What do we need to consider when planning, implementing and researching the use of alternatives to face-to-face consultations in primary healthcare?

Atherton, Helen; Ziébland, Sue

doi:10.1177/2055207616675559

Cited by 42 publications

(63 citation statements)

References 75 publications

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“…32 A conceptual review and empirical research by one of the co-authors supports the slow growth of the evidence base in this field (although increasing) and demonstrates the low levels of usage of VC in primary care to date. 11,33 exclusion criteria Studies were excluded where the intervention involved two-way synchronous VC between clinicians, asynchronous VC, or use of VC as a method of treatment. The study did not include the grey literature, unpublished research or published commentary, or discussion articles.…”

Section: Inclusion Criteriamentioning

confidence: 99%

Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review

et al. 2020

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BackgroundVideo consultation (VC) is an emerging consultation mode in general practice. The challenges and benefits of implementing it are not necessarily realised until it is in use, and being experienced by patients and clinicians. To date, there has been no review of the evidence about how patients and clinicians experience VC in general practice.AimThe study aimed to explore both patients' and clinicians' experiences of VCs in primary care.Design & settingA systematic scoping review was carried out of empirical studies.MethodAll major databases were searched for empirical studies of any design, published from 1 January 2010 to 11 October 2018 in the English language. Studies were included where synchronous VCs occurred between a patient and a clinician in a primary care setting. Outcomes of interest related to experience of use. The quality of included studies were assessed. Findings were analysed using narrative synthesis.ResultsSeven studies were included in the review. Patients reported being satisfied with VC, describing reduced waiting times and travel costs as a benefit. For patients and clinicians, VC was not deemed appropriate for all presentations and all situations, and a face-to-face consultation was seen as preferable where this was possible.ConclusionThe findings of this scoping review show that primary care patients and clinicians report both positive and negative experiences when using VCs, and these experiences are, to a certain extent, context dependent. VC is potentially more convenient for patients, but is not considered superior to a face-to-face consultation. Accounts of experience are useful in the planning and implementation of any VC service.

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Section: Inclusion Criteriamentioning

confidence: 99%

Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review

et al. 2020

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“…These forms of communication are relatively expensive and time-consuming, and looking to the future, as multimorbidity increases, will likely be impractical and unsustainable, especially if large numbers of professionals are involved [ 6 ]. While some face-to-face and one-by-one interactions are essential for key interactions to be successfully undertaken, others could be replaced or augmented by other forms of communication or consultation, including e-portals, interprofessional clinics and/or videoconferencing [ 51 ]. We agree with Mercer et al .…”

Section: Discussionmentioning

confidence: 99%

Exploring Interprofessional, Interagency Multimorbidity Care: Case Study Based Observational Research

et al. 2017

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BackgroundThe increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care.ObjectiveTo explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care.DesignUsing a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration.ResultsThe two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals.ConclusionCases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them.

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“…Overall, the limitations can be placed in two large groups: in the United States 20,48 , Australia 33 , and Japan 45 the raised issues are under the logic of the market, including productivity and billing, or technical-administrative issues, in the effort to integrate the teleconsultations into the routine of business as usual, with rare exceptions 51 . In the United Kingdom [15][16][17]21,29,32,40 , Denmark 19,43 and Canada 41 the main concerns refers to equitable access to this innovative service, security -both clinical and data-related -and care with the teleconsultation implementation, more aligned with the principles of universal health systems, currently in place in these countries.…”

Section: Chart 2 Continuationmentioning

confidence: 99%

“…This accreditation is similar to the certification process carried out by the Brazilian Society of Medical Informatics for electronic health record systems, except that, in the US case, it covers also communication systems between doctor and patient by video or text messages. Another British study points out that patient privacy and confidentiality are important points not commonly addressed 17 .…”

Section: Data Securitymentioning

confidence: 99%

“…The acceptability of video teleconsultations by patients and health professionals is not clear due to the limited data reported for this analysis 27 . However, there is a set of organizational, professional and contextual requirements to be met when considering alternatives for face-to-face consultations 17 . For the teleconsultation to be successful, there must be an integration of health care providers, organizations and professionals, in a new way of offering health services, depending on the clinical adequacy and patient preference 33 , planning to maximize their potential for success, with the possibility of service redesigning 33,36 and the development of new models of care.…”

Section: Doctor-patient Relationshipmentioning

confidence: 99%

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Teleconsulta: uma Revisão Integrativa da Interação Médico-Paciente Mediada pela Tecnologia

Catapan

Calvo

2020

Rev. bras. educ. med.

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Medical teleconsultation can apply different technologies to mediate the communication between doctors and patients located in different geographic spaces. Its implementation has been encouraged in several countries, under the assumption of its potential to overcome distances, offering health care in a shorter time, reducing costs and workload. The scarcity of evidence about these allegations, in addition to the need of clarifying the situations in which teleconsultation can be adequate, safe and effective, have generated debates, intensified after the publication of Resolution N. 2.227/2018 by the Federal Council of Medicine, which allowed medical teleconsultation, containing principles and recommendations. This article aims to analyze the international experience of medical teleconsultation, including the media and technologies employed, their use, benefits and limitations, highlighting and associating the controversial points of the resolution recently published by the Federal Council of Medicine. An integrative review of the literature was carried out to identify these experiences from January 2013 to February 2019. Of the 1912 identified references, 42 were analyzed after applying the exclusion and inclusion criteria. Data collection and analysis indicated that telephone, e-mail, e-consulting systems, video or a combination of those have been used in several countries to mediate the doctor-patient relationship. Its use goes ranges from diagnosis to treatment, monitoring, management and prescription, both in acute and chronic conditions. The main benefits include less demand for face-to-face consultations, with the possibility of doctors’ workload management, allowing systems’ reorganization. Moreover, the teleconsultation allows overcoming distance barriers, in a flexible and convenient way for patients, possibly contributing to continuity of care, patient autonomy and resource savings, in the latter case, when it avoids work absenteeism due to face-to-face consultation. Some limitations of the teleconsultation include the inability to perform the physical examination, so it is not recommended for the first consultation. Technical and communication difficulties for each media, as well as its inadequacy for some groups of patients, are other important barriers. Data security regarding diagnosis and clinical precision, patients’ and professionals’ acceptance and the need for organizational adjustments are also considered limitations of the teleconsultation. The success of the teleconsultation depends on the integration of different organizations and professionals, aiming to maximize its potential and improve service design, encompassing clinical, technical, organizational and context issues. Therefore, it is important to investigate in which contexts, situations and conditions the teleconsultation can be beneficial, safe and effective for patient care, as well as the most appropriate means of communication.

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What do we need to consider when planning, implementing and researching the use of alternatives to face-to-face consultations in primary healthcare?

Cited by 42 publications

References 75 publications

Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review

Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review

Exploring Interprofessional, Interagency Multimorbidity Care: Case Study Based Observational Research

Teleconsulta: uma Revisão Integrativa da Interação Médico-Paciente Mediada pela Tecnologia

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