Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

Abstract

BackgroundGovernments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain.ObjectiveThis study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care.MethodsA systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis.ResultsThis review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes.ConclusionsE-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

How do patients and general practitioners in Denmark perceive the communicative advantages and disadvantages of access via email consultations? A media-theoretical qualitative study

“…As pointed out by Mold et al (2019) in their review of 57 electronic consultation studies in primary care, remote care includes many other forms of communication than email (eg, telephone, video, text messaging, web-based portals and so on) and research in this area recognises this heterogeneity. 8 …”

“…Patient access to healthcare is highly topical as ageing populations mean that healthcare systems often strain to meet the growing demand for healthcare. 8 GPs in the Danish context, which is our present concern, are required to see increasing numbers of patients, 9 and Danish patients often struggle to see their GPs at the clinic due to GPs’ heavily booked schedules. 10 A sense of inaccessibility may be exacerbated by spatial and physical aspects of the clinical setting, as access is mediated by the gatekeeping role of secretaries, having to wait in a waiting room and the length of the consultation, including GPs’ own (need for) time management.…”

Video consultations in UK primary care in response to the COVID-19 pandemic

“…Moreover, the relative advantages and disadvantages of video versus telephone e-consultations remain unclear. 3 However, given the exceptional circumstances we find ourselves in, it is our view that implementation of technology to facilitate alternative methods of remote consultation, including video consultations, needs to happen urgently to enable primary care practitioners to provide ongoing care to patients who are unable to attend in person.…”

Diabetes virtual clinics: technology‐enabled care services (TECS) – the new norm?

“…It was seen as a more effective way of delivering health care, supporting patients along their pathways of care, improving their well-being and empowering more self care. [5][6][7][8] Shortage of trained staff in primary care encouraged this new way of working. Since the onset of the pandemic, staff in primary care have quickly risen to the challenge of using TECS to enable the monitoring and review of people with diabetes and also to encourage and support behavioural change.…”