Improving the digital delivery of primary health care post COVID-19

COVID-19大流行导致在初级保健中迅速引入远程会诊，许多做法默认为远程。服务提供的这一变化使医疗服务得以继续提供，同时限制了COVID传播的风险。虽然“远程”在目前的语境中有时指的是通过电话提供的服务，但互联网视频平台的使用已经显著增加，而且这些平台将继续存在。这项研究是一个独特的机会，以确定在初级保健中使用视频咨询所带来的具体沟通挑战，并确定将其最小化的方法。该项目将重点关注以下问题：1)在视频会诊过程中，全科医生和患者面临的主要沟通挑战是什么？2)这些挑战是否会在特定的环境中再次出现（例如，患者群体或会诊中的活动类型）？3)如何协商和最小化这些挑战，以优化远程医疗服务？该项目包括对话分析（CA）研究。这种归纳定性的方法分析社会互动，关注语言和身体行为及其社会后果。多次发作的密集比较分析可以识别和解释复发模式及其后果，从而使分析超越个体心理倾向。通过这项研究，研究结果将突出全科医生和患者目前发现的具有挑战性的领域，以及这些挑战是否有反复出现的背景，以及参与者制定的谈判和克服这些挑战的成功策略。调查结果将在监督小组的协助下传播给临床医生。这个项目也有可能为更广泛的社会学辩论提供信息，讨论对数字技术的更大依赖对社会互动的影响。

The COVID-19 pandemic has resulted in the rapid introduction of remote consultations in primary care, with many practices becoming remote by default. This change to service delivery allows care provision to continue, whilst limiting the risk of COVID transmission. While 'remote' in the current context has sometimes referred to services delivered by telephone, use of video-over-the-internet platforms has increased significantly and these are here to stay. This research is a unique opportunity to identify the specific communicative challenges posed by the use of video consultations in primary care and identify ways to minimise them. The project will focus on the following questions: 1) What are the key communicative challenges arising for GPs and patients during video consultations?2) Are there particular contexts in which these challenges recur (e.g. patient group, or activity type within consultation)?3) How can these challenges be negotiated and minimised in order to optimise remote care delivery?The project consists of a conversation analytic (CA) study. This inductive qualitative approach analyses social interaction, focusing on verbal and bodily conduct and its social consequences. Intensive comparative analysis of multiple episodes allows identification and explication of recurrent patterns and their consequences, thereby moving the analysis beyond individual psychological dispositions. Through this research the findings will highlight areas GPs and patients currently find challenging, and whether there are recurring contexts for these challenges, as well as successful strategies developed by participants to negotiate and overcome them. Findings will be disseminated to clinicians with the assistance of the supervisory team. This project also has potential to inform wider sociological debate on the impact that greater reliance on digital technology has on social interaction.