28 | Nursing in Practice | Spring 2022

RESEARCH UPDATE

What has research found about the positives and negatives of remote consultations , notably for vulnerable patients , before and during the Covid-19 pandemic ?

Unintended consequences of online consultations : a qualitative study in UK primary care The Covid-19 pandemic has brought the use of digital tools to the forefront of healthcare . Increasing numbers of clinicians are using telemedicine to deliver care to their patients , and online consultations are now commonplace . ¹

While online consultations are intended to increase efficiency and patient access to healthcare , a study by Turner and colleagues ² set out to determine if they produced any unintended consequences in primary care . They undertook semi-structured individual interviews with patients ( 19 ) and staff ( 18 ) from seven general practices in south-west and north-west England in 2019 and early 2020 ( before the pandemic ). Practices with a variety of patient list sizes and demographics were recruited through the National Institute for Health Research clinical research network .

The results showed the unintended consequences identified were as much down to the processes introduced to implement online consultation tools as to the tools themselves . Some patients had difficulty communicating effectively with a GP , which therefore restricted their access to services , and those who were not accustomed to using digital services were disadvantaged . There was uncertainty among patients about how their queries were addressed and also whether they were expected to use online communication as the preferred method to contact their practice . The study also highlighted that gains in practice efficiency were limited by the creation of additional work to redesign and adapt services . Staff also experienced isolation and resultant dissatisfaction .

The main limitation of the study was that participating practices were early adopters of online consultations , rather than those obliged to adapt services rapidly to reduce Covid-19 infection risk . Nevertheless , it highlights unintended consequences that could be mitigated for future implementation , such as patients ’ difficulties in explaining their problems using online questionnaires .

References 1 NHS England ( 2021 ) Digital first primary care . bit . ly / 36yupRT 2 Turner A et al . Unintended consequences of online consultations : a qualitative study in UK primary care . British Journal of General Practice ; 72 ( 715 ): e128-e137 . bit . ly / 3ImLBrB

Lucille Kelsall-Knight is a lecturer in children ’ s nursing at University of Birmingham School of Nursing

Challenges of safeguarding via remote consulting during the Covid-19 pandemic : a qualitative interview study Rapid alterations to consultation methods were imposed on primary care in response to the Covid-19 pandemic , which included initial contacts being made via email or telephone , and remote consulting . However , no guidance was provided for the handling of safeguarding concerns in the new working environment . ¹ A study by Dixon and colleagues ² aimed to explore general practice perspectives and concerns about safeguarding practice during the pandemic , focusing on the challenges and opportunities created by remote consultation . They interviewed 18 GPs from cities and towns across England between June and November 2020 . This research will also be of direct concern to practice nurses .

The results showed that GPs worried they might miss visual cues during remote consultations and that conversations might not be private or safe , limiting disclosure . They also felt continuity of care was affected , potentially reducing opportunities to safeguard . They saw remote consultations as more ‘ transactional ’, with less chance to probe ‘ other reasons ’ – which could include new safeguarding needs . Additionally , there were concerns for those who were vulnerable due to language barriers , literacy and / or cognitive impairment , as well as difficulties using digital platforms . However , GPs did recognise that remote consulting could allow some vulnerable patients – such as those with mobility issues – to seek safeguarding support . Overall , though , most reported that remote consultation was riskier , more complex and emotionally draining , which increased GP anxiety and reduced job satisfaction .

The study ’ s main limitation was the absence of the patient perspective . Overall , it highlighted the need to consider the impact of remote management of safeguarding needs . While current guidance recommends face-to-face consultation for safeguarding concerns , the desire to retain remote consulting beyond the pandemic means updated guidance is urgently needed .

References 1 Murphy M et al . Implementation of remote consulting in UK primary care following the COVID-19 pandemic : a mixed-methods longitudinal study . British Journal of General Practice 2021 ; 71 ( 704 ): e166-e177 . bit . ly / 3pQmczp 2 Dixon S et al . Challenges of safeguarding via remote consulting during the COVID-19 pandemic : a qualitative interview study . British Journal of General Practice 2022 ; 72 ( 716 ): e199-e208 . bit . ly / 33S5fNk

ALAMY