Patients′ and clinicians′ experiences of remote consultation? A narrative synthesis

Abstract

Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.

The impact of eHealth on relationships and trust in primary care: A review of reviews

“…'Provider perceptions, attitudes, and concerns' (in relation to communication systems) were also frequently found to in uence the impact of eHealth on patient-provider relationships and trust. Although negative provider perceptions about technology sometimes seemed to have a negative impact on the patient-provider relationship, 99,68 we found that these perceptions could change after providers use technology (see for example Walthall et al, 90 Bassi et al, 100 Brewster et al, 101 and Sharma et al 102 ). We also found that there were some discrepancies between providers' perceptions of patient expectations and patients' actual expectations regarding technology use (see for example Brewster et al 101 ).…”

“…54 One review noted that patients and providers felt that the ability of remote consultations to facilitate patient empowerment and participation could change as the patient's illness progressed. 90 3. Sociodemographic factors were related to relationships and trust in 10 reviews, mostly focusing on communication systems.…”

“…With respect to communication systems (teleconsultations and remote monitoring systems), providers' ability to develop a "video presence", 65 adjust communication style by using non-verbal cues, 62,65 provide undivided attention and create a supportive and relaxed environment, 90 use technology for direct and indirect patient communication 83 and information exchange by sharing charts and test results 88 were linked with a positive impact on relationships.…”

“…Some reviews suggested that the negative impact resulting from the provider's technology use style and communication can be mitigated by: using strategies speci c to the care delivery modality (telephone or video consultation) 58,64,90,96,97 ; provider training in technology use, 77,79 in the limitations and regulations related to technology and in judging appropriateness of the modality 86 ; considering the context and patient preferences and experiences while designing and implementing new technologies 77,98 ; and setting clear expectations between patient and provider. 69 2.…”

“…100,101 Some reviews noted that providers' initial concerns about potential negative impacts of teleconsultations changed to a perceived positive impact after use. 90,102 In some cases, provider perceptions of patient expectations in uenced the impact on relationships and trust. For example, providers believed that patients preferred in-person interactions and that use of patient-generated health data would exacerbate social isolation and hinder collaboration.…”