Voices from the field: healthcare professionals' insights on sustaining telemedicine for diabetes management in Hong Kong primary care.

Introduction: Diabetes mellitus is a prevalent chronic illness that imposes substantial health and financial burdens. In routine follow-up for diabetes, telemedicine offers a promising alternative to traditional face-to-face care within primary care settings, yet real-world adoption remains uneven and often discontinuous. This study explored how healthcare professionals experience the implementation of telemedicine consultations for diabetes management, identifying facilitators, barriers, and resources needed for long-term operation. Methods: We conducted a qualitative study with 21 healthcare professionals involved in a hybrid telemedicine program in public primary care. Semi-structured interviews underwent a three-stage analysis: first, inductive thematic coding; second, organization of themes using the NASSS framework (Non-Adoption, Abandonment, Scale-Up, Spread, Sustainability); and third, ecological mapping of each NASSS-organized theme to micro, meso, exo, macro, and chrono levels to trace cross-level pathways and temporal shifts. Results: Thirteen themes were identified and grouped across ecological levels and NASSS domains. Key facilitators included coordinated policy and organizational support, prepared clinic infrastructure, effective training and IT support, and positive perceptions among staff and caregivers. Major barriers included staffing constraints and workflow burden, patient digital literacy challenges and environmental constraints, process complexity including identity verification and e-payment steps, limited suitability for unstable clinical presentations, and gaps in end-to-end service features such as medication delivery. Discussion: Sustaining telemedicine in primary care will require addressing these barriers while reinforcing enabling conditions through aligned policy and financing, streamlined infrastructure and workflows, targeted patient and staff supports, and continued adaptation over time. The combined NASSS and ecological approach clarifies what the determinants are and where and how they operate, offering level-specific, actionable directions to strengthen the long-term delivery of diabetes care via telemedicine. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05183685, identifier NCT05183685.