The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey (Preprint)

Abstract

BACKGROUND Patient experience is a key outcome of health and care, a key component of quality of care and an important policy focus for the NHS. Patient experience of general practice can be influenced by using online consultation tools for access and triage. Patient experience is known to vary in relation to socio-demographic factors. OBJECTIVE Given the rapid scale up and diversity of online consultation tools in English general practice, we investigated the association between implementation of an online consultation tools and patient experience, and how that varied by the online consultation tool design and implementation model and practice socio-demographic factors. METHODS We categorised practices according to their usage of one of two online consultation tools which differed in their design and implementation model: ‘free-text’ (FT) with an embedded single workflow with supporting total triage; or ‘mixed-text’ (MT) with mixed input of free-text and logic based multiple choice without an embedded workflow supporting total triage. We considered survey responses from the General Practice Patient Survey in England in relation to domains of overall experience, experience of making an appointment, continuity of care and use of self-care before making an appointment. We used logistic regression models at practice level to explore association between usage of the online consultation tool and patient experience. RESULTS We included 287,194 responses from 2,423 MT and 170 FT practices. At MT practices increased usage was associated with reductions of more than 19% (P<.001) in experience across all dimensions other than self-care but an increase of 28% (P<.001) in self-care. Conversely, at FT practices increased usage was associated with improvements of more than 23% (P<.001) in experience across all dimensions other than self-care, but no effect on self-care. The association between usage and patient experience varied by practice socio-demographic characteristics. For example, greater improvements in overall patient experience with increased usage at FT practices in urban areas, and with the greatest proportions of younger and non-White ethnicity patients masked declines at the opposite cohorts of FT practices (in rural areas and with the smallest proportions of younger and non-White ethnicity patients). In general, inequalities in patient experience tended to narrow with increased usage reflecting greater improvements for groups that traditionally experience most challenges. CONCLUSIONS Online consultation tools offering free-text input and embedded using a single workflow with total triage can lead to improved patient experience of general practice and reduced socio-demographic disparities in access to care. However, stark differences in reported patient experience at practices using different online consultation tools suggest that careful consideration as to how online consultation tools are designed and implemented is required to achieve this. Generalising impacts across different online consultation tools is likely to be difficult or impossible.