Experiences with online consultation systems in primary care: case study of one early adopter site

Casey, Michael; Shaw, Sara; Swinglehurst, Deborah

doi:10.3399/bjgp17x693137

Cited by 41 publications

(74 citation statements)

References 36 publications

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“…In a recent paper on the introduction of online consultations, the authors reported that work was redistributed from the GPs to the patients and the administrative staff. 29 The authors’ findings support the view that the introduction of alternatives to face-to-face consultations could have unforeseen implications for other primary care staff, which may increase their workload. There is little evidence that the introduction of alternatives to face-to-face consultations are associated with any reduction in GP workload.…”

Section: Discussionsupporting

confidence: 59%

Receptionists’ role in new approaches to consultations in primary care: a focused ethnographic study

et al. 2018

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BackgroundThe receptionist is pivotal to the smooth running of general practice in the UK, communicating with patients and booking appointments.AimThe authors aimed to explore the role of the receptionist in the implementation of new approaches to consultations in primary care.Design and settingThe authors conducted a team-based focused ethnography. Three researchers observed eight general practices across England and Scotland between June 2015 and May 2016.MethodInterviews were conducted with 39 patients and 45 staff in the practices, all of which had adopted one or more methods (telephone, email, e-consultation, or internet video) for providing an alternative to face-to-face consultation.ResultsReceptionists have a key role in facilitating patient awareness regarding new approaches to consultations in primary care, while at the same time ensuring that patients receive a consultation appropriate to their needs. In this study, receptionists’ involvement in implementation and planning for the introduction of alternative approaches to face-to-face consultations was minimal, despite the expectation that they would be involved in delivery.ConclusionA shared understanding within practices of the potential difficulties and extra work that might ensue for reception staff was lacking. This might contribute to the low uptake by patients of potentially important innovations in service delivery. Involvement of the wider practice team in planning and piloting changes, supporting team members through service reconfiguration, and providing an opportunity to discuss and contribute to modifications of any new system would ensure that reception staff are suitably prepared to support the introduction of a new approach to consultations.

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Section: Discussionsupporting

confidence: 59%

Receptionists’ role in new approaches to consultations in primary care: a focused ethnographic study

et al. 2018

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“…Patients make use of online consulting services, but the uptake is currently low (two online consultations per 1000 patients per month in one study),13 particularly at weekends 131415. Most online consultations are conducted during normal general practice opening hours 13…”

Section: Emerging Evidencementioning

confidence: 99%

“…General practices are motivated to establish online services because they want to be seen to be progressive and because they think it may be a way of managing demand 14. (Atherton H, personal communication, 2018) …”

Section: Emerging Evidencementioning

confidence: 99%

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Online consulting in general practice: making the move from disruptive innovation to mainstream service

Marshall

Shah

Stokes-Lampard

2018

BMJ

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“…There is currently limited published research that explores such potential effects. There is extensive evidence focusing on communication and interaction in health care consultations, highlighting how communication is shaped by wide ranging factors, such as patient preferences and available time [ 48 - 50 ], patient and clinician ethnicity, gender, behavior, and orientation to patient-centered care [ 50 - 53 ], interpretation (eg, of parental requests for further information) [ 54 ], nonverbal communication [ 55 ], and the use of technology (eg, electronic patient records) [ 56 - 58 ]. To our knowledge, there are no studies reporting the impact of remote consulting technology on communication and interaction in medical consultations.…”

Section: Introductionmentioning

confidence: 99%

Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project

et al. 2018

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BackgroundRemote videoconsulting is promoted by policy makers as a way of delivering health care efficiently to an aging population with rising rates of chronic illness. As a radically new service model, it brings operational and interactional challenges in using digital technologies. In-depth research on this dynamic is needed before remote consultations are introduced more widely.ObjectiveThe objective of this study will be to identify and analyze the communication strategies through which remote consultations are accomplished and to guide patients and clinicians to improve the communicative quality of remote consultations.MethodsIn previous research, we collected and analyzed two separate datasets of remote consultations in a National Institute for Health Research–funded study of clinics in East London using Skype and a Wellcome Trust–funded study of specialist community heart failure teams in Oxford using Skype or FaceTime. The Qualitative Analysis of Remote Consultations (QuARC) study will combine datasets and undertake detailed interactional microanalysis of up to 40 remote consultations undertaken by senior and junior doctors and nurse specialists, including consultations with adults with diabetes, women who have diabetes during pregnancy, people consulting for postoperative cancer surgery and community-based patients having routine heart failure reviews along with up to 25 comparable face-to-face consultations. Drawing on established techniques (eg, conversation analysis), analysis will examine the contextual features in remote consultations (eg, restricted visual field) combined with close analysis of different modes of communication (eg, speech, gesture, and gaze).ResultsOur findings will address the current gap in knowledge about how technology shapes the fine detail of communication in remote consultations. Alongside academic outputs, findings will inform the coproduction of information and guidance about communication strategies to support successful remote consultations.ConclusionsIdentifying the communication strategies through which remote consultations are accomplished and producing guidance for patients and clinicians about how to use this kind of technology successfully in consultations is an important and timely goal because roll out of remote consultations is planned across the National Health Service.Registered Report IdentifierRR1-10.2196/10913

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Experiences with online consultation systems in primary care: case study of one early adopter site

Cited by 41 publications

References 36 publications

Receptionists’ role in new approaches to consultations in primary care: a focused ethnographic study

Receptionists’ role in new approaches to consultations in primary care: a focused ethnographic study

Online consulting in general practice: making the move from disruptive innovation to mainstream service

Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project

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