Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review

Authors

DOI:

https://doi.org/10.5195/ijms.2022.1363

Keywords:

Telemedicine, Primary Health Care, General Practice, Qualitative Research , Source: MeSH-NLM

Abstract

The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.

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References

World Health Organization, editor. Telemedicine: opportunities and developments in member states: report on the second Global survey on eHealth. Geneva, Switzerland: World Health Organization; 2010. 93 p. (Global observatory for eHealth series).

Wootton R. Recent advances: Telemedicine. BMJ. 2001;323(7312):557–60.

Asiri A, AlBishi S, AlMadani W, ElMetwally A, Househ M. The Use of Telemedicine in Surgical Care: a Systematic Review. Acta Inform Medica. 2018;26(2):201.

Wade VA, Karnon J, Elshaug AG, Hiller JE. A systematic review of economic analyses of telehealth services using real time video communication. BMC Health Serv Res. 2010;10(1):233.

Greenhalgh T, Vijayaraghavan S, Wherton J, Shaw S, Byrne E, Campbell-Richards D, et al. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open. 2016;6(1):e009388.

Atmojo JT, Sudaryanto WT, Widiyanto A, Ernawati E, Arradini D. Telemedicine, Cost Effectiveness, and Patients Satisfaction: A Systematic Review. J Health Policy Manag. 2020;5(2):103–7.

Dorsey ER, Topol EJ. State of Telehealth. Campion EW, editor. N Engl J Med. 2016;375(2):154–61.

Mills EC, Savage E, Lieder J, Chiu ES. Telemedicine and the COVID-19 Pandemic: Are We Ready to Go Live? Adv Skin Wound Care. 2020;33(8):410–7.

Hjelm NM. Benefits and drawbacks of telemedicine. J Telemed Telecare. 2005;11(2):60–70.

Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: A systematic review of reviews. Int J Med Inf. 2010;79(11):736–71.

Batsis JA, DiMilia PR, Seo LM, Fortuna KL, Kennedy MA, Blunt HB, et al. Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review. J Am Geriatr Soc. 2019;67(8):1737–49.

Lee JY, Lee SWH. Telemedicine Cost–Effectiveness for Diabetes Management: A Systematic Review. Diabetes Technol Ther. 2018;20(7):492–500.

Holtz BE. Patients Perceptions of Telemedicine Visits Before and After the Coronavirus Disease 2019 Pandemic. Telemed E-Health. 2021;27(1):107–12.

Kannampallil T, Ma J. Digital Translucence: Adapting Telemedicine Delivery Post-COVID-19. Telemed E-Health. 2020;26(9):1120–2.

Leite H, Hodgkinson IR, Gruber T. New development: ‘Healing at a distance’—telemedicine and COVID-19. Public Money Manag. 2020;40(6):483–5.

Thornton J. Covid-19: how coronavirus will change the face of general practice forever. BMJ. 2020;m1279.

Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for covid-19. BMJ. 2020;m998.

Lovell T, Albritton J, Dalto J, Ledward C, Daines W. Virtual vs traditional care settings for low-acuity urgent conditions: An economic analysis of cost and utilization using claims data. J Telemed Telecare. 2021;27(1):59–65.

Fisk M, Livingstone A, Pit SW. Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States. J Med Internet Res. 2020;22(6):e19264.

Chiang C, Halker Singh R, Lalvani N, Shubin Stein K, Henscheid Lorenz D, Lay C, et al. Patient experience of telemedicine for headache care during the COVID‐19 pandemic: An American Migraine Foundation survey study. Headache J Head Face Pain. 2021;61(5):734–9.

Jonnagaddala J, Godinho MA, Liaw ST. From telehealth to virtual primary care in Australia? A Rapid scoping review. Int J Med Inf. 2021;151:104470.

NHS Digital. Appointments in General Practice – Appointment Mode. 2022 Available from: https://app.powerbi.com/view?r=eyJrIjoiYzU2OTA2ODktZTIyNy00ODhmLTk1ZGEtOGVlZmRlZDNjYzY3IiwidCI6IjUwZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9. Cited Apr 14, 2022.

Drake C, Lian T, Cameron B, Medynskaya K, Bosworth HB, Shah K. Understanding Telemedicine’s “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics. Telemed E-Health. 2022;28(1):51–9.

Liaw ST, Kuziemsky C, Schreiber R, Jonnagaddala J, Liyanage H, Chittalia A, et al. Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development. Yearb Med Inform. 2021;30(01):044–55.

Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US. JAMA Netw Open. 2020;3(10):e2021476.

Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed E-Health. 2016;22(5):342–75.

Daniel H, Sulmasy LS. Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper. Ann Intern Med. 2015;163(10):787.

Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242.

Cohen JB, Myckatyn TM, Brandt K. The Importance of Patient Satisfaction: A Blessing, a Curse, or Simply Irrelevant? Plast Reconstr Surg. 2017;139(1):257–61.

Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient Involvement in Health Care Decision Making: A Review. Iran Red Crescent Med J. 2014;16(1):e12454.

National Health System (NHS). NHS England » Involving people in their own care. NHS. Available from: https://www.england.nhs.uk/ourwork/patient-participation/. Cited Mar 6, 2021.

MacFarlane A, Harrison R, Wallace P. The Benefits of a Qualitative Approach to Telemedicine Research. J Telemed Telecare. 2002;8(2_suppl):56–7.

Peeters JM, Krijgsman JW, Brabers AE, Jong JDD, Friele RD. Use and Uptake of eHealth in General Practice: A Cross-Sectional Survey and Focus Group Study Among Health Care Users and General Practitioners. JMIR Med Inform. 2016;4(2):e11.

Bleyel C, Hoffmann M, Wensing M, Hartmann M, Friederich HC, Haun MW. Patients’ Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers. J Med Internet Res. 2020;22(4):e17330.

Imlach F, McKinlay E, Middleton L, Kennedy J, Pledger M, Russell L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract. 2020;21(1):269.

Powell RE, Henstenburg JM, Cooper G, Hollander JE, Rising KL. Patient Perceptions of Telehealth Primary Care Video Visits. Ann Fam Med. 2017;15(3):225–9.

Reed ME, Huang J, Parikh R, Millman A, Ballard DW, Barr I, et al. Patient-Provider Video Telemedicine Integrated With Clinical Care: Patient Experiences. Ann Intern Med. 2019;171(3):222–4.

Sevean P, Dampier S, Spadoni M, Strickland S, Pilatzke S. Patients and families experiences with video telehealth in rural/remote communities in Northern Canada. J Clin Nurs. 2009;18(18):2573–9.

West KS. Perceptions of Adult Patients Accessing Telehealth in an Urban Medical Group [Internet] [Doctor of Nursing Practice]. [San Jose, CA, USA, San Jose, CA, USA]: San Jose State University, Northern California Consortium, Doctor of Nursing Practice Program, California State University, Fresno and San José State University; 2019. Available from: https://scholarworks.sjsu.edu/etd_doctoral/93. Cited Mar 13, 2021.

Liaw WR, Jetty A, Coffman M, Petterson S, Moore MA, Sridhar G, et al. Disconnected: a survey of users and nonusers of telehealth and their use of primary care. J Am Med Inform Assoc. 2019;26(5):420–8.

Grubaugh AL, Cain GD, Elhai JD, Patrick SL, Frueh BC. Attitudes Toward Medical and Mental Health Care Delivered Via Telehealth Applications Among Rural and Urban Primary Care Patients. J Nerv Ment Dis. 2008;196(2):166–70.

Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ. 2000;320(7248):1517–20.

Williams TL, May CR, Esmail A. Limitations of Patient Satisfaction Studies in Telehealthcare: A Systematic Review of the Literature. Telemed J E Health. 2001;7(4):293–316.

Mold F, Hendy J, Lai YL, de Lusignan S. Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Med Inform. 2019;7(4):e13042.

Bunn F, Byrne G, Kendall S. The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review. Br J Gen Pract J R Coll Gen Pract. 2005;55(521):956–61.

Thiyagarajan A, Grant C, Griffiths F, Atherton H. Exploring patients’ and clinicians’ experiences of video consultations in primary care: a systematic scoping review. BJGP Open. 2020;4(1):bjgpopen20X101020.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(1):181.

Cooke A, Smith D, Booth A. Beyond PICO: The SPIDER Tool for Qualitative Evidence Synthesis. Qual Health Res. 2012;22(10):1435–43.

The EndNote Team. EndNote. Philadelphia, PA: Clarivate; 2013.

Centre for Reviews and Dissemination, editor. CRD’s guidance for undertaking reviews in healthcare. 3. ed. York: York Publ. Services; 2009. 281 p. (Systematic reviews).

Meline T. Selecting Studies for Systemic Review: Inclusion and Exclusion Criteria. Contemp Issues Commun Sci Disord. 2006;33(Spring):21–7.

Noyes J, Lewin S, Booth A, Hannes K, Harden A, Harris J, et al. Chapter 5: Extracting qualitative evidence. In: Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions [Internet]. 2011. Available from: http://cqrmg.cochrane.org/supplemental-handbook-guidance

Aveyard H. Doing a literature review in health and social care: a practical guide. Third edition. Maidenhead: McGraw-Hill Education, Open University Press; 2014. 190.

Critical Appraisal Skills Programme. CASP Qualitative Checklist [Internet]. 2018. Available from: https://casp-uk.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-2018_fillable_form.pdf . Cited Mar 8, 2021.

Salmon P. Assessing the quality of qualitative research. Patient Educ Couns. 2013;90(1):1–3.

Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):160940691773384.

Ball SL, Newbould J, Corbett J, Exley J, Pitchforth E, Roland M. Qualitative study of patient views on a ‘telephone-first’ approach in general practice in England: speaking to the GP by telephone before making face-to-face appointments. BMJ Open. 2018;8(12):e026197.

Gabrielsson-Järhult F, Kjellström S, Josefsson KA. Telemedicine consultations with physicians in Swedish primary care: a mixed methods study of users’ experiences and care patterns. Scand J Prim Health Care. 2021;1–10.

Holmström IK, Nokkoudenmäki MB, Zukancic S, Sundler AJ. It is important that they care - older persons’ experiences of telephone advice nursing. J Clin Nurs. 2016;25(11–12):1644–53.

Lindberg J, Bhatt R, Ferm A. Older people and rural eHealth: perceptions of caring relations and their effects on engagement in digital primary health care. Scand J Caring Sci. 2021;scs.12953.

Nymberg VM, Bolmsjö BB, Wolff M, Calling S, Gerward S, Sandberg M. ‘Having to learn this so late in our lives…’ Swedish elderly patients’ beliefs, experiences, attitudes and expectations of e-health in primary health care. Scand J Prim Health Care. 2019;37(1):41–52.

Eccles A, Hopper M, Turk A, Atherton H. Patient use of an online triage platform: a mixed-methods retrospective exploration in UK primary care. Br J Gen Pract. 2019;69(682):e336–44.

Javanparast S, Roeger L, Kwok Y, Reed RL. The experience of Australian general practice patients at high risk of poor health outcomes with telehealth during the COVID-19 pandemic: a qualitative study. BMC Fam Pract. 2021;22(1):69.

Cowie J, Calveley E, Bowers G, Bowers J. Evaluation of a Digital Consultation and Self-Care Advice Tool in Primary Care: A Multi-Methods Study. Int J Environ Res Public Health. 2018;15(5):896.

Farr M, Banks J, Edwards HB, Northstone K, Bernard E, Salisbury C, et al. Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production. BMJ Open. 2018;8(3):e019966.

West K, Artinian B. Weighing options: Perceptions of adult patients accessing telehealth in primary care. Online J Nurs Inform. 2019;23(3).

Porritt K, Gomersall J, Lockwood C. JBI’s Systematic Reviews: Study Selection and Critical Appraisal. Am J Nurs. 2014;114(6):47–52.

Aromataris E, Riitano D. Constructing a Search Strategy and Searching for Evidence. Am J Nurs. 2014;114(5):49–56.

Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):245.

Atherton H, Pappas Y, Heneghan C, Murray E. Experiences of using email for general practice consultations: a qualitative study. Br J Gen Pract. 2013;63(616):e760–7.

Bulik RJ. Human factors in primary care telemedicine encounters. J Telemed Telecare. 2008;14(4):169–72.

Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev. 2017;18(02):149–60.

Donaghy E, Atherton H, Hammersley V, McNeilly H, Bikker A, Robbins L, et al. Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. Br J Gen Pract. 2019;69(686):e586–94.

Hiratsuka V, Delafield R, Starks H, Ambrose AJ, Mau MM. Patient and provider perspectives on using telemedicine for chronic disease management among Native Hawaiian and Alaska Native people. Int J Circumpolar Health. 2013;72(1):21401.

Leng S, MacDougall M, McKinstry B. The acceptability to patients of video-consulting in general practice: semi-structured interviews in three diverse general practices. J Innov Health Inform. 2016;23(2):493.

Mangin D, Parascandalo J, Khudoyarova O, Agarwal G, Bismah V, Orr S. Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth. BMJ Open. 2019;9(2):e023731.

McKinstry B, Watson P, Pinnock H, Heaney D, Sheikh A. Telephone consulting in primary care: a triangulated qualitative study of patients and providers. Br J Gen Pract. 2009;59(563):e209–18.

Radhakrishnan K, Xie B, Jacelon CS. Unsustainable Home Telehealth: A Texas Qualitative Study. The Gerontologist. 2016;56(5):830–40.

Zanaboni P, Fagerlund AJ. Patients’ use and experiences with e-consultation and other digital health services with their general practitioner in Norway: results from an online survey. BMJ Open. 2020;10(6):e034773.

Cernadas Ramos A, Bouzas-Lorenzo R, Mesa del Olmo A, Barral Buceta B. Opinión de los facultativos y usuarios sobre avances de la e-salud en atención primaria. Aten Primaria. 2020;52(6):389–99.

Kung K, Wong H, Chen J. An exploratory qualitative study of patients’ views on medical e-consultation in a public primary care setting. Hong Kong Pract. 2016;38(4):120–7.

Published

2022-08-09 — Updated on 2022-10-21

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How to Cite

Allen, J. (2022). Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. International Journal of Medical Students, 10(3), 288–315. https://doi.org/10.5195/ijms.2022.1363 (Original work published September 28, 2022)