The impact of virtual consultations on the quality of primary care: a systematic review
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: The adoption of virtual consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. Due to its rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.
Objective: We evaluated the impact of virtual consultations on the quality of primary care.
Methods: Six databases were searched. Studies evaluating the impact of virtual 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.
Findings: Thirty studies (5,469,333 participants) were included in the review. Our findings suggest that virtual consultations are equally or more effective than F2F care for the management of conditions including mental illness, excessive smoking, and alcohol consumption. Four studies indicated positive impacts on some aspects of patient-centredness, however, a negative impact was noted on patients’ perceived autonomy support (i.e., the degree to which people perceive others in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care. The evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities between other subgroups depending on contextual factors.
Conclusions: Our systematic review has demonstrated that virtual consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care However, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centredness, highlighting areas where future research efforts should be devoted. Capitalising on real-world data, as well as clinical trials, is crucial to ensure use of virtual consultations is tailored according to patient needs and preferences. Data collection methods which are bespoke to the primary care context, account for patient characteristics and are inclusive of its intended end-users, are necessary to generate a stronger evidence base to inform future virtual care policies.
Funding: National Institute for Health and Care Research Applied Research Collaboration Northwest London.
Objective: We evaluated the impact of virtual consultations on the quality of primary care.
Methods: Six databases were searched. Studies evaluating the impact of virtual 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.
Findings: Thirty studies (5,469,333 participants) were included in the review. Our findings suggest that virtual consultations are equally or more effective than F2F care for the management of conditions including mental illness, excessive smoking, and alcohol consumption. Four studies indicated positive impacts on some aspects of patient-centredness, however, a negative impact was noted on patients’ perceived autonomy support (i.e., the degree to which people perceive others in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care. The evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities between other subgroups depending on contextual factors.
Conclusions: Our systematic review has demonstrated that virtual consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care However, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centredness, highlighting areas where future research efforts should be devoted. Capitalising on real-world data, as well as clinical trials, is crucial to ensure use of virtual consultations is tailored according to patient needs and preferences. Data collection methods which are bespoke to the primary care context, account for patient characteristics and are inclusive of its intended end-users, are necessary to generate a stronger evidence base to inform future virtual care policies.
Funding: National Institute for Health and Care Research Applied Research Collaboration Northwest London.
Date Issued
2023-08-30
Date Acceptance
2023-07-31
Citation
Journal of Medical Internet Research, 2023, 25, pp.1-17
ISSN
1438-8871
Publisher
JMIR Publications
Start Page
1
End Page
17
Journal / Book Title
Journal of Medical Internet Research
Volume
25
Copyright Statement
©Kate Campbell, Geva Greenfield, Edmond Li, Niki O'Brien, Benedict Hayhoe, Thomas Beaney, Azeem Majeed, Ana Luísa
Neves. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.08.2023. This is an open-access
article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the
Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication
on https://www.jmir.org/, as well as this copyright and license information must be included.
Neves. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.08.2023. This is an open-access
article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the
Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication
on https://www.jmir.org/, as well as this copyright and license information must be included.
License URL
Identifier
https://www.jmir.org/2023/1/e48920
Publication Status
Published
Article Number
e48920
Date Publish Online
2023-08-30