Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study

Howells, Kelly; Amp, Mat; Burrows, Martin; Brown, Jo; Brennan, Rachel; Dickinson, Joanne L.; Jackson, Sarah; Yeung, Wan-Ley; Ashcroft, Darren M.; Campbell, Stephen; Blakeman, Tom; Sanders, Caroline

doi:10.3399/bjgp.2021.0596

Cited by 22 publications

(35 citation statements)

References 39 publications

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“…These trends in consultation mode have been observed elsewhere but not in a large nationally representative sample. (3,6,7,12,13) The dip in the proportion of face-to-face consultations at the start of the pandemic likely reflects operational guidance at the time. The pandemic created a driver for change.…”

Section: Discussionmentioning

confidence: 99%

Consultation rate and mode in English general practice, 2018 to 2022: a population-based study by deprivation

Vestesson

Corte

Crellin

et al. 2022

Preprint

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Background The COVID-19 pandemic has had a significant impact on primary care service delivery. With general practice delivering record numbers of appointments and rising concerns around access, funding and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and mode (face-to-face versus remote). Methods We did a retrospective analysis of 9,429,919 consultations by GP, nurse or other health care professional between March 2018 and February 2022 for patients registered at 397 English general practices. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national datasets. Negative binomial models were used to predict consultation rates and modes (remote versus face-to-face) by age, sex, and socio-economic deprivation. Findings Overall consultation rates increased by 15% from 4.92 in 2018-19 to 5.66 in 2021-22 with some fluctuation during the start of the pandemic. Consultation rates increased with deprivation. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups but varies by age. Socioeconomic differences in consultation rate, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18 more consultations in the most deprived). The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultations rates. Interpretation Substantial increases in consultation rates imply increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas. Funding No external funding.

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Section: Discussionmentioning

confidence: 99%

Consultation rate and mode in English general practice, 2018 to 2022: a population-based study by deprivation

Vestesson

Corte

Crellin

et al. 2022

Preprint

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“…Such conclusions may be drawn from evidence gathered from other groups who bypass primary care albeit for differing reasons 42 . Furthermore, ethnic minority groups experience a higher burden of some conditions that are potentially preventable and perceptions of reduced access and poorer experiences of care may lead to increases in preventable emergency hospital admissions for this group of patients 43 …”

Section: Discussionmentioning

confidence: 99%

“…42 Furthermore, ethnic minority groups experience a higher burden of some conditions that are potentially preventable and perceptions of reduced access and poorer experiences of care may lead to increases in preventable emergency hospital admissions for this group of patients. 43 Good communication is an essential skill and core feature of good quality general practice. 44,45 Our findings in a UK sample also emphasise the importance of communication skills for patients' use and experience of accessing and using new models of care resonating with International studies [10][11][12] .…”

Section: Reduced Patient Choicementioning

confidence: 99%

Exploring the experiences and preferences of South Asian patients' of primary care in England since COVID‐19

Small,

Masood,

Stevenson

et al. 2024

Health Expectations

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IntroductionRemote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operate on a remote‐first (digital‐first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care.MethodsQualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in‐person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data.FindingsThree major interlinked themes were identified: (1) reduced access, (2) reduced patient choice and (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face‐to‐face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non‐verbal aspects of communication and ‘hands‐on’ care leading to perceptions of reduced psycho‐social safety.ConclusionSA patients' experiences of remote‐led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face‐to‐face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South‐Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future.Public ContributionMembers of the public were involved in all phases of research in the study. This included co‐working in partnership throughout the study including, reviewing patient‐facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co‐authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.

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“…Research and surveys undertaken by others in 2021-2022 affirmed a number of findings of this familiarisation phase, including problems of accessing primary care 29 ; substantially increased workload in UK primary care 30 ; perceptions by GPs of increased clinical risk with some remote consultations 31 , 32 or when patients are encouraged to monitor their own chronic conditions such as blood pressure and report by telephone 33 ; exacerbation of inequities, especially among the most vulnerable groups, as services went digital 34 – 40 ; a primary care workforce that is increasingly stressed and underconfident 41 – 44 ; multiple infrastructural challenges to establishing remote services during the pandemic 45 – 48 ; and challenges to patient input to research efforts during the pandemic 49 .…”

Section: Discussionmentioning

confidence: 99%

Remote care in UK general practice: baseline data on 11 case studies

et al. 2022

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Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods: Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results: Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features—notably system-level stressors such as high workload and staff shortages, and UK’s technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the ‘digital front door’ (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions: General practices’ responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.

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Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study

Cited by 22 publications

References 39 publications

Consultation rate and mode in English general practice, 2018 to 2022: a population-based study by deprivation

Consultation rate and mode in English general practice, 2018 to 2022: a population-based study by deprivation

Exploring the experiences and preferences of South Asian patients' of primary care in England since COVID‐19

Remote care in UK general practice: baseline data on 11 case studies

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