Factors associated with the availability of virtual consultations in primary care across 20 countries: A cross-sectional study (Preprint)

Abstract

BACKGROUND Virtual consultations represent a notable change in healthcare delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing healthcare system resilience and adaptability in times of crisis. OBJECTIVE (1) To describe the availability and hours of use of telephone, video and human chat consultations before and during the COVID-19 pandemic period, and (2) identify factors associated with their availability. METHODS Primary Care Physicians (PCPs) from 20 upper-middle and high-income countries completed a cross-sectional online survey in 2020. Factors associated with availability were investigated using chi-squared tests and effect size (ES) estimates calculated. RESULTS A total of 1,370 PCPs were included in this study (85.4% of the total sample of 1,605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%) (all P<.0001). The largest increase in use was observed for telephone consultations (+11.0 hours per week, P<.0001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES: 0.2) and during (ES: 0.2) the pandemic (P<.0001 for both), and with chat consultations before the pandemic only (ES: 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.0001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES: 0.5, P<.0001) to weak (ES: 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES: 0.3, P<.0001) to strong (ES: 0.5, P<.0001). CONCLUSIONS Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how contextual factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099