Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 15, 2020
Open Peer Review Period: Apr 15, 2020 - Jun 10, 2020
Date Accepted: Jul 26, 2020
Date Submitted to PubMed: Oct 9, 2020
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Barriers and enablers in implementing electronic consultations in primary care: a scoping review
ABSTRACT
Background:
Often promoted as a way to address increasing demands, improve patient accessibility, and overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the recent Covid-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit the effective implementation of electronic consultations is severely limited.
Objective:
The aim of this research was to therefore identify the factors that support and inhibit the implementation of electronic consultations in primary care.
Methods:
Five electronic databases (PubMed, Medline, Embase, CINAHL and PscyINFO) were systematically searched for studies exploring the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data was analysed using Normalisation Process Theory (NPT) as an analytic framework.
Results:
227 articles were initially identified, 13 were included. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of clinical and admin workload duplication, as opposed to reduction and concerns of IT reliability also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation.
Conclusions:
Efforts should be made wherever possible to incorporate factors identified as beneficial in facilitating electronic-consultations to ensure maximum impact and success. Future research should explore the possibility of health inequalities in electronic consultations and their economic impacts from a patient, professional and commissioners perspective to further evidence their potential value, if at all.
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.