Abstract
BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice, compared to face-to-face consultations, on utilisation and clinical outcomes across socioeconomic and disadvantaged groups.Design & settingSystematic review.MethodThe authors undertook an electronic search of MEDLINE, EMBASE, and Web of Science from inception to June 2020. The study included studies that compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data were synthesised narratively.ResultsBased on 13 studies that explored telephone and internet-based consultations, this review found that telephone consultations were used by younger people of working age, the very old, and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socioeconomic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger, working people, non-immigrants, older patients, and women, with internet-based consultations more by younger, affluent, and educated groups. Widespread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.
Highlights
Remote consultations in general practice have become increasingly important over the past year
Based on 13 studies that explored telephone and internet-based consultations, this review found that telephone consultations were used by younger people of working age, the very old, and non-immigrants, with internet-b ased consultations more likely to be used by younger people
Remote consultations appeared to help patients with opioid dependence remain engaged with primary care
Summary
Remote consultations in general practice have become increasingly important over the past year. Remote consulting was used before COVID-19, offering potential benefits in access, especially for those in rural areas or with mobility issues, and appointment flexibility. It is potentially more costand time-effective than face-to-face consultations, and has been explored as a possible solution to increased GP workload and GP shortages.[4] Remote consulting includes telephone and video consultations, as well as synchronous or asynchronous internet-based communications, such as emails or web-b ased consultation platforms. COVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown
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