# Acceptability of Telehealth as the Default Modality for Multiple Sclerosis Care in Switzerland: Cross-Sectional Study

## TL;DR

This study found that only a small proportion of people with multiple sclerosis in Switzerland are willing to accept telehealth as their primary care modality.

## Contribution

The study identifies factors influencing telehealth acceptance among MS patients in Switzerland, including digital communication habits and disease progression.

## Key findings

- Only 15.5% of respondents were willing to accept telehealth as their default care modality.
- Digital communication with healthcare providers and internet use for healthcare searches were strongly associated with telehealth acceptance.
- Secondary progressive MS diagnosis was negatively associated with telehealth acceptance.

## Abstract

Telehealth can improve access to care for people living with multiple sclerosis (MS), but information on its acceptance is limited in Switzerland.

This study aimed to determine the proportion of people living with MS willing to accept telehealth as a new default and the factors associated with their acceptance.

We conducted a cross-sectional analysis using survey data from the Swiss Multiple Sclerosis Registry. We defined “telehealth as a default” as a health care model where remote consultations (telephone and/or video calls) are the primary mode of interaction between patients and their physicians, with in-person visits based on clinical necessity. Multivariable logistic regression was performed to evaluate the association between telehealth acceptance and sociodemographic and health-related factors. Telehealth acceptance was described in relation to 3 survey variables that mirrored key constructs from the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. The variables were digital communication preferences, internet use for health provider searches, and experience with telemedicine.

Among 427 respondents, 15.5% (66/427) reported a willingness to accept telehealth as their default. In this group, only 21.2% (14/66) had experience using telemedicine. A descriptive analysis of our 3 NASSS-derived key constructs showed that among the 78.5% (335/427) respondents who generally agreed to digital access to health data, only 17.0% (57/335) accepted telehealth as a default. Notably, 30.7% (129/427) of participants stated a wish for support for using devices or the internet. Among those 129 individuals, 17.1% (22/129) were willing to accept telehealth as a default. Of the 89 people with prior telehealth experience, 15.7% (14/89) were willing to accept telehealth. In multivariable analysis, digital communication with health care providers (adjusted odds ratio [aOR] 14.56, 95% CI 6.18‐39.04; P<.001), current internet use for health care provider search (aOR 7.78, 95% CI 1.34‐45.32; P=.021), and a secondary progressive MS diagnosis (aOR 0.22, 95% CI 0.05‐0.72; P=.021) were independently associated with accepting telehealth as a default.

Our findings suggest a low acceptance of telehealth as a default among people living with MS in Switzerland. While our 3 postulated NASSS-derived key constructs were not associated with telehealth acceptance, we noted additional behavioral factors, including previous digital communication with health care providers and using the internet to search for health care provider information, which were associated with telehealth acceptance. Moreover, advanced disease states like secondary progressive MS were negatively associated with telehealth acceptance. Thus, telehealth as a default will be most acceptable in people living with MS who already use the internet for their health, and those with less severe disease. Future research should explore provider perspectives and evaluate long-term strategies for the acceptance of telehealth in MS care.