The impact of remote consultations on the quality of primary care: A systematic review

Abstract

AbstractBackgroundThe adoption of remote consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. We evaluated the impact of remote consultations on the quality of primary care.MethodsSix databases were searched. Studies evaluating the impact of remote consultations, for any disease, were included. Title and abstract screening, and full-text screening were performed by two pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.FindingsThirty studies (5,469,333 participants) were included in the review. Remote consultations generally had a positive or equivalent impact compared to face-to-face (F2F) consultations, particularly in reducing patient costs and improving time efficiency. The effectiveness of remote consultations was non-inferior to F2F care in six out of seven studies evaluating this aspect. Two studies found that remote consultations reduced wait times for appointments. Younger, female patients were more likely to use remote consultations and those of lower socioeconomic status were less likely to use video consultations than telephone appointments. The impacts on safety and patient-centeredness were largely inconclusive.InterpretationRemote consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care. Those of lower socioeconomic status were more likely to use consultations delivered via telephone than videoconference. Developing a strong evidence-base capitalising on real-world data as well as clinical trials is crucial for the future development of remote consultations and tailoring them to patient needs and preferences.FundingNational Institute for Health and Care Research Applied Research Collaboration Northwest London.What is already known on this topicExisting literature reviews exploring remote consultations have primarily been confined to assessing their impact on effectiveness, efficiency, or specific clinical conditions whilst utilising a broad definition regarding what constitutes remote services. Evidence was largely heterogeneous, often focussing on interventions delivered in secondary care facilities or by specialists only. There is a paucity of systematic reviews pertaining to primary care.What this study addsThis systematic review investigates the impact of remote consultations on the quality of primary care. Our results show that remote consultations may be equally as effective as F2F care and have a potentially positive impact on efficiency, timeliness of care, and reduced rates of follow-up in secondary or tertiary care. Patients from lower socioeconomic backgrounds were more likely to use consultations delivered via telephone than video conference.How this study might affect research, practice or policyOur systematic review has demonstrated that remote consultations have the potential to be just as effective as F2F consultations by reducing waiting times, patient costs, and rates of follow-up in hospitals. However, there currently remains a lack of robust studies available exploring the effect of remote consultations on patient safety, equity, and patient-centredness, highlighting areas where future research efforts need to be devoted. Data collection methods more bespoke to the primary care context, better accounting for patient characteristics and needs, and inclusive of its intended end-users, are necessary to generate a stronger evidence base to inform future remote care policies.