Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Mi...

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Vydané v:	British journal of general practice Ročník 71; číslo 704; s. e166
Hlavní autori:	Murphy, Mairead, Scott, Lauren J, Salisbury, Chris, Turner, Andrew, Scott, Anne, Denholm, Rachel, Lewis, Rhys, Iyer, Geeta, Macleod, John, Horwood, Jeremy
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England 01.03.2021
Predmet:	Adult Aged, 80 and over Attitude of Health Personnel Change Management Communicable Disease Control - methods COVID-19 - epidemiology COVID-19 - prevention & control Disease Transmission, Infectious - prevention & control Female General Practitioners - statistics & numerical data Humans Infant, Newborn Male Practice Patterns, Nurses' - trends Practice Patterns, Physicians' - trends Primary Health Care - methods Primary Health Care - organization & administration Primary Health Care - trends Remote Consultation - organization & administration SARS-CoV-2 United Kingdom - epidemiology United Kingdom remote consultation telephone consultation triage general practitioners online consultation
ISSN:	1478-5242, 1478-5242
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Abstract	To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
AbstractList	To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms.BACKGROUNDTo reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms.To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.AIMTo investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.DESIGN AND SETTINGMixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory.METHODLongitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory.There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.RESULTSThere was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.CONCLUSIONThe shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment. To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
Author	Scott, Lauren J Denholm, Rachel Turner, Andrew Horwood, Jeremy Murphy, Mairead Lewis, Rhys Iyer, Geeta Salisbury, Chris Scott, Anne Macleod, John
Author_xml	– sequence: 1 givenname: Mairead surname: Murphy fullname: Murphy, Mairead organization: Centre for Academic Primary Care (CAPC), University of Bristol, Bristol Medical School, Bristol – sequence: 2 givenname: Lauren J surname: Scott fullname: Scott, Lauren J organization: National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol – sequence: 3 givenname: Chris surname: Salisbury fullname: Salisbury, Chris organization: National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol – sequence: 4 givenname: Andrew surname: Turner fullname: Turner, Andrew organization: National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol – sequence: 5 givenname: Anne surname: Scott fullname: Scott, Anne organization: Centre for Academic Primary Care (CAPC), University of Bristol, Bristol Medical School, Bristol – sequence: 6 givenname: Rachel surname: Denholm fullname: Denholm, Rachel organization: NIHR Bristol Biomedical Research Centre, University of Bristol; CAPC, University of Bristol, Bristol – sequence: 7 givenname: Rhys surname: Lewis fullname: Lewis, Rhys organization: One Care, Whitchurch, Bristol – sequence: 8 givenname: Geeta surname: Iyer fullname: Iyer, Geeta organization: North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol – sequence: 9 givenname: John surname: Macleod fullname: Macleod, John organization: National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol – sequence: 10 givenname: Jeremy surname: Horwood fullname: Horwood, Jeremy organization: National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol
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SubjectTerms	Adult Aged, 80 and over Attitude of Health Personnel Change Management Communicable Disease Control - methods COVID-19 - epidemiology COVID-19 - prevention & control Disease Transmission, Infectious - prevention & control Female General Practitioners - statistics & numerical data Humans Infant, Newborn Male Practice Patterns, Nurses' - trends Practice Patterns, Physicians' - trends Primary Health Care - methods Primary Health Care - organization & administration Primary Health Care - trends Remote Consultation - organization & administration SARS-CoV-2 United Kingdom - epidemiology
Title	Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study
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