Barriers and Enablers in Implementing Electronic Consultations in Primary Care: Scoping Review

Abstract

Background Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. Objective With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. Methods In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). Results In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. Conclusions This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care.

Patient Satisfaction With Remote Consultations in a Primary Care Setting

“…The implementation of remote consultations in the form of text messages and telephone and video appointments has been ramped up significantly in recent years [1][2][3]. Telehealth has been shown to be a useful alternative to face-to-face appointments and has advantages for patients, health practitioners and the environment [1][2][3][4][5][6]. Today the use of remote consultations is omnipresent across medical specialities, a process greatly accelerated by the coronavirus disease 2019 (COVID-19) pandemic [2,[6][7][8].…”

“…Telehealth has been shown to be a useful alternative to face-to-face appointments and has advantages for patients, health practitioners and the environment [1][2][3][4][5][6]. Today the use of remote consultations is omnipresent across medical specialities, a process greatly accelerated by the coronavirus disease 2019 (COVID-19) pandemic [2,[6][7][8]. The Royal College of General Practitioners and other similar bodies have recently reiterated that remote consultations will form a fundamental role in future care delivery and emphasize the need for ongoing research and investment into telehealth to optimise both the provision of care and the patient experience [7,9].…”

“…The advantages of telehealth have been documented in previous papers, with much focus on investigating patients and health care professionals' experiences and attitudes in a secondary care setting [4][5]10]. In the primary care setting, much focus has been on investigating health practitioners' attitudes and experiences with remote consultations [6,8,11], with less emphasis on patient´s experience and satisfaction with remote consultations [12][13]. In response to the ongoing long-term transition in health care provision, this paper aims to measure patient satisfaction and attitudes concerning telehealth encounters in a general practice setting.…”

“…Telehealth has been shown to be a useful alternative to face-to-face appointments and has advantages for patients, health practitioners and the environment [ 1 - 6 ]. Today the use of remote consultations is omnipresent across medical specialities, a process greatly accelerated by the coronavirus disease 2019 (COVID-19) pandemic [ 2 , 6 - 8 ].…”

Understanding how the design and implementation of Online Consultations influence primary care outcomes: Systematic review of evidence with recommendations for designers, providers, and researchers

“…Previous reviews have not reported design or implementation details of the OCs they studied (e.g. [18][19][20]), despite their importance in understanding the causal mechanisms of how they impact outcomes [48]. In this paper, we systematically review and synthesise the empirical quantitative and qualitative literature in a theoretically-informed way to address this knowledge gap.…”