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Electronic consultations offer few benefits for GP practices, says study

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5141 (Published 07 November 2017) Cite this as: BMJ 2017;359:j5141
  1. Jacqui Wise
  1. London

Electronic consultations appear to offer some benefit to patients but increase the workload of GPs, research published in the British Journal of General Practice shows.1

Policy makers have suggested that online consultations could ease pressure on GP practices and improve patient access, but there is limited research on whether they are able to deliver such improvements. Only around 6% of practices have used some form of electronic consultation but a further 20% have plans to do so in the future. There are currently two main e-consultation systems being used in primary care in the UK—askmyGP (http://askmygp.uk) and eConsult (www.emishealth.com/product/econult) previously known as WebGP.

Thirty six practices in the west of England participated in a 15 month pilot study of eConsult during 2015 and 2016. The system, which was provided free in the pilot study, gives patients access to advice and care through their GP practice website. To submit an e-consultation, the patient completes an online form to give a structured medical account of their condition. Practices are obliged to respond to a patient’s e-consultation within one working day.

Researchers from the University of Bristol carried out 23 interviews at six representative practices with a range of staff including receptionists, practice managers, and GPs. Overall there was an average of 18 e-consultations a month at each of the practices. The e-consultations were not a two way online based interaction, which meant that GPs could not probe for further information.

The overall feeling from practices was that the system generated work by adding another stage in the workflow for GPs and administration staff. Most e-consultations resulted in GPs needing to follow up with a telephone or face to face appointment because they did not have enough information to inform clinical decision making. For example, one doctor commented: “When someone says, ‘I have felt unwell for three weeks with headache, dizziness, limb aches, vision’s blurred’ it’s impossible to disentangle that with an e-consult—you’ve got to see them.”

Doctors felt happy to deal with an e-consultation without creating a further appointment for straightforward clinical queries such as slight changes in medication for an ongoing issue—such as changes in blood pressure tablets following changes in blood pressure. They also found them useful for responding to questions about fit notes, test results, or prescriptions.

One of the biggest frustrations expressed by practice staff was that some patients were using e-consultations to bypass the normal telephone booking system.

Practice staff did say that e-consultations offered benefits to patients. For example, they said they can help some patients articulate their concerns with less fear of embarrassment.

However, the study authors concluded: “The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in this system.”

References

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