This review includes evidence from 28 studies since the start of the Covid-19 pandemic. One of the main conclusions is a preference towards a hybrid system including text, phone, video, email and in-person appointments.
Headline findings include:
- There are mixed views about remote (not face-to-face) consultations – for most they are beneficial (more convenient) and satisfaction is high. Some people find remote consultations a less stressful experience than visiting their GP, easier to share information, and a simpler and quicker route to care.
- However, for others there are concerns about remote access overlooking individual support requirements with some fears of misdiagnosis.
- Other concerns include not having a specific time for the appointment; not feeling able, or being too rushed, to fully explain their condition in a remote setting; lack of privacy; Wi-Fi and connectivity problems (including use of personal data allowance); and concerns over data security.
- People whose first language was not English find making appointments or speaking to a GP over the phone challenging, and for those with learning disabilities people feel that a face-to-face appointment is better especially as facial expressions are important to them.
- People who are deaf or who have hearing loss face additional difficulties making some remote appointments difficult to comprehend. Some report putting off appointments as a consequence. GP surgeries making conscientious adjustments to meet the patient’s communication preferences, and the use of assistive technology are recommended.
- Some young people were particularly concerned that remote appointments did not allow people to establish rapport and communicate effectively with the health or social care professional remotely; that the remote appointment increased anxiety; raised worries over privacy; and a perception that this may increase the risk of misdiagnosis.
- For mental health remote consultations, some young people were worried about communication and trust; privacy and confidentiality; anxiety and lack of confidence; technology; and stigma and fear of being judged.
- People with disabilities and Lesbian, Gay and Bisexual people were generally the least satisfied with their remote appointments during the pandemic.
- In general, older people and those people with disabilities were less happy to have remote consultations in the future.
- There is a preference for primary care to incorporate a hybrid system, doing everything possible to reduce barriers to accessing care remotely while giving people the agency to decide what kind of appointment is right for them. A blended offer, including text, phone, video, email, and in-person is thought to be the most favourable solution for patients.
- A choice of remote appointment, whether phone, video or SMS was also considered to be preferable.
- GPs highlight several functionality benefits of remote consultations that are likely to extend beyond the pandemic. These include smartphone compatibility; video calls auto-populating a patient name, phone number and other details; sending bespoke SMS; sharing attachments; and having a full audit trail of communication to and from the patient.
- In the long-term, improving digital skills is important to enable people to receive health and social care support online.