Challenge
Online consultations (OCs) allow patients to contact their healthcare teams online. They have been rapidly rolled out since the Covid-19 pandemic and, at the time of this study, were available in 85% of GP practices. In those using them as their primary method of contact, it was estimated that they accounted for 72% of all patient requests for appointments.
In spite of the speed of their take-up, little was known about patients’ experiences using OCs. This meant that neither GP practices nor OC system designers knew exactly why patients chose to use OCs – nor, conversely, for what reasons and in which scenarios they might opt against using them.
It was clear that practical information was sorely lacking. We therefore set out to perform in-depth research into patient experiences of OCs, in the hope that their design and implementation could be optimised. Our study was the largest reported qualitative study thus far.
Solution
Between December 2019 and July 2022, our Chief Medical Officer, Dr Ben Brown – along with a team of five other researchers – conducted a qualitative study in 428 English GP practices using the Patchs OC system.
Before the team’s research, most existing studies had taken place before the onset of the pandemic. Moreover, given that they had predominantly looked into clinician experience of OCs, exploration of patient views had been limited. Of those studies which had been completed, most had employed survey-based methods rather than qualitative, interview-based techniques.
Ben and the team decided to conduct a qualitative study, triangulating patient interviews with large volumes of written feedback. The study took in 44,644 written comments from 23,813 patients, along with semi-structured interviews with 25 patients.
The team chose to use an NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework in their analysis, meaning that they were able to assess the new and unfolding OC technology in real time.
Outcome
The team found that during the pandemic, most patients felt happy using OCs because they felt that they helped to comply with social distancing and relieve their GP’s workload. However, some felt that they were a temporary response, and now that the pandemic was over, they hoped for a return to in-person consultations as default.
The reasons for these differing responses were shown to depend both on the quality of any given practice’s implementation of the OC system, and on how well the OC system itself had been designed.
What patients most appreciated about OCs was that they were:
- Quick: they often received a reply from a clinician much quicker than via traditional, non-urgent in-person appointments.
- Flexible: they could submit queries at any time and communicate with health professionals remotely. This was especially convenient for those working full-time or with childcare responsibilities.
- Efficient: they did not have to wait in a telephone queue or sit in a waiting room. If a telephone or in-person consultation was necessary, they could provide clinicians with detailed written information in advance.
Importantly, however, these benefits were negated:
- if a patient’s GP practice failed to advertise the OC well
- if (for reasons of demand management) it was not made sufficiently available
- if the OC design itself was felt to be inflexible.
When it came to OC design, what patients enjoyed most was being able to access a written record of their queries. They also appreciated being able to communicate those queries via free-text responses (rather than being forced to select a problem from a limited set of options). Those who typically struggled to communicate in traditional consultations reported finding it easier to use OCs, and male patients in particular chose to contact their GP practice more readily when an OC was available.
When it came to views on clinical safety and the ease which patients felt when discussing sensitive topics, opinions remained divided.
Following these findings, the team were able to make a number of recommendations to both GP practices and to the creators of OCs. Their work will help to improve both the uptake and effectiveness of OCs in the future.
You can read the full research paper at the British Journal of General Practice here.
Find out more
The findings of this research have fed into the iterative design of Patchs, our online consultation software. This is one of the key things that sets us apart from our competitors.
You can read more about Patchs’ features here.