Centre for Academic Primary Care (CAPC), University of Bristol, Bristol Medical School, Bristol.
National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol.
Br J Gen Pract. 2021 Feb 25;71(704):e166-e177. doi: 10.3399/BJGP.2020.0948. Print 2021.
To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms.
To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.
Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.
Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory.
There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.
The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
为了降低 COVID-19 的传播风险，2020 年 3 月，英国的全科医生主要通过电话、视频或在线咨询平台提供远程咨询服务。
调查远程咨询的快速实施情况，并探讨其在 COVID-19 大流行最初几个月的影响。
在布里斯托尔、北萨默塞特和南格洛斯特郡的 21 家全科医生诊所进行混合方法研究。
对 2020 年 4 月至 7 月与 2019 年 4 月至 7 月的咨询量和咨询类型进行了纵向观察性定量分析。使用负二项式模型来确定不同患者群体的变化是否存在差异。对来自四个轮次的 87 名纵向访谈的定性数据进行了分析，这些访谈是针对实践中向远程咨询转变的经验、面临的挑战和解决方案展开的。主题分析利用了正常化进程理论。
普遍认为远程咨询是必要的。这促使 2020 年 4 月远程全科医生咨询（护士为 46%）达到 90%。与 2019 年相比，2020 年 4 月至 7 月的咨询量有所减少；全科医生和护士仍专注于老年患者、受保护的患者和精神健康状况较差的患者。许多患者的问题可以通过电话咨询解决，视频咨询使用较少，随着封锁的放松，视频咨询变得不那么必要。短信服务增加了两倍多。全科医生担心临床风险增加，一些人在封锁放松时难以确定面对面看诊的门槛。
向远程咨询的转变是成功的，并对弱势患者保持关注。这是为了降低传染风险而驱动的，可能存在风险；大流行后，该模式将需要调整。
