Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery

Abstract

The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians – including family physicians, paediatricians, pharmacists, academics and patients – to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.

Remote care – good for some, but not for all?

“…In their essay published in the Journal of Health Services Research and Policy, Williams et al 7 consider the implications of remote primary care consultations for policy and care delivery across low-, middle-, and high-income countries. As part of a thoughtful process incorporating a literature review and gathering experiential learning from an expert panel, they explored the challenges and opportunities of remote consulting for patients and clinicians.…”

“…A health services research agenda for remote health and care Williams et al 7 call for research to help identify what kinds of patient consultations work best remotely and suitable outcome measures. These are needed.…”

Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review protocol

“…Complex supply and demand factors govern access to health services and multiple frameworks have been developed, typically defining access as the ability to perceive, seek, reach, pay for and engage with care 2 7–11. Access is increasingly being extended through the use of digital services and remote consultations 12 13. While these services are useful, they come with their own set of barriers and equity issues, and cannot fully replace the central role played by in-person clinical providers 12 14.…”

“…Access is increasingly being extended through the use of digital services and remote consultations 12 13. While these services are useful, they come with their own set of barriers and equity issues, and cannot fully replace the central role played by in-person clinical providers 12 14. When it comes to identifying barriers to attending in-person clinical services and potential solutions, WHO has noted that ‘it is the experts who identify the problems and formulate interventions, while the problems and solutions as perceived by those at particular risk rarely constitute the base for action’ 15.…”