Whitechapel Health Centre, London, UK
Whitechapel Health Centre, London, UK.
BMJ Open Qual. 2021 Jun;10(2). doi: 10.1136/bmjoq-2020-001310.
The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called 'Dr iQ'. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan-Do-Study-Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.
COVID-19 大流行促使基层医疗服务迅速发生变化。面对面预约已显著转变为远程方式，如电子咨询（e-consultation）。伦敦一位基层医疗服务提供者的患者被积极鼓励使用名为“Dr iQ”的在线咨询平台。Dr iQ 出现了一群高频用户，临床医生担心他们的健康需求无法通过该平台得到满足。在传统的全科医疗环境中，高频就诊与增加的时间和医疗成本相关联。
本项目评估了一家繁忙的市内全科诊所中 5 个月内每月进行 10 次或更多 Dr iQ 咨询的高频用户（定义为每月进行 10 次或更多咨询的用户）数量。我们旨在将所有 Dr iQ 高频用户的后续每月使用频率从 10 次或更多咨询减少到少于 10 次咨询。我们的干预措施包括半结构化电话访谈、多学科团队讨论以及定期安排的电话或面对面预约。经过两个计划-执行-研究-行动循环，所有 12 名高频用户都减少了向 Dr iQ 提交的咨询次数，使其每月少于 10 次咨询。
本项目提出了一种管理电子咨询高频用户的方法。大多数高频用户都有未满足的健康需求，在 Dr iQ 上感到缺乏连续性护理。他们通常存在复杂的身心健康问题。随着远程咨询技术的不断发展，需要进行更多研究以了解电子咨询高频使用的流行病学和病因学，以改善患者的治疗效果。
