E-consultation in primary care: A systematic review

Background: Governments and healthcare providers are keen to find innovative ways to more efficiently deliver care. Interest in e-consultation has grown, but evidence of benefit is uncertain. Objective: Aims: To assess the evidence of delivering e-consultation using secure email/messaging or video links in primary care. Methods: A systematic review was conducted on the use and application of e-consultations in primary care. We searched seven international databases (Medline, Embase, CINAHL, Cochrane Library, PsycINFO, Econlit and Web of Science) (1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesised using thematic analysis. Results: This review included fifty-seven (n=57) studies from a range of countries, mainly the USA (n=30) and the UK (n=13). There were disparities in uptake and utilisation towards more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary healthcare staff, e-consultation delivers challenges around time-management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leaves unanswered questions about usage, quality, cost and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow. Clinical Trial: PROSPERO (International Prospective Register of Systematic Reviews) Registration Number: CRD42015019152