Primary care practitioners’ and patients’ views on the benefits and challenges of remote consulting for anxiety and depression in general practice

Problem

Research conducted prior to the pandemic suggested that around 40% of primary care consultations were related to mental health. There is evidence that this figure has increased since COVID. Whilst research has focused on the implementation of remote consulting across primary care, we do not know what the benefits and challenges are for those with diagnosed common mental disorders (CMD) – depression and anxiety. Understanding practitioners’ and patients’ views of remote consultations (e-consults, telephone, videocalls) for CMDs will inform how and when these modes should be used in general practice.

Approach

We interviewed 20 primary care practitioners (GPs, nurses, pharmacists, wellbeing coaches) and 21 patients from five general practices in Bristol and the surrounding areas. Interviews were audio-recorded, transcribed verbatim and analysed thematically. A PPI co-applicant and PPI group with lived experience of anxiety and/or depression were actively involved throughout. They provided input on patient-facing materials, topic guides, analysis and dissemination.

Findings

Themes suggest many practitioners found remote consulting helpful for patients with CMDs because they increased accessibility and helped manage demand. However, they found assessing risk challenging and found telephone and e-consults transactional. To mitigate this, practitioners said that continuity of care was even more important for remote mental health care, compared to remote physical health care. Patients said continuity of care was important, but that it was easier to withhold information about their mental health over the telephone, although some added the ‘anonymity’ of a telephone call could make it easier to disclose sensitive information.Some practices required a telephone or e-consult prior to in-person appointments, and in urgent scenarios, telephone consults were often the only option available, despite this not always being the patient’s preference. Many patients did not like this approach, and thought it was important that they were offered a choice between consultation modes. Patients who appeared to prefer consulting remotely were younger, living in less deprived areas, reporting less severe symptoms, or had such severe symptoms they felt unable to leave their home. Many patients described waiting between four to 12 hours for a telephone call as anxiety-provoking, but suggested a narrower calling ‘window’ would alleviate this. Patients thought telephone consultations were more time efficient for GPs than in-person, but GPs reported no difference when compared to in-person consults for mental health. Practitioners and patients reported a need for practitioner training in what makes a ‘good’ remote mental health consult, particularly for assessing risk and building rapport.

Consequences

This project reinforces the importance of continuing to offer patients a choice of consultation modes, but also highlights a need for practices to consider if modes offered are being provided in a patient-centred way, and for training for practitioners to discuss mental health remotely and assess risk.