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Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production
OBJECTIVES: To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. DESIGN: Mixed-method evaluation of a primary care e-consultation system. SETTING: Primary care practices in Sou...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875620/ https://www.ncbi.nlm.nih.gov/pubmed/29555817 http://dx.doi.org/10.1136/bmjopen-2017-019966 |
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author | Farr, Michelle Banks, Jonathan Edwards, Hannah B Northstone, Kate Bernard, Elly Salisbury, Chris Horwood, Jeremy |
author_facet | Farr, Michelle Banks, Jonathan Edwards, Hannah B Northstone, Kate Bernard, Elly Salisbury, Chris Horwood, Jeremy |
author_sort | Farr, Michelle |
collection | PubMed |
description | OBJECTIVES: To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. DESIGN: Mixed-method evaluation of a primary care e-consultation system. SETTING: Primary care practices in South West England. METHODS: Qualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients’ records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients’ and staff touchpoints. RESULTS: We found different expectations between patients and staff on how to use e-consultations ‘appropriately’. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation. CONCLUSIONS: Where both patients and staff interact with technology, it is in effect ‘co-implemented’. How patients used e-consultations impacted on practice staff’s experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints. |
format | Online Article Text |
id | pubmed-5875620 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58756202018-04-02 Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production Farr, Michelle Banks, Jonathan Edwards, Hannah B Northstone, Kate Bernard, Elly Salisbury, Chris Horwood, Jeremy BMJ Open General practice / Family practice OBJECTIVES: To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. DESIGN: Mixed-method evaluation of a primary care e-consultation system. SETTING: Primary care practices in South West England. METHODS: Qualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients’ records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients’ and staff touchpoints. RESULTS: We found different expectations between patients and staff on how to use e-consultations ‘appropriately’. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation. CONCLUSIONS: Where both patients and staff interact with technology, it is in effect ‘co-implemented’. How patients used e-consultations impacted on practice staff’s experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints. BMJ Publishing Group 2018-03-19 /pmc/articles/PMC5875620/ /pubmed/29555817 http://dx.doi.org/10.1136/bmjopen-2017-019966 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | General practice / Family practice Farr, Michelle Banks, Jonathan Edwards, Hannah B Northstone, Kate Bernard, Elly Salisbury, Chris Horwood, Jeremy Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
title | Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
title_full | Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
title_fullStr | Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
title_full_unstemmed | Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
title_short | Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
title_sort | implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production |
topic | General practice / Family practice |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875620/ https://www.ncbi.nlm.nih.gov/pubmed/29555817 http://dx.doi.org/10.1136/bmjopen-2017-019966 |
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