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The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study Thumbnail


Authors

Helen Atherton

Heather Brant

Sue Ziebland

Annemieke Bikker

John Campbell

Andy Gibson

Brian McKinstry

Tania Porqueddu

Chris Salisbury



Abstract

Background: There is international interest in the potential role of different forms of communication
technology to provide an alternative to face-to-face consultations in health care. There has been
considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or
internet video. However, little is understood about how, under what conditions, for which patients and in
what ways these approaches may offer benefits to patients and practitioners in general practice.

Objectives: Our objectives were to review existing evidence about alternatives to face-to-face consultation;
conduct a scoping exercise to identify the ways in which general practices currently provide these alternatives;
recruit eight general practices as case studies for focused ethnographic research, exploring how practice
context, patient characteristics, type of technology and the purpose of the consultation interact to determine
the impact of these alternatives; and synthesise the findings in order to develop a website resource about the
implementation of alternatives to face-to-face consultations and a framework for subsequent evaluation.

Design: Mixed-methods case study.

Setting: General practices in England and Scotland with varied experience of implementing alternatives to
face-to-face consultations.

Participants: Patients and practice staff.

Interventions: Alternatives to face-to-face consultations include telephone consultations, e-mail,
e-consultations and internet video.

Main outcome measures: How context influenced the implementation and impact of alternatives to the
face-to-face consultation; the rationale for practices to introduce alternatives; the use of different forms of
consultation by different patient groups; and the intended benefits/outcomes.

Review methods: The conceptual review used an approach informed by realist review, a method for
synthesising research evidence regarding complex interventions.

Results: Alternatives to the face-to-face consultation are not in mainstream use in general practice, with
low uptake in our case study practices. We identified the underlying rationales for the use of these
alternatives and have shown that different stakeholders have different perspectives on what they hope to
achieve through the use of alternatives to the face-to-face consultation. Through the observation of real-life
use of different forms of alternative, we have a clearer understanding of how, under what circumstances
and for which patients alternatives might have a range of intended benefits and potential unintended
adverse consequences. We have also developed a framework for future evaluation.

Limitations: The low uptake of alternatives to the face-to-face consultation means that our research
participants might be deemed to be early adopters. The case study approach provides an in-depth
examination of a small number of sites, each using alternatives in different ways. The findings are
therefore hypothesis-generating, rather than hypothesis-testing.

Conclusions: The current low uptake of alternatives, lack of clarity about purpose and limited evidence of
benefit may be at odds with current policy, which encourages the use of alternatives. We have highlighted
key issues for practices and policy-makers to consider and have made recommendations about priorities for
further research to be conducted, before or alongside the future roll-out of alternatives to the face-to-face
consultation, such as telephone consulting, e-consultation, e-mail and video consulting.

Future work: We have synthesised our findings to develop a framework and recommendations about
future evaluation of the use of alternatives to face-to-face consultations.

Funding details: The National Institute for Health Research Health Services and Delivery
Research programme.
ABSTRACT
NIHR

Citation

Atherton, H., Brant, H., Ziebland, S., Bikker, A., Campbell, J., Gibson, A., …Salisbury, C. (2018). The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study. Health Services and Delivery Research, 6(20), 1-200. https://doi.org/10.3310/hsdr06200

Journal Article Type Article
Acceptance Date Apr 1, 2018
Publication Date Jun 7, 2018
Deposit Date Jun 20, 2018
Publicly Available Date Mar 29, 2024
Journal Health Services and Delivery Research
Print ISSN 2050-4349
Publisher NIHR Journals Library
Peer Reviewed Peer Reviewed
Volume 6
Issue 20
Pages 1-200
DOI https://doi.org/10.3310/hsdr06200
Keywords General practice, alternatives to face to face consultations, mixed methods, case study
Public URL https://uwe-repository.worktribe.com/output/866900
Publisher URL http://dx.doi.org/10.3310/hsdr06200
Additional Information Additional Information : Licensed under the Non Commercial Government Licence 2.0, further information is available here: http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/version/2/

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