JMIR Publications

ABSTRACT

Background:

The adoption of remote consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. We evaluated the impact of remote consultations on the quality of primary care.

Objective:

Six databases were searched. Studies evaluating the impact of remote consultations, for any disease, were included. Title and abstract screening, and full-text screening were performed by two pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.

Methods:

Thirty studies (5,469,333 participants) were included in the review. Remote consultations generally had a positive or equivalent impact compared to face-to-face (F2F) consultations, particularly in reducing patient costs and improving time efficiency. The effectiveness of remote consultations was non-inferior to F2F care in six out of seven studies evaluating this aspect. Two studies found that remote consultations reduced wait times for appointments. Younger, female patients were more likely to use remote consultations and those of lower socioeconomic status were less likely to use video consultations than telephone appointments. The impacts on safety and patient-centeredness were largely inconclusive.

Results:

Remote consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care. Those of lower socioeconomic status were more likely to use consultations delivered via telephone than videoconference. Developing a strong evidence-base capitalising on real-world data as well as clinical trials is crucial for the future development of remote consultations and tailoring them to patient needs and preferences.

Conclusions:

Our systematic review has demonstrated that remote consultations have the potential to be just as effective as F2F consultations by reducing waiting times, patient costs, and rates of follow-up in hospitals. However, there currently remains a lack of robust studies available exploring the effect of remote consultations on patient safety, equity, and patient-centredness, highlighting areas where future research efforts need to be devoted. Data collection methods more bespoke to the primary care context, better accounting for patient characteristics and needs, and inclusive of its intended end-users, are necessary to generate a stronger evidence base to inform future remote care policies.