There was a total of 5447 unique entries. A total of 5140 patients (94.4%) left a free-text description of their reason for using the platform.
Quantitative analysis
Practice data
These came from nine general practices in the UK. They included practices from a range of rural, semi-rural, and urban areas, and with a range of deprivation scores, from 1–10 (most to least deprived) on the English indices of deprivation.14 One practice was using the platform as a trial during the study period. The number of patient users varied across the practices, with 59.4% of entries from users registered at practice 2 (Table 1).
Table 1. Practice characteristics
Characteristics of users
Of those using the platform, 65.5% (3570/5447) were female. The mean age of users was 36 (range 0 to 95) years, with the highest number of users in the 25 to 34 years age group (22.7%, 1234/5447). Levels of use reduced as age increased, and fewer than 1% of users were aged ≥85 years. Age was not reported for 5.4% (292/5447) of the sample (Table 2).
Table 2. Patient characteristics, N = 5447
Patterns of use
Levels of use varied according to the day of the week: total number of encounters was highest on a Monday (25.6%, 1392/5447) and Tuesday (19.2%, 1046/5447), with the lowest levels of use on a Saturday (2.2%, 118/5447) and Sunday (5.1%, 279/5447) (Table 3).
Table 3. Number of patient encounters by day of the week, N = 5447
Across the week, highest usage levels occurred between 0800 and 0959 (27.4%, 1494/5447), and lowest levels of use were between 0200 and 0359 (0.2%, 13/5447) (Table 4).
Table 4. Patient encounters by time of day, N = 5447
During Monday to Friday, usage was highest between 0800 and 0959 (28.9%, 1460/5050) (Figure 1). A different pattern was observed at the weekend with highest levels of use observed between 2000 and 2159 (19.8%, 79/397 [total weekend users]). Levels of weekend use were higher on a Sunday (70.3%, 279/397) than a Saturday (29.7%, 118/397) (Figure 2).
Figure 1. Time of use by patients during the week.
Figure 2. Time of use by patients at the weekend.
Reasons for query
The authors report 34 different categories of ‘reason for query’ given by patients. The most common was an enquiry about medication: 10.29% (529 out of 5140 reasons). Subsequent reasons were: to place an administrative request, 8.44% (434/5140); to report a specific symptom, 8.35% (429/5140); to report a skin condition, 7.98% (410/5140); to report an ear, nose, and throat-related query, 5.80% (298/5140); and for musculoskeletal issues, 5.76% (296/5140). The least common queries stated by patients were neurological, 0.06% (3/5140) and to request access to a specific service, 0.08% (4/5140).
Mental health-related queries accounted for 4.47% of queries (230/5140). Just 1.61% (83/5140) reported wanting to discuss multiple conditions. The full list of categories can be viewed in Table 5.
Table 5. Reason given by patient for query, grouped into categories, N = 5140
Qualitative analysis
Of 5447 patients in the dataset, 569 (10.4%) left feedback about their experience of using the platform as a free-text comment.
Characteristics of users leaving comments
The 569 users who left a comment comprised more females (62%) than males (38%) and mean age was 44.2 (range 0 to 91) years (data not shown).
Findings
Key themes identified were: nature of a remote contact, quality of communication, perceived appropriateness, demand, and the role of online triage.
The authors observed both positive and negative perceptions of the same issues, suggesting that experiences of using the online platform were complex and relative to the patient and their characteristics, as well as the context in which the patient made the contact.
Nature of a remote contact
The nature of the alternative route for making contact with general practice was important in how patients perceived it. Some users found the type of access offered by the platform was positive, whereas others felt it to be negative. This was due in part to the mixed-mode approach: the initial patient contact is made online via the platform but the response from the practice is by telephone.
For some, the removal of the need for verbal interaction was viewed positively:
‘Love this. If you are feeling poorly the last thing you want to do first thing in the morning is make a phone call, so this online facility works perfectly.’
(Female [F], 35 years)
Conversely some patients felt that verbal interaction was important:
‘This a very frustrating way of dealing with patients. I want to explain to a person not a computer.’
(Parent/guardian of child [P/G], aged 3 years)
There were certain health conditions where a non-verbal form of communication was easier:
‘For a deaf person it is marvellous to be able to communicate without using a voice phone.’
(Male [M], 83 years)
Though this was not always the case and the online visual element could be a disadvantage, for example, in a patient with sight problems:
‘Having a sight problem, I need help to fill this in. It makes things less confidential for me.’
(F, 63 years)
Some patients expressed a dislike of the asynchronous interaction offered by the platform:
‘If you’re under stress because you’re poorly, I’d prefer to speak to a human!’
(F, 47 years)
‘Would rather see a doctor face to face not sure how you can tell someone is ill over the phone.’
(F, 51 years)
This linked into concerns about how patients could be adequately assessed remotely. How the problem would subsequently be dealt with on the telephone was a key element of the patient experience of the platform.
Despite the initial encounter being online, the logistical process of taking the telephone call response from the practice could be difficult. This was sometimes due to work responsibilities:
‘Difficult to wait by phone to take a call as driving instructor.’
(P/G, 15 years)
Some patients appeared to have encountered problems with the telephone call back. Some claimed they missed, or did not receive, the follow-up call from the GP surgery and subsequently were unsure how to proceed, or started the process again:
‘I have had to request a response multiple times this week for the same problem and have not had any contact from a doctor. This has meant I am now almost out of my medication and am worried about what might happen if I do not get a repeat.’
(F, 23 years)
‘Sometimes I have missed a call because I have been busy at work but the doctor does not retry at a later time, so I have to go through the whole process of raising a call again … ’
(F, 44 years)
Comments were indicative of teething problems associated with trying a new approach.
Quality of communication
Some noted how this method of contacting their GP may potentially influence the quality of communication. Some saw it as a potential improvement where they could take the time to write about what they wanted to discuss, whereas others highlighted concerns about the quality of the description they were able to leave in reference to their problem:
‘… would probably mention things you might forget when you are face to face.’
(P/G, 13 years)
‘I like this option because I can explain myself better.’
(P/G, <1 year)
Perceived appropriateness
Some users found the platform particularly appropriate for certain problems but less appropriate for others, especially where the patient was not sure what was wrong:
‘Difficult to know if symptoms are being overlooked by the patient.’
(F, 73 years)
For example, if a patient was sure they wanted to book a face-to-face appointment, using the platform was seen as a barrier to doing this:
‘ Very long-winded when in a rush and I just want to see a doctor.’
(F, 27 years)
However, users who were unsure whether their problem warranted an appointment considered the service as a useful way of checking:
‘Great service as don’t really want to waste an appointment if nothing can be done with problem but good to check.’
(F, 37 years)
The online element caused concern because of the need for patients to have computer skills. These comments tended to relate to hypothetical persons and not the person leaving the comment:
‘The system is good if you are computer savvy; however, for older patients they might find [the] system difficult to comprehend.’
(M, 64 years)
This was especially interesting because the patients were not directly invited to comment on suitability for others or indeed themselves, but did this regardless, deeming it to be an important factor.
Demand and the role of online triage
Patients referred to having to use the system out of necessity, because of prohibitively busy phone lines or because they had been signposted by reception staff to use the platform in lieu of booking an appointment. The comments referenced a general dissatisfaction with current routes for accessing GPs, including online triage:
‘Have used system because I was told on phone I would be unlikely to get a response via phone as practice too busy.’
(P/G, 9 years)
‘When a person is ill it would be helpful if they could speak to a person to book an appointment rather than giving personal details out across the internet. The hold time on your telephone is now at least 10 minutes.’
(F, 35 years)
Those who felt it was a useful intermediary step often showed concern about their personal use of resources, viewing the system as a potential way to save GPs’ time and prioritise appointments:
‘A really good idea for relieving GP surgeries of unnecessary appointments.’
(M, 31 years)
‘… saves ringing and making an appointment which another patient could have.’
(F, 64 years)
Some patients perceived it as working better than booking via the phone, whereas others commented on previous experiences of it working well for them:
‘Last time when I used it, I got a prompt and helpful response. No waiting on the lines and being stressed any more.’
(F, 36 years)
‘I have always got a great response.’
(F, 45 years)
There were clearly patients for whom online triage offered distinct advantages.
