Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine, and Health, School of Health Sciences, University of Manchester, Manchester, UK.
Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK.
Health Expect. 2024 Feb;27(1):e13982. doi: 10.1111/hex.13982.
Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operate on a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care.
Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data.
Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choice and (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and 'hands-on' care leading to perceptions of reduced psycho-social safety.
SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future.
Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.
远程（数字和/或电话）访问和咨询模式正在受到国家政策的推动，目标是到 2029 年，国民保健制度（NHS）能够基于远程优先（数字优先）的原则运作。先前的研究表明，远程医疗服务和咨询方式可能会扩大某些患者和/或群体（如少数族裔群体）的健康不平等。南亚（SA）患者是英格兰最大的少数族裔群体。了解这一群体的经历和需求对于确保普通科医生能够提供公平、高质量的医疗保健至关重要。
定性研究。招募了 37 名参与者（来自印度、巴基斯坦和/或孟加拉国背景），他们要么参加英语现场首选语言焦点小组，要么参加远程半结构化访谈。对定性数据进行了主题分析，以确定主题。
确定了三个主要的相互关联的主题：（1）获得服务的机会减少，（2）患者选择减少，（3）质量和安全问题。研究结果突出了通过任何远程方式预约时遇到的一般问题（i）和与语言障碍相关的特定问题（ii），这些问题为获得服务和护理增加了额外的障碍，从而导致了获取服务的机会减少。一些患者重视远程访问的便利性，但也对预约的可用性和患者选择的减少表示担忧。面对面咨询更受欢迎，但可用性较低。研究结果强调了参与者如何认为远程护理质量较低且安全性较低。英语水平有限（LEP）的参与者的担忧最大，因为非言语交流和“动手”护理的缺失导致他们感到心理社会安全降低。
南亚患者对远程主导的初级保健服务的体验是负面的，只有少数人对此持积极态度，并且仅在某些特定情况下如此。面对面的护理模式仍然是首选的咨询模式，特别是对 LEP 患者而言。混合的访问模式为患者提供了最大的选择，并且可能满足南亚患者群体未来的各种需求。远程优先的初级保健服务模式可能是一种理想的服务模式，但需要认识到其局限性并加以考虑，以确保初级保健服务现在和将来都是公平的服务。
公众成员参与了研究的所有阶段。这包括在整个研究过程中与合作伙伴合作，包括审查面向患者的文件、招募参与者、数据促进、翻译工作、数据分析以及共同撰写本文。我们研究成功的关键是协作团队合作，这涉及具有南亚文化知识的有经验的公众成员与研究团队一起合作，并且是研究团队不可或缺的一部分。
