Experiences of using email for general practice consultations: a qualitative study

Abstract

BackgroundReports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. AimTo understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. Design and settingA qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. MethodA maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. ResultsIn total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. ConclusionConsultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice

“…There were also a few positive accounts of experiences and an acknowledgement of when, how, and for whom these alternatives may be beneficial, reflecting previously reported findings. 11,20,33 Implications for research and practice Due to the limited use of email or internet video within the responder group, in keeping with previous literature, the concerns listed are based primarily on perception and anecdote. 21 This general reluctance to adopt alternatives to face-to-face consultations is therefore unlikely to change without a change in policy.…”

“…16,19,22 Similarly, the concern found in the literature about how and when to use alternatives to face-to-face consultations was upheld. 20,21 However, 21% of practices reported having tried using email, and 10% using internet video, despite a general antipathy towards their introduction, and had since reduced such use. This may provide support for these concerns.…”

“…Studies have sought opinions from patients and healthcare professionals on whether and how they would use these alternatives 14,15 but these data have been based on hypothetical opinions rather than experience. Although professional bodies are making tentative steps towards embracing some of the newer technologies [16][17][18] practitioners are generally more sceptical, [19][20][21][22] reflecting uncertainty arising from a lack of evidence in the general practice setting and wider concerns about general practice workload.…”

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

“…The barriers identified were mobility of populations and lack of continuity, 51,58,64 unwillingness to divulge address (for personal safety, such as women living in domestic violence shelters, or fear of legal repercussions, such as failed asylum seekers), 65 and patients' lack of knowledge about health service structure and how to access services. 47,50 Digital clinical communication improves continuity of care for mobile populations and those unwilling to divulge their address, 13,66,67 and the relative anonymity provided could encourage populations who wish to remain hidden to seek help. 66,68 However, this type of communication alone will not improve knowledge about health service structure and how to access services.…”

“…E-mail offered efficiency, speed, and flexibility, for example, patients and carers could use e-mail to communicate with their clinician while at work. 13,35 Asynchronous technology Medline, CINAHL, EMBASE, PsycInfo, ASSIA, and Web of Knowledge "General practice" and "access" † were combined with the following within each database: "mental health" or "mental illness", or "carer"*, or "refugee"* or "asylum seeker"…”