of Award	9 Sept 2025
Original language	English
Awarding Institution	City University of Hong Kong
Supervisor	Chi Wai Ron KWOK (Supervisor) & Xitong Guo (External Supervisor)