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Patient online consultation requests ‘mirror’ busiest surgery times

Patient online consultation requests ‘mirror’ busiest surgery times 

  • Patients still make enquiries at busiest hours, despite 24/7 online access
  • University of Warwick publishes first independent evaluation of one of the main providers of online consultation platforms
  • Targeting services at younger patients and those with general administrative enquiries could be most effective
  • “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes.” Says supervising author.

Patients are using online consultations in the same way they would arrange a consultation via traditional means, a new independent evaluation by the University of Warwick reveals.

Despite this, the study identifies several opportunities to tailor online platforms to specific patient requirements and improve their experience.

Primary care researchers from Warwick Medical School have today (26 March) published the first independent evaluation of one of the main providers of online consultation platforms in NHS general practice. Published in the British Journal of General Practice, it provides independently analysed information on the types of patients that are using online triage systems, how and when patients are using this platform, and what they think of it.

Online triage is a system in which patients describe their problems via an online form and subsequently are telephoned by a GP to conduct a telephone consultation or arrange a face-to-face consultation. Practices aim to respond within one hour of receiving the request.

The researchers examined routine information from 5140 patients at nine general practices using the askmyGP platform over a 10 week period. Highest levels of use were between 8 am and 10 am on weekdays (at their highest on Mondays and Tuesdays) and 8 pm and 10 pm at weekends, mirroring the busiest time for patients contacting their practice via telephone.

Supervising author Dr Helen Atherton, from Warwick Medical School, said: “With online platforms there is an assumption that having a 24/7 ability to make contact with a general practice will cater to those who wish to deal with their health problem at a convenient time, often when the practice is shut, and that being online means they will perhaps share different problems than they would over the telephone or face-to-face.

“In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes. This suggests that patients’ consulting behaviour will not be easily changed by introducing online platforms. Therefore practices should be clear as to exactly why they are introducing these online platforms, and what they want to achieve for themselves and their patients in doing so – the expectation may well not meet reality.”

The NHS Long term plan sets out that over the next five years all patients will have the right to online ‘digital’ GP consultations. The main way these are being delivered is via online consultation platforms. The online platforms claim to offer patients greater convenience and better access and to save time and workload for GPs, however there is currently a lack of independent evidence about their impact on patient care and care delivery.

Patient feedback analysed as part of the study showed that many found the askmyGP system convenient and said that it gave them the opportunity to describe their symptoms fully, whilst others were less satisfied, with their views often depending on how easily they can normally get access to their practice, and on the specific problem they are reporting.

The study found that two thirds of users were female and almost a quarter were aged between 25 and 34, corroborating existing evidence. The commonest reason for using the service was to enquire about medication, followed by administrative requests and reporting specific symptoms, with skin conditions, ear nose and throat queries and musculoskeletal problems leading the list.

The researchers argue that practices should avoid a ‘one size fits all’ approach to implementing online consultations and should tailor them to suit their practice populations and model of access, considering whether it is likely to add value for their patient population.

Dr Atherton adds: “Individual online consultation platforms are uniform in their approach, patients are not. We found that patient satisfaction is context specific – online consultation is not going to be suitable for all patients and with all conditions and that one approach is unlikely to work for everyone.

“Practices could focus on encouraging people to deal with administrative issues using the platform to free up phone lines for other patients. It could be promoted specifically to younger patients, or those who prefer to write about their problems and not to use the telephone. Clear information for patients and a better understanding of their needs is required to capture the potential benefits of this technology.”

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    Dr Ian Jackson
    1 April 2019 at 1:13 pm
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    We were interested to read the article about online triage system from Warwick University.
    One should not be surprised that the workload was not reduced when the only intervention was the option to form filling as opposed to telephoning the surgery. The queries still require an answer and one is merely replicating current practice without consider the redesign of services.
    The report mentions that individual online consultation platforms are uniform in their approach. I would suggest that this is not the case and some offer far more flexibility of approach for GP practices or even Primary Care Networks (PCNs). I suggest the ability for secure two way messaging is an important step forward but for this to work well, then using a web portal is not the answer.
    Key user groups identified are used to having Apps on their phones and there are several advantages in using an App based approach. These include security and positive identification of the patient, ability to securely message to the patient – so suitable for results, advice about medication etc, plus allowing a mechanism for follow up questions.
    To really begin to affect clinical workload then we must look towards clinical teams in an area working together to manage demand – logically this is the PCN. So gradual education of the population into using an App or web portal to contact, allows messaging to be triaged. The triage process should allow hand off to the most appropriate person to respond.
    I suggest to radically change pattern of behaviour of patients this requires a more instant response i.e 24/7 365 days a year triage of messages. Receiving a message that your request will be reviewed in office hours will only encourage daytime use, as found in this study.
    PCNs are large enough to organise 24/7 cover – this ensures that urgent matters are dealt with immediately by messaging, telephone, teleconsultation or face to face consultation.
    Add in the ability to include recording of the messaging stream into the GP system and to set up teleconsultation clinics if you wish, then you are truly starting to move into the digital age rather than the current analogue approach.

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