Unintended consequences of online consultations: a qualitative study in UK primary care

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Andrew Turner¹  Rebecca Morris²  Dylan Rakhra³  Fiona Stevenson⁴  Lorraine McDonagh⁴  Fiona Hamilton⁴  Helen Atherton⁵  Michelle Farr¹  Sarah Blake⁶  Jon Banks¹  Gemma Lasseter⁷  Sue Ziebland⁸  Emma Hyde⁹  John Powell⁸  Jeremy Horwood^1,10 

[1] National Institute for Health Research Applied Research Collaboration West ,(NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust;NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care, University of Manchester;Department of Philosophy/School of Oral and Dental Sciences, University of Bristol;Research Department of Primary Care and Population Health, University College London;Unit of Academic Primary Care, University of Warwick;University of Bristol;NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Science, University of Bristol;Nuffield Department of Primary Care Health Sciences, University of Oxford;School of Sociology and Social Policy, University of Leeds;NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Centre for Academic Primary Care, University of Bristol, Bristol Medical School

关键词: digital first primary care;    digital health;    health services accessibility;    online consultations;    qualitative research;    unintended consequences;   

DOI  :  10.3399/BJGP.2021.0426

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Health services are increasingly using digital tools to deliver care, and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care.Aim To identify and understand the unintended consequences of online consultations in primary care.Design and setting Qualitative interview study in eight general practices using online consultation tools in South West and North West England between February 2019 and January 2020.Method Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff.Results Consequences of online consultations were identified that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with, and whether practices used online consultations as their preferred method for patients to contact the practice. Consequences were identified that limited increases in practice efficiency by creating additional work, isolation, and dissatisfaction for some staff.Conclusion Unintended consequences often present operational challenges that are foreseeable and partly preventable. However, these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Process changes tailored to local circumstances are critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated information exchange that leads to diffuse relationships and a more transactional style of medicine.

【 授权许可】

Free