Abstract
BACKGROUND: Telemedicine has revolutionized healthcare delivery, significantly improving accessibility and efficiency. In China, the predominant mode of telemedicine service delivery is Business-to-Business (B2B). However, the utilization of B2B telemedicine is relatively low. Within the B2B context, primary care physicians (PCPs) are critical users. There is a lack of knowledge regarding PCPs' continuous intention to use the B2B. To address this gap, the study aims to study and unveil factors affecting PCPs' continuous usage intention for B2B telemedicine. METHOD: This study proposes an integrated Technology-Individual-Environment theoretical framework to analyze factors and mechanisms influencing PCPs' continuous usage intention for B2B telemedicine, considering exogenous, technology, and endogenous dimensions. We used Partial Least Squares Structural Equation Modeling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to test the research model. A cross-sectional study was conducted among PCPs with prior B2B telemedicine usage experience across more than 30 primary healthcare institutions in China. Overall, 421 (63.88%) out of 659 questionnaires were valid. RESULTS: The PLS-SEM results revealed that within the individual dimension, attitude, perceived behavioral control, and intrinsic motivation positively influence PCPs' continuous usage intention, while perceived risk had a negative impact. Within the technological dimension, assurance and reliability demonstrated direct positive effects on continuous usage intention, whereas tangibility indirectly influenced intention through attitudinal mediation. Notably, the environmental dimension showed no statistically significant effects on continuous usage intention. Complementing the PLS-SEM findings, fsQCA analysis identified three configurations that lead to high continuous usage intention and three configurations leading to low intention. Based on these results, factors influencing PCPs' continuous usage intentions are classified into foundation factors, performance factors, and enhancement factors. CONCLUSION: Within B2B telemedicine, this study focuses on the factors and mechanisms influencing PCPs' continuous usage intention. These findings provide a robust theoretical foundation for policymakers and healthcare administrators seeking to enhance PCPs' engagement with B2B telemedicine platforms, ultimately contributing to the advancement of integrated healthcare delivery systems.