Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England.
Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England.
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全科医生在线服务的使用和可用性：在COVID-19大流行之前和期间，基于定性访谈、常规eConsult使用和反馈数据分析以及对英国德文郡和康沃尔全科医生网站的评估，进行了一项混合方法序贯研究。
DOI：
10.1136/bmjopen-2021-058247
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发表时间：
2022-03-07
期刊：
影响因子：
2.9
通讯作者：
Chatterjee A
中科院分区：
文献类型：
--
作者：
Jones RB;Tredinnick-Rowe J;Baines R;Maramba IDC;Chatterjee A
我们探讨了全科医生（GP）在线服务的使用和可用性。英格兰的德文郡和康沃尔。基于定性访谈、常规电子咨询使用和反馈数据分析以及全科医生网站评估的混合方法序贯研究。首先，我们在2018年6月采访了来自七个诊所的32名工作人员和18名患者。其次，我们使用了常规收集的咨询元数据，第三，从2018年6月到2021年3月使用eConsult的所有实践的患者反馈数据。最后，我们于2020年1月及2021年9月检视GP网站的可用性。访谈表明，在eConsult实施中，患者很少参与的做法。一些患者“玩弄”系统以达到他们想要的目的。使用数据显示，COVID-19导致eConsult大幅增加。女性使用eConsult的次数是男性的两倍。老年患者的eConsult咨询率与年轻患者相似。只有不到3%的咨询完成了患者反馈表。大多数患者对eConsult感到满意，但有些人担心其长度和重复性，随着时间的推移以及eConsult和医疗记录之间缺乏连续性。我们没有发现明确的证据表明患者建议的改善措施得到了落实。最后，很少有全科医生网站符合可访问性指南，可能会阻碍人们访问在线国家服务，如eConsult。鉴于老年人面对面咨询更多，使用数据表明老年人减少了上网。使用eConsult的女性与男性比例甚至大于“传统”面对面比例，这是出乎意料的，需要进一步研究。虽然eConsult收集并使用常规患者反馈来改进系统，但更开放的患者反馈系统（如Care Opinion）可能会更有效地帮助在线系统发展。最后，我们对全科医生网站的必要性提出质疑，并建议国家或地区服务机构更适合维护无障碍服务。
We explored use and usability of general practitioner (GP) online services. Devon and Cornwall, England. Mixed-methods sequential study based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites. First, we interviewed 32 staff and 18 patients from seven practices in June 2018. Second, we used routinely collected consultation meta-data and, third, patient feedback data for all practices using eConsult from June 2018 to March 2021. Lastly, we examined GP websites’ usability in January 2020 and September 2021. Interviews suggested practices infrequently involved patients in eConsult implementation. Some patients ‘gamed’ the system to achieve what they wanted. Usage data showed a major increase in eConsult resulting from COVID-19. Women used eConsult twice as much as men. Older had similar eConsult consultation rates to younger patients. Patient feedback forms were completed for fewer than 3% of consultations. Patients were mostly satisfied with eConsult but some had concerns about its length and repetitiveness, lack of continuity over time and between eConsult and medical records. We did not find clear evidence that patients’ suggested improvements were acted on. Finally, few GP websites met accessibility guidelines and may hinder access to online national services such as eConsult. Given that, face to face, older people consult more, usage data suggest that older people have reduced online access. That the female-to-male ratio of eConsult use use was even greater than ‘traditional’ face-to-face ratio was unexpected and needs further research. Although eConsult collects and uses routine patient feedback to improve the system, more open systems for patient feedback, such as Care Opinion, may be more effective in helping online systems evolve. Lastly, we question the need for GP websites and suggest that national or regional services are better placed to maintain accessible services.
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