Experiences with online consultation systems in primary care: case study of one early adopter site
Open accessAbstract
Background: There is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care. Aim: To explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices. Design and setting: Mixed methods case study in an inner-city general practice. Method: The study was conducted through interviews with IT developers, clinicians, and administrative staff, and scrutiny of documents, websites, and demonstrator versions of Tele-Doc, followed by thematic analysis and discourse analysis. Results: Three interrelated themes were identified: online consultation systems as innovation, managing the ‘messiness’ of general practice consultations, and redistribution of the work of general practice. These themes raise timely questions about what it means to consult in contemporary general practice. Uptake of Tele-Doc by patients was low. Much of the work of the consultation was redistributed to patients and administrators, sometimes causing misunderstandings. The ‘messiness’ of consultations was hard to eliminate. In-house training focused on the technical application rather than associated transformations to practice work that were not anticipated. GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice. Conclusion: Tele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs’ workload. Tele-Doc’s potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences.
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One study found 70.88% of users avoided face-to-face primary care during the pandemic, with e-consultation rates increasing from 5.61 per 1000 patients in March 2020 to 33.1 per 1000 patients in June 2020 in one healthcare system.
“One study found 70.88% of users avoided face-to-face primary care during the pandemic, 30 with e-consultation rates increasing from 5.61 per 1000 patients in March 2020 to 33.1 per 1000 patients in June 2020 in one healthcare system. 28”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [30]
Citation 28 is attached to the March–June 2020 e-consultation rates; the 70.88% figure has a separate citation. The Introduction and Results describe an earlier Tele-Doc case study, but our copy gives neither of the claimed rates. Searches for the figures and the March–June 2020 period found no matching passage. (LLM, conf=0.76)
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- Authors
- Casey, M., Shaw, S., & Swinglehurst, D.
- Affiliations
- University of Oxford (GB)
- Queen Mary University of London (GB)
- Venue
- British Journal of General Practice
- Published
- 2017-10-09
- Volume
- 67
- Issue
- 664
- Pages
- e736-e743
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC5647916
- OpenAlex
- W2763556726
- Cited by
- 41
- References
- 42
- Citations by year
- 2025: 6 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 8 · 2020: 7 · 2019: 1 · 2018: 5
- FWCI
- 3.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- British Journal of General Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (CS-2015-15-004)
- 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 › General Health Professions › Primary Care and Health Outcomes
- Keywords
- telemedicine, general practice, primary care, work practices, workload redistribution, patient uptake, consultation efficiency, IT implementation, general practitioners
- MeSH terms
- Attitude of Health Personnel, Humans, Physician-Patient Relations, Primary Health Care, Workload, Patient Satisfaction, Remote Consultation, Internet, Qualitative Research, General Practitioners
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