Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

Abstract

Background Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered. Aim To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics. Methods Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively. Results Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001). Conclusions Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities. Trial registration PROSPERO registration no: CRD42021241791.

Remote Assessment in healthcare—Technologies, methods, benefits, and challenges

“…From a technological point of view, remote assessment is often associated with the use of telephones, smartphones, video, or web-based technologies. This is also evident in this collections, where most studies use video/phone consultation [ 4 ], web-based systems [ 1 , 5 – 7 ], or smartphones [ 2 , 10 ]. Interestingly, however, a few of the included studies also involve remote assessment using medical devices.…”

“…The papers in the collection address a wide spectrum of health topics including mental health [ 1 , 10 ], cognitive assessment [ 5 ], blood sampling and diagnosis [ 9 ], dental health [ 8 ], COVID-19 infections [ 7 ], and prenatal diagnosis [ 3 ]. Two studies also address how remote assessment using online surveys can be implemented and used [ 2 , 6 ], and one study review health inequalities in real-time remote outpatient consultations [ 4 ].…”

“…A clear benefit to remote assessment is a better recruitment process. Remote assessment (i) allows the recruitment of large and diverse samples of participants in terms of age, gender, origin, culture and social status [ 2 , 5 ], (ii) offers tremendous potential to engage representative cohorts, scale biomedical research, (iii) promotes accessibility by reducing barriers common in traditional trial design [ 7 ], and (iv) may help reach and drive uptake in under-represented participant groups [ 4 ] or groups that are “hard-to-reach” [ 2 ]. Moreover, some patient groups—like young university students—who are ‘digital natives’ may even prefer online platforms [ 1 ].…”

“…Not surprisingly given the timing and the wording of the call for papers, many of the papers address the COVID-19 lockdown and discuss how remote assessment methods can be used during a pandemic where people are more or less isolated and physical presence in clinics and between study participants needs to be minimized [ 1 , 2 , 4 , 6 , 7 , 9 ]. As argued by Sacristán-Galisteo and colleagues [ 6 ], the COVID-19 pandemic has led to an unprecedented situation in which there has been a major push to implement telemedicine consultations, emphasizing the need for remote assessment tools, which offers the possibility to assess patients’ functional status without needing outpatient visits.…”

Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation

“…Interestingly, this analysis extends these insights by highlighting that some family members appeared to struggle with access due to digital literacy and access to appropriate technology. There have been several reports describing the negative impact which virtual clinic attendance has on health inequalities, with those from more socioeconomically deprived areas, and older adults most likely to be disadvantaged [ 26 , 27 ]. To our knowledge, this evidence is not available in relation to virtual visiting for family members.…”