Unintended consequences of online consultations: a qualitative study in UK primary care

Abstract

Background: Health services are increasingly using digital tools to deliver care and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care. Aim: To identify and understand the unintended consequences of online consultations in primary care. Design and Setting: Qualitative interview study in eight general practices using online consultation tools in South West and North West England. Method: Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff. Results: We identified consequences of online consultations that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with and whether practices used online consultations as their preferred method for patients to contact the practice. We identified consequences that limited increases in practice efficiency by creating additional work, isolation and dissatisfaction for some staff. Conclusion: Unintended consequences often present operational challenges that are foreseeable and partly preventable. However these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Bespoke process change is critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated, information exchange that leads to diffuse relationships and a more transactional style of medicine.

Formalising triage in general practice towards a more equitable, safe, and efficient allocation of resources

“…Safety concerns have been raised about patients submitting emergency or urgent requests through the online triage platform and then awaiting a response rather than immediately seeking care elsewhere 49. Some online platforms screen for symptoms related to potential life threatening conditions and signpost patients to urgent care pathways if needed, and others have the capability of highlighting or flagging urgent requests as soon as they are submitted 27.…”

“…Some online platforms screen for symptoms related to potential life threatening conditions and signpost patients to urgent care pathways if needed, and others have the capability of highlighting or flagging urgent requests as soon as they are submitted 27. Although these algorithms have been described as “overly cautious” by some,49 they may mitigate concerns about patient safety during early stages of adopting the technology.…”

“…Finally, many have acknowledged the potential of online triage platforms being used to bypass the traditional system to obtain a quicker appointment, disadvantaging patients who do not have the skills or resources to use the online platform 333438495051. To mitigate this risk, the form should also be completed for patients who call or visit the practice to make an appointment, either by the patients themselves or with the help of reception staff 2.…”

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

“…This occurred when any doctor could reply to an OC query and patients were not able to specify a doctor to whom to address their query (e.g. [47]).…”

“…Moreover, OC system product design has progressed significantly to become more specialised and technologically advanced [24], with several more empirical research studies published on their use (e.g. [25-47]).…”