Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
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Abstract
Background: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective: This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods: A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results: This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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A pre-pandemic review on uses of e-consultations in primary care highlighted that research into effectiveness and safety of asynchronous telemedicine is needed.
“A pre-pandemic review on uses of e-consultations in primary care highlighted that research into effectiveness and safety of asynchronous telemedicine is needed. 14”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [14]
The Results (Patient Outcomes) report insufficient good-quality evidence to assess benefits of e-consultations, and the Discussion (Governance and Safety) calls for attention to diagnostic and prescribing safety. But the review covers email, messaging, and video e-consultations rather than assessing asynchronous telemedicine as a distinct category; its Introduction also says it excludes telemedicine and telemonitoring focused on long-term specialist care. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA pre-pandemic review of e-consultations in primary care found similar patterns of patient use, including more female users and use across all age groups.
“A pre-pandemic review of e-consultations in primary care found similar patterns of patient use, including more female users and use across all age groups.”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [14]
The Results > Patient Access section reports that e-consultation users were primarily women, while noting studies with different gender findings. It also reports users in several adult age ranges, including over 60, but does not establish use across all age groups; the Discussion > Patient Access section says elderly patients were less likely to use these services. Page numbers were not provided in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMold et al found patients were more likely to use e-consultations if they thought a face-to-face consultation was not needed, and no increased workload for clinicians, both inconsistent with our findings.
“Mold et al found (i) patients were more likely to use e-consultations if they thought a face-to-face consultation was not needed, and (ii) no increased workload for clinicians, both of which findings are inconsistent with our findings. 14”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [14]
The Results > Patient Access passage reports that patients used e-consultations when they did not think a face-to-face visit was warranted. Results > Workforce reports little additional time or no adverse workload effects in some studies, but also warns that cumulative consultation time may lengthen clinicians’ working days. The unqualified claim of no increased clinician workload overstates the review’s mixed findings. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is a lack of guidance for use of both synchronous and asynchronous telemedicine, making confidentiality a concern.
“Consistencies with synchronous telemedicine include providing time and cost savings for patients, 51–53 and evidence suggesting a lack of guidance for use of both makes confidentiality a concern. 14,54”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [14]
The Results and Discussion sections on Governance and Safety report a lack of guidance for technology consultations, while the Discussion’s Conclusions separately call for attention to patient privacy and confidentiality. The paper does not say that the lack of guidance causes confidentiality concerns, or establish that finding for both synchronous and asynchronous telemedicine. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMold and colleagues found socioeconomically disadvantaged patients used e-consultations less, which is inconsistent with our findings.
“Mold and colleagues found socioeconomically disadvantaged patients used e-consultations less, which is inconsistent with our findings. 14”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [14]
There are gaps in the existing evidence on the spread and scale-up of video consulting, particularly in relation to interorganizational networking, which is critical in enabling and sustaining innovation and yet is not explored in-depth.
“There are gaps in the existing evidence on the spread and scale-up of video consulting. This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [30]
Interorganizational networking is critical in enabling and sustaining innovation.
“This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [30]
There remains much uncertainty regarding the safety and effectiveness of remote consultations.
“there remains much uncertainty regarding the safety and effectiveness of remote consultations [4,5].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [4]
More recent reviews agree that there is a need for more research on the safety of care and the quality and safety of prescribing through remote consultations.
“More recent reviews agree that there is a need for more research on the safety of care [4] and the quality and safety of prescribing through remote consultations [4,32].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [4]
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“14 These differences could be influenced by their review, including synchronous and asynchronous telemedicine and being carried out before COVID-19, or could be owing to the qualitative nature of evidence found in our review.”
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- Authors
- Mold, F., Hendy, J., Lai, Y.-L., & de Lusignan, S.
- Affiliations
- University of Surrey (GB)
- Brunel University of London (GB)
- University of Portsmouth (GB)
- Corresponding author
- Mold, Freda
- Venue
- JMIR Medical Informatics
- Publisher
- JMIR Publications Inc.
- Published
- 2019-12-03
- Volume
- 7
- Issue
- 4
- Pages
- e13042
- ISSN
- 2291-9694 (ISSN-L)
- PMC
- PMC6918214
- OpenAlex
- W2966705814
- Cited by
- 181
- References
- 87
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 31 · 2023: 24 · 2022: 30 · 2021: 34 · 2020: 26
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Medical Informatics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BIROn (Birkbeck, University of London) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- e-consultation, primary care, email security, video consultation, patient satisfaction, chronic disease, remote patients, clinical workflow, health disparities, telehealth adoption
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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