Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice

Chang, Feng Yee; Paramsothy, Thivaher; Roche, Matthew; Gupta, Nidhi

doi:10.1017/s1463423616000414

Cited by 22 publications

(22 citation statements)

References 18 publications

(59 reference statements)

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“… 29 30 While these RCT results cannot be directly compared with the earlier pilot study, there is a suggestion that these results are more in line with our own findings. Research in North America has reported that both patients 10 and clinicians 31 felt that email communication is particularly appropriate for administrative requests, which may help explain our observation that administrative requests were the most common reason for completing an e-consultation.…”

Section: Discussionmentioning

confidence: 70%

“…Communications and online technology (such as email, video and online consultations) are currently being investigated to improve patient access and make more efficient use of practitioners’ time. So far, the evidence about use and effectiveness of such technology is conflicting 10–19 and few studies have been performed in the UK. Rigorous evaluation of online consultation systems is crucial before nationwide encouragement or roll-out of such systems.…”

Section: Introductionmentioning

confidence: 99%

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Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

et al. 2017

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ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

et al. 2017

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“…Our recommendations around patient education, tailoring of eConsult to specific users and/or conditions are reflected in the existing literature [ 26 , 32 , 33 ]. With regard to issues around integration with existing practice processes and impact on workload, Chang et al [ 10 ] found that clear guidance around how to ensure successful adoption and integration of digital systems is key. Lastly, the general consensus that the introduction of digital services to support primary care provision is a positive step replicates the findings of Liddy et al [ 7 ], who conducted a similar study around the use of Champlain BASE (an e-Consultation tool for primary care).…”

Section: Discussionmentioning

confidence: 99%

“…However, uptake of such tools by primary care has been slow and eHealth use in this area is still in its infancy [ 8 ]. As identified by Banks et al [ 9 ], there are still limited research findings regarding the effectiveness of such tools [ 10 ] and there are only a minority of evaluations conducted within the UK [ 11 ]. It is imperative that such tools are fully evaluated before potential adoption and large-scale use.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Digital Consultation and Self-Care Advice Tool in Primary Care: A Multi-Methods Study

Cowie

Calveley

Bowers

et al. 2018

IJERPH

144

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Digital services are often regarded as a solution to the growing demands on primary care services. Provision of a tool offering advice to support self-management as well as the ability to digitally consult with a General Practitioner (GP) has the potential to alleviate some of the pressure on primary care. This paper reports on a Phase II, 6-month evaluation of eConsult, a web-based triage and consultation system that was piloted across 11 GP practices across Scotland. Through a multi-method approach the evaluation explored eConsult use across practices, exposing both barriers and facilitators to its adoption. Findings suggest that expectations that eConsult would offer an additional and alternative method of accessing GP services were largely met. However, there is less certainty that it has fulfilled expectations of promoting self-help. In addition, low uptake meant that evaluation of current effectiveness was difficult for practices to quantify. The presence of an eConsult champion(s) within the practice was seen to be a significant factor in ensuring successful integration of the tool. A lack of patient and staff engagement, insufficient support and lack of protocols around processes were seen as barriers to its success.

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“…Email has been effectively used to communicate with medical practices for repeat prescriptions, appointment bookings and obtaining test results. 22 Furthermore, internet-based cognitive behavioural therapy for post-traumatic stress disorder and videoconferencing therapy for substance misuse were both found to be at least as good as face-toface therapy. 13 23 24 utilisation is low Despite technology use for health purposes being effective and able to improve to access issues in rural areas, uptake has been slow.…”

Section: Introductionmentioning

confidence: 98%

Attitudes of rural communities towards the use of technology for health purposes in New Zealand: a focus group study

et al. 2020

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ObjectivesExamine attitudes to using online health and wellness services, and determine what barriers may exist to this in two rural communities in New Zealand.DesignA thematic analysis informed by a social constructivist paradigm explored the attitudes of youth and adults to give voice to these communities. Eighteen focus groups—nine in each region—were held for an hour each, with between three and nine participants in each group.SettingTwo rural areas at the Northern and Southern ends of New Zealand were chosen. In each area, we partnered with a local health centre providing primary care services. Three localities were identified within each region where we conducted the data collection.ParticipantsParticipants were youth aged 12–15 years, aged 16–20 years and adults over 21 years. Overall, 74 females and 40 males were recruited. Recruitment occurred through schools, community organisations or personal contacts of the facilitators, who were youth workers in their respective communities. Ethnicity of the participants was representative of each area, with a higher percentage of Māori participants in Northland.ResultsEight themes were identified which described participants’ attitudes to technology use in healthcare. Themes covered accessibility, cost, independence, anonymity and awareness issues: technology makes health information easily accessible; access to technology can be limited in rural communities; technology can reduce the cost of healthcare but it is too expensive for some; technology increases independence and autonomy of people’s own health; independent healthcare decisions come with risks; anonymity encourages people to seek help online; technology can help raise awareness and provide peer-support for people with health issues; technology impacts on social relationships.ConclusionsParticipants—particularly youth—were generally positive about the role of technology in healthcare delivery, and interested in ways technology could improve autonomy and access to health and wellness services.

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Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice

Abstract: Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.

Cited by 22 publications

References 18 publications

Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

Evaluation of a Digital Consultation and Self-Care Advice Tool in Primary Care: A Multi-Methods Study

Attitudes of rural communities towards the use of technology for health purposes in New Zealand: a focus group study

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