Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England.
Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England.
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DOI：
10.1136/bmjopen-2017-016901
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发表时间：
2017-11-22
期刊：
影响因子：
2.9
通讯作者：
Northstone K
中科院分区：
文献类型：
--
作者：
Edwards HB;Marques E;Hollingworth W;Horwood J;Farr M;Bernard E;Salisbury C;Northstone K
初级保健在线咨询系统试点研究的评价。我们描述了谁使用该系统，何时以及为什么，以及与其使用相关的国民健康服务成本。15-月观察研究。英格兰西南部的初级保健实践。36家全科诊所参与了试验计划，涉及396 828名病人。在试点期间，在线咨询网站被浏览了35 981次（平均每月每1000名患者9.11次访问）。7472名患者继续完成“电子咨询”（平均每月每1000名患者进行2.00次在线咨询）。电子咨询主要在工作日和正常工作时间进行。患者记录（n=485）被提取为八个实践，并显示女性更有可能使用电子咨询比男性（64.7%比35.3%）和用户的中位年龄为39岁（IQR 30-50）。电子咨询最常见的原因是行政要求（例如，检查结果，信件和重复处方（22.5%）），其次是感染/免疫学问题（14.4%）。大多数患者（65.2%）在2天内收到缓解。最常见的结果是面对面（38%）或电话咨询（32%）。咨询新疾病的患者更经常需要前者（OR 1.56，95% CI 1.05至2.27，p=0.049）。一个实践的响应电子咨询的平均成本是£36.28，主要是分流时间和所需的面对面/电话咨询。电子咨询的使用率很低，特别是在周末。除非这一点能够得到改善，否则对工作人员工作量和病人等待时间的任何影响都可能微不足道。使用电子咨询可能会增加初级保健的工作量和成本。可以开发在线咨询系统，以提高工作人员和患者的效率。这些发现对软件开发人员以及正在考虑投资在线咨询系统的初级保健服务和政策制定者具有影响。
Evaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use. 15-month observational study. Primary care practices in South West England. 36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed. Use of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.
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DOI：
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影响因子：
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