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Atherton H, Eccles A, Poltawski L, Dale J, Campbell J, Abel G. Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study. J Med Internet Res 2024; 26:e51931. [PMID: 38976870 PMCID: PMC11263895 DOI: 10.2196/51931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. OBJECTIVE This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients' views regarding online appointment booking arrangements. METHODS This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. RESULTS The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. CONCLUSIONS Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice.
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Affiliation(s)
- Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Abi Eccles
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Leon Poltawski
- University of Exeter Medical School, Exeter, United Kingdom
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
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Homburg M, Berger M, Berends M, Meijer E, Kupers T, Ramerman L, Rijpkema C, de Schepper E, Olde Hartman T, Muris J, Verheij R, Peters L. Dutch GP healthcare consumption in COVID-19 heterogeneous regions: an interregional time-series approach in 2020-2021. BJGP Open 2024; 8:BJGPO.2023.0121. [PMID: 38128964 PMCID: PMC11300972 DOI: 10.3399/bjgpo.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Many countries observed a sharp decline in the use of general practice services after the outbreak of the COVID-19 pandemic. However, research has not yet considered how changes in healthcare consumption varied among regions with the same restrictive measures but different COVID-19 prevalence. AIM To investigate how the COVID-19 pandemic affected healthcare consumption in Dutch general practice during 2020 and 2021, among regions with known heterogeneity in COVID-19 prevalence, from a pre-pandemic baseline in 2019. DESIGN & SETTING Population-based cohort study using electronic health records. The study was undertaken in Dutch general practices involved in regional research networks. METHOD An interrupted time-series analysis of changes in healthcare consumption from before to during the pandemic was performed. Descriptive statistics were used on the number of potential COVID-19-related contacts, reason for contact, and type of contact. RESULTS The study covered 3 595 802 contacts (425 639 patients), 3 506 637 contacts (433 340 patients), and 4 105 413 contacts (434 872 patients) in 2019, 2020, and 2021, respectively. Time-series analysis revealed a significant decrease in healthcare consumption after the outbreak of the pandemic. Despite interregional heterogeneity in COVID-19 prevalence, healthcare consumption decreased comparably over time in the three regions, before rebounding to a level significantly higher than baseline in 2021. Physical consultations transitioned to phone or digital over time. CONCLUSION Healthcare consumption decreased irrespective of the regional prevalence of COVID-19 from the start of the pandemic, with the Delta variant triggering a further decrease. Overall, changes in care consumption appeared to reflect contextual factors and societal restrictions rather than infection rates.
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Affiliation(s)
- Maarten Homburg
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolein Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthijs Berends
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Medical Epidemiology, Certe Medical Diagnostics and Advice Foundation, Groningen, the Netherlands
| | - Eline Meijer
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thijmen Kupers
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lotte Ramerman
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Corinne Rijpkema
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Evelien de Schepper
- Department of General Practice, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Jean Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robert Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Tranzo, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Lilian Peters
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Turnbull J, Prichard J, MacLellan J, Pope C. eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey. J Med Internet Res 2024; 26:e50376. [PMID: 38833297 PMCID: PMC11185907 DOI: 10.2196/50376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/21/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. OBJECTIVE This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. METHODS A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. RESULTS Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). CONCLUSIONS These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.
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Affiliation(s)
- Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Zanaboni P, Bergmo TS, Kristiansen E. Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey. BMJ Open 2024; 14:e075352. [PMID: 38272547 PMCID: PMC10824015 DOI: 10.1136/bmjopen-2023-075352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text). DESIGN A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway. SETTING Primary care. PARTICIPANTS Patients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020. RESULTS Of the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001). CONCLUSIONS Patients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.
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Affiliation(s)
- Paolo Zanaboni
- University Hospital of North Norway, Tromso, Norway
- UiT The Arctic University of Norway, Tromso, Norway
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Yang YT, Zhong X, Fahmi A, Watts S, Ashcroft DM, Massey J, Fisher L, MacKenna B, Mehrkar A, Bacon SCJ, Goldacre B, Hand K, van Staa T, Palin V. The impact of the COVID-19 pandemic on the treatment of common infections in primary care and the change to antibiotic prescribing in England. Antimicrob Resist Infect Control 2023; 12:102. [PMID: 37717030 PMCID: PMC10504725 DOI: 10.1186/s13756-023-01280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/22/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND There is concern that the COVID-19 pandemic altered the management of common infections in primary care. This study aimed to evaluate infection-coded consultation rates and antibiotic use during the pandemic and how any change may have affected clinical outcomes. METHODS With the approval of NHS England, a retrospective cohort study using the OpenSAFELY platform analysed routinely collected electronic health data from GP practices in England between January 2019 and December 2021. Infection coded consultations and antibiotic prescriptions were used estimate multiple measures over calendar months, including age-sex adjusted prescribing rates, prescribing by infection and antibiotic type, infection consultation rates, coding quality and rate of same-day antibiotic prescribing for COVID-19 infections. Interrupted time series (ITS) estimated the effect of COVID-19 pandemic on infection-coded consultation rates. The impact of the pandemic on non- COVID-19 infection-related hospitalisations was also estimated. RESULTS Records from 24 million patients were included. The rate of infection-related consultations fell for all infections (mean reduction of 39% in 2020 compared to 2019 mean rate), except for UTI which remained stable. Modelling infection-related consultation rates highlighted this with an incidence rate ratio of 0.44 (95% CI 0.36-0.53) for incident consultations and 0.43 (95% CI 0.33-0.54) for prevalent consultations. Lower respiratory tract infections (LRTI) saw the largest reduction of 0.11 (95% CI 0.07-0.17). Antibiotic prescribing rates fell with a mean reduction of 118.4 items per 1000 patients in 2020, returning to pre-pandemic rates by summer 2021. Prescribing for LRTI decreased 20% and URTI increased 15.9%. Over 60% of antibiotics were issued without an associated same-day infection code, which increased during the pandemic. Infection-related hospitalisations reduced (by 62%), with the largest reduction observed for pneumonia infections (72.9%). Same-day antibiotic prescribing for COVID-19 infection increased from 1 to 10.5% between the second and third national lockdowns and rose again during 2022. CONCLUSIONS Changes to consultations and hospital admissions may be driven by reduced transmission of non-COVID-19 infections due to reduced social mixing and lockdowns. Inconsistencies in coding practice emphasises the need for improvement to inform new antibiotic stewardship policies and prevent resistance to novel infections.
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Affiliation(s)
- Ya-Ting Yang
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Xiaomin Zhong
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Ali Fahmi
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Simon Watts
- Health Education England, Manchester, M1 3BN, UK
| | - Darren M Ashcroft
- Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Faculty of Biology, Medicine and Health, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Sebastian C J Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Kieran Hand
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Tjeerd van Staa
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Victoria Palin
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK.
- Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, The University of Manchester, Manchester, M13 9WL, UK.
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The changing face of missed appointments. Br J Gen Pract 2023; 73:134-135. [PMID: 36823055 PMCID: PMC9976814 DOI: 10.3399/bjgp23x732249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Kristiansen E, Atherton H, Austad B, Bergmo T, Norberg BL, Zanaboni P. Older patients' experiences of access to and use of e-consultations with the general practitioner in Norway: an interview study. Scand J Prim Health Care 2023; 41:33-42. [PMID: 36592342 PMCID: PMC10088919 DOI: 10.1080/02813432.2022.2161307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore older patients' experiences with accessing and using e-consultations to send text-based clinical inquiries to the general practitioner (GP) online. DESIGN Qualitative study based on semi-structured interviews. Results were analysed through a six-phase thematic analysis and interpreted through Levesque's framework of patient-centred access to health care. SETTING General practice in Norway. SUBJECTS Patients aged over 65 years (n = 16) with experience in using e-consultations. RESULTS Respondents considered e-consultations as an integrated part of general practice which helped them achieve better access to health care. We identified four themes describing older patients' access to and use of e-consultations: 1) the importance of digital health literacy to learn about and use the service - and the fear of losing it, 2) the high availability of the service as the main advantage, due to the perceived unavailability of physical GP services, 3) the importance of voluntary use of e-consultations, 4) the importance of a trusting relationship with the GP. IMPLICATIONS Information about e-consultations and guidelines for suitable use are recommended to ensure equal access to all patients, regardless of their digital health literacy. Availability problems and high work burdens for the GPs could affect the patients' choice for using e-consultations. If e-consultations are used for triage purposes, caution should be taken to avoid a shift in workload from the health secretary to the GP.Key points of articleThe extended use of e-consultations with the general practitioner has raised concerns that the service may not be accessible and suitable for older patients.For older users, e-consultations can represent a positive addition to physical consultation forms due to the high availability of the service in a general practice setting characterised by long waiting times.Digital health literacy is essential to learn about and use the service. Information about the service and how to use it should be available to all patients to ensure equal access.A trusting relationship with the GP is described as essential for older patients to perceive the outcome of e-consultations as appropriate and safe.
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Affiliation(s)
- Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, UK
| | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Bergmo
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Børge Lønnebakke Norberg
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Ndayishimiye C, Lopes H, Middleton J. A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery. HEALTH AND TECHNOLOGY 2023; 13:273-284. [PMID: 36628261 PMCID: PMC9816012 DOI: 10.1007/s12553-023-00725-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019-2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews. A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.); behavior promotion and digital health literacy (e.g., combating vaccine hesitancy); surveillance functions; vaccination and drugs; and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19. DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives). Supplementary Information The online version contains supplementary material available at 10.1007/s12553-023-00725-7.
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Affiliation(s)
- Costase Ndayishimiye
- Association of Schools of Public Health in the European Region (ASPHER), 1150 Brussels, Belgium
- Health Economics and Social Security Department, Jagiellonian University Medical College, 8 Skawińska, 31-066 Krakow, Poland
| | - Henrique Lopes
- Association of Schools of Public Health in the European Region (ASPHER), 1150 Brussels, Belgium
- Comité mondial pour les apprentissages tout au long de la vie (CMAtlv), partenaire officiel de l’UNESCO, 75004 Paris, France
| | - John Middleton
- Association of Schools of Public Health in the European Region (ASPHER), 1150 Brussels, Belgium
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Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care. BJGP Open 2022; 6:BJGPO.2022.0038. [PMID: 36270671 PMCID: PMC9904784 DOI: 10.3399/bjgpo.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/12/2022] [Accepted: 09/09/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively. AIM To assess the experiences of patients in primary care during the COVID-19 pandemic. DESIGN & SETTING A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. METHOD A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. RESULTS Twenty-eight patients were interviewed (13 men and 15 women, aged 27-91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated. CONCLUSION Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care.
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Partner GP, Jinks C, Narayanasamy M, Scott IC, Sahota O, Ryan S. Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. BMC Musculoskelet Disord 2022; 23:312. [PMID: 35366845 PMCID: PMC8976169 DOI: 10.1186/s12891-022-05273-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among patients with osteoporosis and rheumatoid arthritis. Methods Three UK qualitative studies, exploring patient experiences of accessing and receiving healthcare, undertaken during the pandemic, with people with osteoporosis and rheumatoid arthritis. Study team members agreed a consistent approach to conduct rapid deductive analysis using the Theoretical Framework of Acceptability (TFA) on transcripts from each data set relating to RC, facilitated by group meetings to discuss interpretations. Findings from the three studies were pooled. Results Findings from 1 focus group and 64 interviews with 35 people were included in the analysis. Participants’ attitudes to RC, views on fairness (ethicality) and sense-making (intervention coherence) varied according to their needs within the consultation and views of the pandemic. Some participants valued the reduced burden associated with RC, while others highly valued non-verbal communication and physical examination associated with face-to-face consults (opportunity costs). Some participants described low confidence (self-efficacy) in being able to communicate in RCs and others perceived RCs as ineffective, in part due to suboptimal communication. Conclusions Acceptability of, and preferences for RC appear to be influenced by societal, healthcare provider and personal factors and in this study, were not condition-dependant. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05273-1.
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