Inequalities in general practice remote consultations: a systematic review

Abstract

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.Design & settingSystematic reviewMethodWe undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.ResultsBased on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

Implementation of remote asthma consulting in general practice in response to the COVID-19 pandemic: an evaluation using extended Normalisation Process Theory

“…The majority of staff in this study indicated that RAC has a role for asthma, which is consistent with previous studies which established that remote consulting for respiratory conditions is an acceptable approach for staff (17,18). Previous studies also raised concerns about how remote consulting impacts access for certain patients (19), and is more likely to be used by the younger working population (16). As staff in this study reported, face-to-face consulting currently appears to remain preferable for patients with complex presentations (17,19).…”

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

“…A recent systematic review found that telephone consulting was favoured by certain groups: women, younger people, very old people and non-immigrants. Similarly, online consulting was weakly associated with younger, more affluent and educated populations [29]. It is vital that the concerns of practitioners in areas of deprivation are reflected in changes to consulting so that the nature of community medicine is not irreversibly altered.…”

Clinician and Patient Experience of Internet-Mediated Eye Movement Desensitisation and Reprocessing Therapy

“…Online therapy in other areas of mental health is generally acceptable, if not universally so [15]. However, online consultations tend to be used by younger, more affluent, and educated groups, and may increase health inequalities [21]. Technical problems cause cancellation and rescheduling of telehealth…”