Inequalities in general practice remote consultations: a systematic review

Abstract

Background: COVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown. Aim: To explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups. Design & setting: Systematic review Method: We undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively. Results: Based on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes. Conclusion: Remote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

Rights

© 2021, The Authors This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Identifiers

DOI

https://doi.org/10.3399/BJGPO.2021.0040

Repository URI

http://eprints.gla.ac.uk/237595/