Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jul 7, 2019
Open Peer Review Period: Jul 8, 2019 - Jul 15, 2019
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The use of patient-facing teleconsultations in the National Health Service: A Scoping review
The NHS’s Long Term Plan has set out a vision of enabling patients to access digital interactions with healthcare professionals within five years, including by video link.
This review looks at the extent and nature of the use of patient-facing teleconsultations within a healthcare setting in the UK and what outcome measures have been assessed.
We conducted a systematic scoping review of teleconsultation studies following the Joanna Briggs methodology. Pubmed, Scopus, Cochrane library and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched for publications up to the end of December 2018 that reported on the use of patient-facing teleconsultations in a United Kingdom healthcare setting.
The search retrieved 3,132, of which 101 were included for full review. Overall the studies were heterogeneous in design, speciality assessed and in the outcome measures that were reported. The technology used for teleconsultations changed over time with earlier studies employing bespoke, often expensive, solutions. Two-thirds of the studies were conducted between 1995 and 2005 thus relied on this method with later studies transitioning to web-based commercial solutions such as Skype. There were four outcome measures that were identified as being assessed which were; 1) Technical Feasibility 2) User satisfaction 3) Clinical effectiveness 4) Cost. Due to the changing nature of technology over time there were different technical aspects of feasibility associated with later studies. Generally teleconsultations were acceptable to patients but this was less consistent amongst healthcare professionals and amongst both face-to-face was still seen as ‘the gold standard’. A wide range of clinical scenarios found teleconsultations to be clinically useful but potentially limited to more straightforward clinical scenarios. The wide array of study type and the change in technology over time makes cost difficult to draw definitive conclusions however cost savings for healthcare providers have been demonstrated by goal directed implementation of teleconsultations.
Technological improvements mean that teleconsultations are now more accessible than ever. Teleconsultations appear to be safe and effective in the right clinical situations. Where offered, it is likely that patients will be supportive of such measures though they should only be offered as an option to support traditional care models rather than replace them outright. Well resourced, goal directed implementation of teleconsultations can be cost effective for healthcare providers. Clinical Trial: N/A
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