Evaluation of the Use of an Ask-the-Expert e-Consultation Service for Support on Health-Related Requests

Nijland, Nicol; Gemert-Pijnen, Julia E.W.C. van; Kelders, Saskia M.; Brandenburg, Bart; Seydel, E.R.

doi:10.1109/etelemed.2010.33

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…We synthesized 63 papers ( Figure 1 ), including 52 (83%) journal papers [ 53 ], 7 (11%) evaluation reports [ 85 ], 3 (5%) conference papers [ 12 ], and 1 (2%) master’s degree thesis [ 13 ]. The studies were quantitative (33/63, 52%), qualitative (12/63, 19%), and mixed methods (18/63, 29%) and analyzed data from patients (16/63, 25% qualitative studies and 18/63, 29% quantitative studies), staff (22/63, 35% qualitative studies and 9/63, 14% quantitative studies), and clinical systems (33/63, 52% quantitative studies).…”

Section: Resultsmentioning

confidence: 99%

“…Decreased equity (qualitative and quantitative) [ 7 , 8 , 12 - 27 , 52 , 57 , 59 , 60 , 63 , 64 , 70 - 73 , 85 , 87 - 92 , 94 , 95 , 97 , 98 , 100 , 101 ]…”

Section: Resultsmentioning

confidence: 99%

“…CERQual rating: high [ 8 , 12 , 13 , 15 , 18 , 20 - 23 , 27 , 52 , 57 , 60 , 70 , 72 , 73 , 87 - 92 , 94 , 95 , 97 , 100 , 101 ]…”

Section: Resultsmentioning

confidence: 99%

“…We searched the Ovid MEDLINE, EMBASE, Web of Science, and Scopus databases during July 2020 (Multimedia Appendix 2 [12,53,56,[58][59][60]63,[70][71][72][73]). Our search strategy was developed from scoping searches of the literature and drew on search strategies used in related literature reviews [45,46].…”

Section: Search Strategymentioning

confidence: 99%

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Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers

Darley¹,

Coulson²,

Peek³

et al. 2022

J Med Internet Res

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Background Online consultations (OCs) allow patients to contact their care providers on the web. Worldwide, OCs have been rolled out in primary care rapidly owing to policy initiatives and COVID-19. There is a lack of evidence regarding how OC design and implementation influence care quality. Objective We aimed to synthesize research on the impacts of OCs on primary care quality, and how these are influenced by system design and implementation. Methods We searched databases from January 2010 to February 2022. We included quantitative and qualitative studies of real-world OC use in primary care. Quantitative data were transformed into qualitative themes. We used thematic synthesis informed by the Institute of Medicine domains of health care quality, and framework analysis informed by the nonadoption, abandonment, scale-up, spread, and sustainability framework. Strength of evidence was judged using the GRADE-CERQual approach. Results We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients’ queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. Conclusions This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). Trial Registration PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy

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Section: Resultsmentioning

confidence: 99%

“…Decreased equity (qualitative and quantitative) [ 7 , 8 , 12 - 27 , 52 , 57 , 59 , 60 , 63 , 64 , 70 - 73 , 85 , 87 - 92 , 94 , 95 , 97 , 98 , 100 , 101 ]…”

Section: Resultsmentioning

confidence: 99%

“…CERQual rating: high [ 8 , 12 , 13 , 15 , 18 , 20 - 23 , 27 , 52 , 57 , 60 , 70 , 72 , 73 , 87 - 92 , 94 , 95 , 97 , 100 , 101 ]…”

Section: Resultsmentioning

confidence: 99%

Section: Search Strategymentioning

confidence: 99%

See 2 more Smart Citations

Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers

Darley¹,

Coulson²,

Peek³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…[63]), three conference papers (e.g. [64]), and one Master's degree thesis [65]. Studies were quantitative (n=32, 52%), qualitative (n=12, 19%), and mixed methods (n=18, 29%), and analysed data from patients (16 qualitative, 17 quantitative studies), staff (22 qualitative studies, 9 quantitative studies), and clinical systems (32 quantitative studies).…”

Section: Descriptive Summarymentioning

confidence: 99%

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

Darley

Coulson

Peek

et al. 2022

Preprint

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Background Online consultations (OCs) allow patients to contact their care provider online, and have been promoted as a way to address increasing workload and decreasing workforce capacity in primary care. Globally, OCs have been rolled out rapidly due to policy initiatives and the COVID-19 pandemic, though there is a lack of evidence regarding how their design and implementation influence care outcomes. Objective Informed by existing theories, synthesise quantitative and qualitative research on: 1) outcomes of OCs in primary care; 2) how these are influenced by OC system design and implementation. Methods We searched Ovid Medline, Embase, Web of Science, Scopus, NTIS, HMIC, and ZETOC from 2010 to November 2021. We included quantitative and qualitative studies of real-world OC use in primary care, written in English, and published 2010 onwards. Quantitative data were transformed into qualitative themes. For objective 1 we used thematic synthesis informed by the Institute of Medicine domains of healthcare quality. For objective 2 we used Framework Analysis informed by the NASSS framework and Realistic Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and strength of evidence judged using GRADE-CERQual. Results We synthesised 62 studies (quantitative n=32, qualitative n=12, mixed methods n=18) in nine countries covering 30 unique OC systems, 13 of which used Artificial Intelligence (AI). Twenty-six were published in 2020 onwards, and 11 were post-COVID-19. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested perceptions of OC safety varied. Some participants believed OCs improved safety, particularly when patients could describe their queries using unstructured free-text. Staff workload decreased when sufficient resources were allocated to implement OCs, and patients used them for simple problems or could describe their queries using free-text. Staff workload increased when OCs were not integrated with other software or organisational workflows, and patients used them for complex queries. OC systems that required patients to describe their queries using multiple choice questionnaires (MCQs) increased workload for both them and staff. Health costs were reduced when patients used OCs for simple queries, and increased when used for complex ones. Patients using OCs were more likely to be female, younger, native speakers, with higher socioeconomic status than those not using OCs. However, OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patient queries. Patient satisfaction increased when using OCs due to better primary care access, though could decrease when using MCQ formats. Conclusions This is the first theoretically-informed synthesis of research on OCs in primary care, and includes studies conducted during COVID-19. It contributes new knowledge that in addition to producing positive outcomes such as increased access and patient satisfaction, they can also have negative outcomes such as increased workload and costs. These negative outcomes can be mitigated by appropriate OC system design (e.g. free-text format), incorporating advanced technologies (e.g. AI), and integration into technical and organisational workflows (e.g. timely responses).

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Unlocking Service Flow—Fast and Frugal Digital Healthcare Design

Knight

Ross²,

Gibbons

et al. 2019

Design of Assistive Technology for Ageing Populations

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Evaluation of the Use of an Ask-the-Expert e-Consultation Service for Support on Health-Related Requests

Cited by 6 publications

References 16 publications

Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers

Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers

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

Unlocking Service Flow—Fast and Frugal Digital Healthcare Design

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