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Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

BACKGROUND: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. OBJECTIVE: This study aimed to assess the evidence of delivering e-consultati...

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Autores principales: Mold, Freda, Hendy, Jane, Lai, Yi-Ling, de Lusignan, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918214/
https://www.ncbi.nlm.nih.gov/pubmed/31793888
http://dx.doi.org/10.2196/13042
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author Mold, Freda
Hendy, Jane
Lai, Yi-Ling
de Lusignan, Simon
author_facet Mold, Freda
Hendy, Jane
Lai, Yi-Ling
de Lusignan, Simon
author_sort Mold, Freda
collection PubMed
description BACKGROUND: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. OBJECTIVE: This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. METHODS: A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. RESULTS: This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. CONCLUSIONS: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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spelling pubmed-69182142020-01-02 Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review Mold, Freda Hendy, Jane Lai, Yi-Ling de Lusignan, Simon JMIR Med Inform Review BACKGROUND: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. OBJECTIVE: This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. METHODS: A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. RESULTS: This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. CONCLUSIONS: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow. JMIR Publications 2019-12-03 /pmc/articles/PMC6918214/ /pubmed/31793888 http://dx.doi.org/10.2196/13042 Text en ©Freda Mold, Jane Hendy, Yi-Ling Lai, Simon de Lusignan. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 03.12.2019. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Review
Mold, Freda
Hendy, Jane
Lai, Yi-Ling
de Lusignan, Simon
Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
title Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
title_full Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
title_fullStr Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
title_full_unstemmed Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
title_short Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review
title_sort electronic consultation in primary care between providers and patients: systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918214/
https://www.ncbi.nlm.nih.gov/pubmed/31793888
http://dx.doi.org/10.2196/13042
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