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

新冠肺炎大流行导致在初级保健中迅速引入远程会诊，许多做法默认成为远程会诊。这种对服务提供的改变允许继续提供护理，同时限制COVID传播的风险。虽然在目前的情况下，“远程”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，可以确定在初级保健中使用视频会诊带来的具体沟通挑战，并确定将其降至最低的方法。该项目将集中于以下问题：1)视频会诊期间全科医生和患者面临的主要沟通挑战是什么？2)这些挑战是否在特定环境中反复出现(例如，患者群体或会诊中的活动类型)？3)如何谈判并将这些挑战降至最低，以优化远程护理交付？该项目由对话分析(CA)研究组成。这种归纳性的定性方法分析社会互动，侧重于语言和身体行为及其社会后果。对多个情节进行深入的比较分析，可以识别和解释反复出现的模式及其后果，从而使分析超越个人的心理倾向。通过这项研究，研究结果将突出全科医生和患者目前发现具有挑战性的领域，以及这些挑战是否存在反复出现的背景，以及参与者为谈判和克服这些挑战而制定的成功战略。调查结果将在监督小组的协助下分发给临床医生。这个项目还有可能为更广泛的社会学辩论提供信息，让他们了解更多对数字技术的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.