Comparison with the existing literature
Observational studies indicate that patients generally welcome telehealth primary care video visits as a reasonable alternative to in-person visits [Our study also identified challenges and drawbacks associated with video-based integrated care, which are of immediate practical importance given the current all-embracing presence of video conferencing. First, some patients missed the ability to develop a good therapeutic relationship in an in-person encounter with the mental health specialist. This observation resonates with findings from the Virtual Outreach Study on joint teleconsultations between patients, PCPs, and a hospital-based specialist, where patients described a sense of alienation arising from the use of technology [Second, although patients did not feel substantially disturbed by connectivity failures, poor network coverage and low bandwidth remain significant barriers for the acceptance of video consultations, particularly in some rural and/or remote areas, which must be addressed through timely and exhaustive broadband expansion [Third, data privacy protection is always an essential prerequisite for the implementation of video consultations. Our findings show that practices manage to regularly provide a quiet and confidential place free from interruptions in consultations. However, while the German government regulations require adherence to the EU General Data Protection Regulation from certified operators (e.g., video and audio communication is not recorded or stored on any server), data breaches can never be fully ruled out for video consultations. Finally, while the expectation of personal benefit is a well-known prerequisite for both patients and health providers to participate in large effectiveness trials [