Unintended consequences of online consultations: a qualitative study in UK primary care
Unintended consequences of online consultations: a qualitative study in UK primary care
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 between February 2019 and January 2020.
Method: thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff.
Results: consequences of online consultations were identified 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. Consequences were identified 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. Process changes tailored to local circumstances are 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.
General Practice/methods, Humans, Primary Health Care/methods, Qualitative Research, Referral and Consultation, United Kingdom
e128-e137
Turner, Andrew
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Morris, Rebecca
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Rakhra, Dylan
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Stevenson, Fiona
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McDonagh, Lorraine
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Hamilton, Fiona
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Atherton, Helen
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Farr, Michelle
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Blake, Sarah
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Banks, Jon
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Lasseter, Gemma
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Ziebland, Sue
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Hyde, Emma
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Powell, John
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Horwood, Jeremy
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February 2022
Turner, Andrew
132ac626-a511-4bc7-8550-f9f5bbd0607b
Morris, Rebecca
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Rakhra, Dylan
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Stevenson, Fiona
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McDonagh, Lorraine
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Hamilton, Fiona
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Atherton, Helen
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Farr, Michelle
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Blake, Sarah
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Banks, Jon
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Lasseter, Gemma
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Ziebland, Sue
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Hyde, Emma
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Powell, John
0616c5bf-0ce6-48ef-9b89-45a72529beb1
Horwood, Jeremy
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Turner, Andrew, Morris, Rebecca, Rakhra, Dylan, Stevenson, Fiona, McDonagh, Lorraine, Hamilton, Fiona, Atherton, Helen, Farr, Michelle, Blake, Sarah, Banks, Jon, Lasseter, Gemma, Ziebland, Sue, Hyde, Emma, Powell, John and Horwood, Jeremy
(2022)
Unintended consequences of online consultations: a qualitative study in UK primary care.
The British journal of general practice : the journal of the Royal College of General Practitioners, 72 (715), .
(doi:10.3399/BJGP.2021.0426).
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 between February 2019 and January 2020.
Method: thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff.
Results: consequences of online consultations were identified 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. Consequences were identified 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. Process changes tailored to local circumstances are 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.
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e128.full
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Accepted/In Press date: 8 September 2021
e-pub ahead of print date: 27 January 2022
Published date: February 2022
Additional Information:
© The Authors.
Keywords:
General Practice/methods, Humans, Primary Health Care/methods, Qualitative Research, Referral and Consultation, United Kingdom
Identifiers
Local EPrints ID: 487667
URI: http://eprints.soton.ac.uk/id/eprint/487667
ISSN: 0960-1643
PURE UUID: cb470e30-c578-424e-94c7-268e0b278dd1
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Date deposited: 29 Feb 2024 18:19
Last modified: 18 Mar 2024 04:18
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Contributors
Author:
Andrew Turner
Author:
Rebecca Morris
Author:
Dylan Rakhra
Author:
Fiona Stevenson
Author:
Lorraine McDonagh
Author:
Fiona Hamilton
Author:
Helen Atherton
Author:
Michelle Farr
Author:
Sarah Blake
Author:
Jon Banks
Author:
Gemma Lasseter
Author:
Sue Ziebland
Author:
Emma Hyde
Author:
John Powell
Author:
Jeremy Horwood
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