The impact of remote care approaches on continuity in primary care: a mixed-studies systematic review.
consultation
continuity of care
primary care
remote consultation
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
05
08
2022
accepted:
30
10
2022
medline:
1
5
2023
pubmed:
28
4
2023
entrez:
27
4
2023
Statut:
epublish
Résumé
The value of continuity in primary care has been demonstrated for multiple positive outcomes. However, little is known about how the expansion of remote and digital care models in primary care have impacted continuity. To explore the impact of the expansion of remote and digital care models on continuity in primary care. A systematic review of continuity in primary care. A keyword search of Embase, MEDLINE, and CINAHL databases was used along with snowball sampling to identify relevant English-language qualitative and quantitative studies from any country between 2000 and 2022, which explored remote or digital approaches in primary care and continuity. Relevant data were extracted, analysed using GRADE-CERQual, and narratively synthesised. Fifteen studies were included in the review. The specific impact of remote approaches on continuity was rarely overtly addressed. Some patients expressed a preference for relational continuity depending on circumstance, problem, and context; others prioritised access. Clinicians valued continuity, with some viewing remote consultations more suitable where there was high episodic or relational continuity. With lower continuity, patients and clinicians considered remote consultations harder, higher risk, and poorer quality. Some evidence suggested that remote approaches and/or their implementation risked worsening inequalities and causing harm by reducing continuity where it was valuable. However, if deployed strategically and flexibly, remote approaches could improve continuity. While the value of continuity in primary care has previously been well demonstrated, the dearth of evidence around continuity in a remote and digital context is troubling. Further research is, therefore, needed to explore the links between the shift to remote care, continuity and equity, using real-world evaluation frameworks to ascertain when and for whom continuity adds most value, and how this can be enabled or maintained.
Sections du résumé
BACKGROUND
The value of continuity in primary care has been demonstrated for multiple positive outcomes. However, little is known about how the expansion of remote and digital care models in primary care have impacted continuity.
AIM
To explore the impact of the expansion of remote and digital care models on continuity in primary care.
DESIGN AND SETTING
A systematic review of continuity in primary care.
METHOD
A keyword search of Embase, MEDLINE, and CINAHL databases was used along with snowball sampling to identify relevant English-language qualitative and quantitative studies from any country between 2000 and 2022, which explored remote or digital approaches in primary care and continuity. Relevant data were extracted, analysed using GRADE-CERQual, and narratively synthesised.
RESULTS
Fifteen studies were included in the review. The specific impact of remote approaches on continuity was rarely overtly addressed. Some patients expressed a preference for relational continuity depending on circumstance, problem, and context; others prioritised access. Clinicians valued continuity, with some viewing remote consultations more suitable where there was high episodic or relational continuity. With lower continuity, patients and clinicians considered remote consultations harder, higher risk, and poorer quality. Some evidence suggested that remote approaches and/or their implementation risked worsening inequalities and causing harm by reducing continuity where it was valuable. However, if deployed strategically and flexibly, remote approaches could improve continuity.
CONCLUSION
While the value of continuity in primary care has previously been well demonstrated, the dearth of evidence around continuity in a remote and digital context is troubling. Further research is, therefore, needed to explore the links between the shift to remote care, continuity and equity, using real-world evaluation frameworks to ascertain when and for whom continuity adds most value, and how this can be enabled or maintained.
Identifiants
pubmed: 37105731
pii: BJGP.2022.0398
doi: 10.3399/BJGP.2022.0398
pmc: PMC10058181
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e374-e383Informations de copyright
© The Authors.
Références
Br J Gen Pract. 2021 May 27;71(707):e432-e440
pubmed: 33947666
CMAJ. 2007 Nov 20;177(11):1362-8
pubmed: 18025427
Milbank Q. 2005;83(3):457-502
pubmed: 16202000
Fam Pract. 2003 Dec;20(6):623-7
pubmed: 14701883
Ann Fam Med. 2005 Mar-Apr;3(2):159-66
pubmed: 15798043
Prim Health Care Res Dev. 2021 Nov 10;22:e68
pubmed: 34753531
BJGP Open. 2021 Jun 30;5(3):
pubmed: 33712502
Implement Sci. 2018 Jan 25;13(Suppl 1):2
pubmed: 29384079
Support Care Cancer. 2021 Jan;29(1):107-116
pubmed: 32318872
BMC Health Serv Res. 2021 Jul 20;21(1):713
pubmed: 34284786
Int J Environ Res Public Health. 2021 Aug 17;18(16):
pubmed: 34444437
BMC Fam Pract. 2021 Apr 8;22(1):69
pubmed: 33832422
BMJ Open. 2021 May 5;11(5):e043038
pubmed: 33952540
J Med Internet Res. 2007 Dec 14;9(5):e37
pubmed: 18093904
BJGP Open. 2022 Mar 22;6(1):
pubmed: 34819294
Ann Fam Med. 2004 Sep-Oct;2(5):445-51
pubmed: 15506579
Br J Gen Pract. 2009 Jun;59(563):e209-18
pubmed: 19520019
BMJ. 2020 Sep 28;370:m3709
pubmed: 32988832
Ann Fam Med. 2003 Sep-Oct;1(3):149-55
pubmed: 15043376
BMJ. 2004 Aug 21;329(7463):435-8
pubmed: 15321902
J Med Internet Res. 2021 Feb 8;23(2):e26433
pubmed: 33465037
BMJ Open. 2018 Dec 31;8(12):e026197
pubmed: 30598491
BMJ Open. 2020 Jun 17;10(6):e039674
pubmed: 32554730
Ann Fam Med. 2017 Mar;15(2):113-119
pubmed: 28289109
J Fam Pract. 1998 Oct;47(4):290-7
pubmed: 9789515
J Med Internet Res. 2021 Oct 7;23(10):e31374
pubmed: 34516389
J Fam Pract. 1996 Feb;42(2):113-6
pubmed: 8606299
Br J Gen Pract. 2001 Sep;51(470):699-700
pubmed: 11593828
Digit Health. 2016 Nov 21;2:2055207616675559
pubmed: 29942570
BMJ. 2017 Sep 27;358:j4197
pubmed: 28954741
PLoS One. 2021 Sep 16;16(9):e0257270
pubmed: 34529705
Int J Gen Med. 2021 Dec 01;14:9237-9246
pubmed: 34880663
Implement Sci. 2018 Jan 25;13(Suppl 1):10
pubmed: 29384082
BMJ Open. 2018 Jun 28;8(6):e021161
pubmed: 29959146
Br J Gen Pract. 2015 Dec;65(641):e813-21
pubmed: 26622034
BMC Fam Pract. 2020 Dec 13;21(1):269
pubmed: 33308161
Br J Gen Pract. 2016 Jul;66(648):e460-6
pubmed: 27215571
BMJ Open Qual. 2021 Jun;10(2):
pubmed: 34112657
Br J Gen Pract. 2020 May 28;70(695):270-271
pubmed: 32393503
Br J Gen Pract. 1997 Dec;47(425):831-3
pubmed: 9463989
NIHR Open Res. 2022 Nov 29;2:47
pubmed: 36814638
Front Digit Health. 2021 Aug 13;3:726095
pubmed: 34713199
Br J Gen Pract. 2020 Jul 30;70(697):e540-e547
pubmed: 32661009