Online consulting in general practice: making the move from disruptive innovation to mainstream service

Marshall, Martin; Shah, Robina; Stokes-Lampard, Helen

doi:10.1136/bmj.k1195

Cited by 42 publications

(59 citation statements)

References 13 publications

(11 reference statements)

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“…7 1315 (27) 27 (49) 6 (11) Overall satisfaction All in all, it was a useful consultation. 20 (36) 22 4013 (24) 0the current study, almost all patients became more confident in the different roles the health professionals play and more confident in whom to contact with a given problem, thereby laying the foundation for confidence in navigating in their pathway and establishing a more coherent trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…Despite fast-growing technology within video communication [10,11], there is still a gap in understanding and troubleshooting when the systems do not work. Taking into consideration the stress and discontent that can be caused when system failures occurred, our results underline the need for easy-tounderstand instructions and a hotline as technical issues is common.…”

Section: Perspectivesmentioning

confidence: 99%

“…Due to geographical reasons and shortage of time, shared consultations are not feasible as part of routine cancer care. Video consultations have become increasingly common [10,11], and video-based communication may be an alternative solution to connect health professionals sitting apart [12][13][14]. Seeing each other is essential for building and establishing professional relationships and can be accomplished through video [15].…”

Section: Introductionmentioning

confidence: 99%

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Cross-sectoral video consultations in cancer care: perspectives of cancer patients, oncologists and general practitioners

Trabjerg

Jensen

Søndergaard

et al. 2020

Support Care Cancer

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Purpose Multidisciplinary video consultations are one method of improving coherence and coordination of care in cancer patients, but knowledge of user perspectives is lacking. Continuity of care is expected to have a significant impact on the quality of cancer care. Enhanced task clarification and shared responsibility between the patient, oncologist and general practitioner through video consultations might provide enhanced continuity in cancer care. Method We used descriptive survey data from patients and doctors in the intervention group based on a randomised controlled trial to evaluate the user perspectives and fidelity of the intervention. Results Patients expressed that they were able to present their concerns in 95% of the consultations, and believed it was beneficial to have both their doctors present in 84%. The general practitioner and oncologist found that tripartite video consultation would lead to better coordination of care in almost 90% of the consultations. However, the benefits of handling social issues and comorbidity were sparser. Consultations were not accomplished in 11% due to technical problems and sound and video quality were non-satisfactory in 20%. Conclusion Overall, multidisciplinary video consultations between cancer patient, general practitioner and oncologist were feasible in daily clinics. Initial barriers to address were technical issues and seamless planning. Patients reported high satisfaction, patient centredness and clarity of roles. General practitioners and oncologists were overall positive regarding role clarification and continuity, although less pronounced than patients. Trial registration www.clincialtrials.gov, NCT02716168.

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Section: Discussionmentioning

confidence: 99%

Section: Perspectivesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cross-sectoral video consultations in cancer care: perspectives of cancer patients, oncologists and general practitioners

Trabjerg

Jensen

Søndergaard

et al. 2020

Support Care Cancer

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“…The growth of private companies offering video consultations for primary care has been controversial. Concerns have been expressed about the safety and effectiveness of managing patients by telephone and video, and there have also been concerns that services focused on speed of access will undermine continuity of care [ 5 , 6 ]. New commercial services could compete for staff at a time when shortages of doctors threaten the viability of some general practices.…”

Section: Controversiesmentioning

confidence: 99%

Private Video Consultation Services and the Future of Primary Care

Salisbury¹,

Quigley²,

Hex³

et al. 2020

J Med Internet Res

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In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development of this type of service has been controversial, particularly in the United Kingdom, but there has been little formal published evaluation of these services in any country. This paper outlines the main controversies about the use of privately provided video consultation services for primary care and shows how they are informed by the limited evaluations that have been conducted, particularly the evaluation of BGPaH. This paper describes the advantages of these services in terms of convenience, speed of access, the ability to consult without traveling or face-to-face patient-doctor contact, and the possibility of recruiting doctors who cannot work in conventional settings or do not live near the patients. It also highlights the concerns and uncertainties about quality and safety, demand, fragmentation of care, impact on other health services, efficiency, and equity. There are questions about whether private primary care services based on video consultations have a sustainable business model and whether they will undermine other health care providers. During the recent COVID-19 pandemic, the use of video consulting has become more widespread within conventional primary care services, and this is likely to have lasting consequences for the future delivery of primary care. It is important to understand the extent to which lessons from the evaluation of BGPaH and other private services based on a video-first model are relevant to the use of video consulting within conventional general practices, and to consider the advantages and disadvantages of these developments, before video consultation–based services in primary care become more widely established.

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“…An emerging application of technology is telemedicine which involves the provision of health care remotely using telecommunication and information technology while delivering the same standard of care compared to face-to-face consultations. Within primary care, there is increasing evidence showing the benefits of telemedicine in providing ease of access for patients while reducing non-attendance rates (The Health Foundation, 2014;Farr et al, 2018;Marshall, Shah and Stokes-Lampard, 2018). Video consultations are well-received especially for patients who require long-term care (NHS England, 2016).…”

Section: What To Keep and What To Discardmentioning

confidence: 99%

COVID-19 – A Covert Catalyst for Pedagogical Stocktake and Transformation: Perspectives of a Global Hub

Khong¹,

Chan²,

Tanner³

et al. 2020

MedEdPublish

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Education in Hong Kong was shifted online on an abrupt and massive scale as the city faced unprecedented disruptions, first from social unrest in 2019 and then again with the COVID-19 pandemic. Concurrent modernization initiatives since early 2019 in The University of Hong Kong's Medical Faculty (HKUMed), conferred a fortuitous head start for this rapid change. Pre-clinical and clinical teaching were restructured for online delivery through elearning solutions for didactic teaching, and new innovative approaches were developed to convert bedside to "webside" teaching. E-learning in the current circumstances provided necessary social distancing while being pedagogically sound. Students were also able to develop key communication and collaboration skills via online platforms, developing digital skills critical to their future profession. However, unforeseen issues including socioeconomic inequality, privacy concerns, and social isolation became apparent and should be addressed as medical education progresses further down the digital path. The goal must entail a sustainable and scholarly approach towards optimizing medical education in an increasingly online environment. This will help safeguard the medical curriculum against disruption and empower future medical professionals for tomorrow's practice. Here, we share experiences and perspectives from educators in a global city characterised by land scarcity and income inequality.

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Online consulting in general practice: making the move from disruptive innovation to mainstream service

Abstract: Services must be rigorously evaluated if we are to maximise benefits and minimise risks, say Martin Marshall and colleagues

Cited by 42 publications

References 13 publications

Cross-sectoral video consultations in cancer care: perspectives of cancer patients, oncologists and general practitioners

Cross-sectoral video consultations in cancer care: perspectives of cancer patients, oncologists and general practitioners

Private Video Consultation Services and the Future of Primary Care

COVID-19 – A Covert Catalyst for Pedagogical Stocktake and Transformation: Perspectives of a Global Hub

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