What are primary care professionals’ views on remote consulting during the COVID-19 pandemic and how has it impacted on service delivery for people with asthma?

Problem

Since March 2020, when the first lockdown due to the COVID-19 pandemic enforced social distancing, primary care clinicians have conducted consultations remotely via telephone, video and asynchronous platforms to reduce the spread of the virus.We aimed to explore primary care practitioners’ views on remote consulting during the pandemic and how it affected service delivery for people with asthma.

Approach

In March 2021, four semi-structured interviews were conducted with GPs and nurses from across the UK and a short online survey was developed and piloted with 23 clinicians. In January 2022, six further interviews were conducted with five GPs and one community pharmacist. All interviews were audio-recorded, transcribed verbatim and analysed thematically.

Findings

The 2021 interviews and survey revealed how the pandemic had driven new innovations but found that remote consultations had had a mixed impact on practice. The quality of technology and provision of adequate infrastructure affected success and further training and support for clinicians was deemed necessary. It was felt that remote consulting presented specific barriers to delivery of high-quality care such as challenges in assessing severity of a presentation without physical examination and in establishing rapport with patients. Participants saw a role in the future for remote platforms to be integrated alongside face-to-face consultations in a hybrid model. A year later, the 2022 interviews reiterated these themes and questioned whether remote consulting was an effective way of reducing the workload in primary care. Telephone and instant messaging were favoured over video consulting which was described as too time consuming to set up and beset by technological issues. There were also reports of reduced job satisfaction amongst GPs when consulting remotely. Remote consulting was felt to improve the convenience and accessibility of on-going asthma care and therefore benefited supported self-management. However, it was felt that the lack of a visual aspect to the consultation made remote methods unsuitable and unsafe for assessment of acute exacerbations or for ongoing education and assessment of inhaler technique.

Consequences

Clinicians felt generally positive about remote consultations but described limitations in terms of quality and suitability for all consultation types and patient groups. Further infrastructure and training needed to be supplied in order to support primary care clinicians with remote consulting. Findings of this study could be used to improve remote platform use in primary care and are also of relevance to policymakers. Additionally, there are emerging concerns about the workload and efficiency of remote consulting as well as GP job satisfaction that could hinder the sustainability of the approach.