Remote first in primary care during COVID-19: views and experiences of patients to inform future service development

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

1E.4

Presenter:

Jenny Downing

Twitter:

@Jenny_Downing1

Co-authors:

Prof Umesh Chauhan, Prof Nefyn Williams, Prof. Tony Marson, Sandra Smith, Koser Khan, Dr Kimberly Lazo, Dr Mark Goodall, Dr Pete Dixon, Dr Victoria Appleton, Prof. Mark Gabbay

Author institutions:

University of Liverpool, University of Central Lancashire, University of Lancaster, NIHR ARC North West Coast

Problem

Covid-19 has created healthcare delivery challenges previously unseen. The rapid switch to access to healthcare through ‘remote first’ was necessary to limit Covid-19 transmission and increase safety, even though our understanding of its acceptability, effectiveness and impact on health inequalities was limited. Remote care has continued due to public health measures, however, almost two years into the pandemic it is important to assess the impact of this natural experiment on the views of patients, particularly considering the consequences of a remote first approach to primary care access to populations with greater need, such as those with multimorbidity, disability or learning difficulties.

Approach

An online survey was designed with a combination of closed questions and free text sections to gather data from patients about their experiences and views of remote first. GP practices across the North West Coast sent out the survey link via text message to a selection of patients. The survey was also promoted on social media. We used descriptive statistics to explore the quantitative data and inductive thematic coding to identify the themes within the qualitative data.

Findings

1030 patients (from 45 practices) completed the survey over 6 weeks. During this time, primary care appointments were reported as most likely to have been by telephone, e-consultation or face-to-face with most being via telephone or face-to-face. Patients overwhelmingly wanted future appointments face-to-face or via telephone and preferred consultations to be remote ‘occasionally’ (32.8%). However, the majority of patients (>50%) were satisfied with their care, their rapport with the clinician, the length of their consultations and the convenience of their consultation. Patients reported that remote first was often efficient, convenient, safe, and good for minor or transactional needs. However, they were least satisfied with any examination conducted by their clinician expressing concerns about the accuracy of remote diagnosis and risk of missing health issues. Patients also stated concerns about lack of choice, difficulties with communication when not face-to-face, and concerns about the quality of care. Patients want more choice in appointment type in the future, in additional to improvements in the triage systems. Those who are elderly with long-term conditions, those with learning difficulties, mental health conditions or hearing impairment reported a need for face-to-face appointments in order to communicate and understand the clinician better. The online survey design resulted in underrepresentation from BAME and other marginalised populations.

Consequences

Primary care triage and consultation types vary now more than ever before. This could potentially provide patients with more choice and easier accessibility, however getting the balance right is a challenge. The findings from this research can help to inform future changes in primary care, specifically in relation to appointment default options for vulnerable populations. Further research focusing on marginalised populations is needed.

Submitted by:

Jenny Downing

Funding acknowledgement:

This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North West Coast. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.