Feasibility, acceptability and effectiveness of an online alternative to face-to-face consultation in general practice: a mixed-methods study of webGP in six Devon practices
Feasibility, acceptability and effectiveness of an online alternative to face-to-face consultation in general practice: a mixed-methods study of webGP in six Devon practices
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DOI：
10.1136/bmjopen-2017-018688
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发表时间：
2018-05-01
期刊：
影响因子：
2.9
通讯作者：
Campbell, John L.
中科院分区：
文献类型：
--
作者：
Carter, Mary;Fletcher, Emily;Campbell, John L.
目的评价webGP的可行性、可接受性和有效性，并以6个全科诊所为试点。方法采用混合方法评价，包括从实践数据库中提取数据，全科医生（GP）完成病例报告，患者问卷调查和工作人员访谈。实施webGP后约6个月，东部和西部德文郡临床调试组的区域（2016年2 - 7月）。参与者六个实践提供咨询数据; 20个全科医生完成病例报告（关于61次电子咨询）; 81名患者完成了调查问卷;结果：评价期间，WebGP的使用率很低，对实践工作量没有明显影响。咨询工作量的横断面数据的完整性在不同的实践中有所不同。全科医生判断41/61（72%）的webGP请求需要面对面或电话咨询。引入webGP似乎与实践工作人员之间以及实践与患者之间的责任和工作量转移有关。81/231例患者完成了邮寄调查（回复率为35.1%）。与面对面的受访者相比，电子咨询师更年轻，更有可能被雇用。WebGP似乎广泛接受病人的及时性和质量/提供的护理经验。所有答复者都提出了类似的问题。这两组人似乎对其他在线实践服务同样熟悉;电子咨询师更有可能使用它们。从半结构化的工作人员访谈，它似乎，而在实践中基本上是可以接受的，引入电子咨询有可能与预先存在的实践systems.Conclusions不良的相互作用有可能评估新系统的咨询模式的影响，通过提取常规数据从实践数据库。工作人员和患者注意到与在线选项相关的责任的微妙变化。更大的吸收需要实践和患者之间的良好沟通，以及系统的组织，以避免冲突和滥用。需要进一步的研究，以评估webGP在管理实践工作量的全部潜力。
Objectives To evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices.Methods Mixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews.Setting General practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group's area approximately 6 months after implementing webGP (February-July 2016).Participants Six practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed.Outcome measures Attitudes and experiences of practice staff and patients regarding webGP.Results WebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices. GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients. 81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them. From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems.Conclusions There is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload.