Background The COVID-19 pandemic has focussed attention on models of healthcare that avoid face-to-face contacts between clinicians and patients, and teleconsultations have become the preferred mode of primary care delivery. However, the effectiveness of remote consultations in this setting remains unclear. Objective To evaluate the impact of telephone or video consultations compared to those conducted face-to-face on key patient-relevant outcomes and healthcare utilisation in primary care, mental health and allied health services, which have had a critical role in the management of the wider and longer-term consequences of COVID-19. Methods A systematic review of primary studies comparing telephone or video consultations versus face-to-face visits, following the PRISMA guidelines. Results Overall, consultations delivered by telephone and videoconference were as effective as face-to-face in-person visits to improve clinical outcomes in adults with mental health conditions and those attending primary care services. Patient satisfaction with telephone and video consultations and the therapeutic alliance was high across the studies. However, high discontinuation rates in patients receiving teleconsultations indicate this may not be a suitable modality of healthcare delivery for all patients. Teleconsultations offer significant patient time savings in primary care, but appropriate implementation, including training of healthcare professionals and management of technical issues, is essential to ensure effective and valuable clinical interventions. Conclusions Teleconsultations via telephone or videoconference are an effective alternative to face-to-face consultations for many patients attending primary care and mental health services. Teleconsultations have the potential to deliver time-efficient and lower-cost interventions at a distance while improving access to healthcare.

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The multinational drug company Pfizer is trying to force leading medical journals to divulge the identities and comments of anonymous peer reviewers who judged articles submitted about two of the company's painkillers. Pfizer, which is facing a claim for damages by users of the cyclo-oxygenase-2 inhibitors celecoxib (Celebrex) and valdecoxib (Bextra), has issued subpoenas against journals including the New England Journal of Medicine, JAMA, the BMJ, and the Lancet. Editors and researchers fear the move could threaten the confidentiality of the peer review system. As the BMJ went to press the US district court in Boston was due to rule on whether Pfizer can force the New England Journal of Medicine (NEJM), which is resisting the subpoena, to hand over the information. The demand includes all documents relating to manuscripts submitted for publication, whether accepted or rejected. The journal has given Pfizer a small amount of material, mainly correspondence between authors and editors relating to suggested editorial changes, but it claims the bulk of the material is privileged. "Scientific journals such as NEJM may have received manuscripts that contain exonerating data for Celebrex and Bextra which would be relevant for Pfizer's causation defence," the company says in the motion filed with the district court. Donald Kennedy, editor in chief of Science, branded the exercise a "fishing expedition" in a signed editorial (2008; 319: 1009). "If this motion succeeds, what journal will not then become an attractive target for a similar assault?" he wrote. "Subpoenas are a routine part of fact gathering in any litigation by both plaintiffs and defendants," said a Pfizer spokesperson. "To defend against the plaintiffs' claims in the Celebrex and Bextra litigation, Pfizer has served subpoenas. Indeed, in this litigation, both parties served subpoenas on a number of authors and medical and scientific journals." UK NEWS Company managed to block creation of generic drug, p 576 World NEWS 94% of patients suing Merck over rofecoxib agree to company's offer, p 580 bmj.com doctors hope consensus on brain death in China will boost transplants news For the full versions of articles in this section see bmj.com