Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

Abstract

ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.

Online medical consultation: a review

“…In a study conducted by Edwards et al (2017) it was seen that women were almost twice as likely to perform an econsultation as men (64.7% vs. 35.3%) and over half of all users were age 25-44 years (median age 39). After the age of 45 years, use declined with age, although young adults (age 18-24 years) also accounted for only a small proportion of total usage (8.7%).…”

“…After the age of 45 years, use declined with age, although young adults (age 18-24 years) also accounted for only a small proportion of total usage (8.7%). 4 …”

“…4 Out of all econsultations, 58.8% occurred from Monday to Wednesday, with usage declining towards the end of the week: just a 12.4% of e-consultations were done at the weekend. In any case, 69.9% happened in between 7 am and 5 pm, with peaks seen around 10 am and 2 pm.…”

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

“…Patients make use of online consulting services, but the uptake is currently low (two online consultations per 1000 patients per month in one study),13 particularly at weekends 131415. Most online consultations are conducted during normal general practice opening hours 13…”

Information flow to enable integrated health care: integration or interoperability

“…Evidence from research shows that in fact technologymediated consultations may lead to more work for GPs, and are not necessarily preferred by patients. [2][3][4][5][6][7] For several types of technology-mediated interactions there is not enough high-quality evidence to be able to claim a transformative impact. 8,9 There is a widely held perception that, when it comes to technology, evidence is unimportant and an assumption that all consequences of use are positive, in a way that would be considered completely unacceptable for other interventions such as pharmaceuticals.…”