Remote clinics: a panacea during the pandemic or a promoter of health inequality?

Mehmi, Ashley; Winters, David; Newman, Thomas H.; Green, James

doi:10.12968/hmed.2020.0555

Cited by 16 publications

(8 citation statements)

References 3 publications

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“…Studies that investigate the impact of remote consulting on quality and safety of care are required, 7 specifically exploring the building of trust and rapport. 9 The potential impact of remote consultations on exacerbating health care disparities, 7,9,22,[25][26][27] particularly among older and vulnerable populations, also needs to be further investigated. There will be an increasing role for studies incorporating implementation science and evaluation in order to assess existing and new practices and modes of care.…”

Section: Implications For Practice Policy and Researchmentioning

confidence: 99%

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

et al. 2021

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BackgroundEarly diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.AimTo understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & settingGPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.MethodA qualitative semi-structured interview study with GPs from the East of England.ResultsThree themes were identified across 23 interviews on GP views on the impact of: (1) patient help-seeking on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how to manage backlog in referrals.ConclusionThis study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.

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Section: Implications For Practice Policy and Researchmentioning

confidence: 99%

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

et al. 2021

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“…The benefits to having a remote consultation for patients in disadvantaged groups include: reduced time and travel costs, have multiple chronic conditions or are unable to take time off work to attend appointments [ 16 ]. Nevertheless, there are many barriers preventing these patients from using remote consultations which often affect those of greatest need.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, many individuals may lack the digital skills required to enable them to safely and confidently navigate the digital world [ 12 , 13 ] or poor internet infrastructure may prevent them from having real-time consultations [ 14 , 15 ]. Patients from disadvantaged backgrounds and those not speaking English as a first language tend to be disenfranchised from remote consultations [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies have evaluated the effectiveness of remote consultations in primary care [ 10 , 18 , 19 ], including a recently published systematic review of health inequalities relating to remote appointments in this setting [ 4 ]. Although studies evaluating remote consultations in secondary care or tertiary care exist [ 6 , 16 , 20 ], there is a gap in the literature assessing the extent to which remote consultations in these settings may exacerbate or alleviate inequalities in offer and uptake of remote outpatient healthcare. The aim of this study was to carry out a systematic review of observational or intervention studies reporting data on the proportion of patients a) invited to, and b) participating in remote outpatient consultations in secondary and tertiary care, and to assess whether these differ according to sociodemographic characteristics known to affect health inequalities.…”

Section: Introductionmentioning

confidence: 99%

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

Jones

Damery²,

Phillips³

et al. 2022

PLoS ONE

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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.

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“…Although video consultation has many benefits, it may also increase health inequality without the correct infrastructure and processes put in place 3…”

mentioning

confidence: 99%

Video consultations will increase health inequality without the correct infrastructure put in place

Mehmi

Winters

Green

2020

BMJ

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Remote clinics: a panacea during the pandemic or a promoter of health inequality?

Abstract: Remote clinics have shown many benefits including patient safety, but if we look closer, does this move exclude certain groups of patients from accessing healthcare and promote health inequality?

Cited by 16 publications

References 3 publications

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

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

Video consultations will increase health inequality without the correct infrastructure put in place

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