Article Figures & Data
Figures
- Figure 1.
GP and nurse/paramedic consultations per 1000 registered patients, February to July 2019 and February to July 2020. Between 97% and 99% of consultations each month were face-to-face or telephone. Monthly percentages for home visits, e-consultations, and video (not shown) varied between 1% to 3% across all three types.
- Figure 2.
Normalisation Process Theory model of remote consulting.
1Bistech = company that provided telephone call routing to enable some reception staff to work from home or sites closed to patients. DOH = Department of Health. F2F = face-to-face. VPN = Virtual Private Network (provides secure connection to a private network). VNC = Virtual Network Computing (provides remote control of a computer from another location).
Tables
How this fits in
The COVID-19 pandemic has rapidly accelerated a move to remote consulting (telephone, video, and online) in general practice. In this mixed-methods longitudinal study, the authors found that this shift to remote consulting had some benefits but was driven by necessity and helped by low consultation volumes in March and April 2020. Despite a drop in consultations overall, contact rates increased or stayed the same for patients who were older, shielding, or had poor mental health. As consultation rates returned to normal by July 2020 and patients began to consult with more complex problems, GPs found remote management can be more time-consuming, clinically challenging, and less satisfying. The appropriate role of remote consulting in future primary care service delivery remains unclear. - Table 1.
Characteristics of all patients registered in participating practices in July 2019
Registered patients, n % Age, years 0–4 18 685 5.32 5–17 46 822 13.34 18–49 158 993 45.30 50–69 77 952 22.21 70–84 35 875 10.22 ≥85 12 639 3.60 Sex Male 175 952 50.13 Female 175 009 49.86 Missing 5 <0.01 IMD quintile 1 (most deprived) 71 378 20.34 2 55 002 15.67 3 53 129 15.14 4 73 119 20.83 5 (least deprived) 96 608 27.53 Missing 1730 0.49 Ethnicity White 228 624 65.14 Asian/Asian British 11 774 3.35 Black/African/Caribbean/Black British 12 234 3.49 Mixed/Multiple ethnic groups 5368 1.53 Other 1210 0.34 Missing 91 756 26.14 Mental health Good 318 329 90.70 Poora 32 637 9.30 Shielding Non-shielding 337 758 96.24 Shielding 13 208 3.76 ↵a Defined as patients with severe mental illness (based on Quality and Outcomes Framework (QOF) business rules19) OR patients with depression (based on QOF rules19) OR patient prescribed antidepressants in the last 3 months (excluding tricyclics, as these are commonly used for non-mental health conditions).
- Table 2.
Changes in consulting rates in April to July 2020 compared to April to July 2019 overall, and stratified by patient characteristicsa
All consultations Face-to-face and home visits Telephone, video, and e-consultations GP consultations IRR 95% CI P-value IRR 95% CI P-value IRR 95% CI P-value Change in consultation rates by variable (2020 versus 2019)b 0.89 0.85 to 0.92 <0.001 0.16 0.14 to 0.19 <0.001 2.76 2.33 to 3.27 <0.001 Age category, yearsc <0.001 <0.001 0.421 0–4 0.81 0.73 to 0.88 <0.001 0.24 0.20 to 0.28 <0.001 2.60 2.14 to 3.15 <0.001 5–17 0.65 0.59 to 0.71 <0.001 0.12 0.10 to 0.14 <0.001 2.19 1.81 to 2.65 <0.001 18–49 0.91 0.83 to 1.00 0.041 0.16 0.14 to 0.19 <0.001 2.77 2.30 to 3.34 <0.001 50–69 0.89 0.81 to 0.97 0.008 0.16 0.14 to 0.19 <0.001 2.76 2.29 to 3.33 <0.001 70–84 0.96 0.87 to 1.05 0.324 0.19 0.16 to 0.22 <0.001 2.84 2.35 to 3.42 <0.001 ≥85 1.05 0.96 to 1.16 0.265 0.24 0.21 to 0.29 <0.001 2.78 2.30 to 3.36 <0.001 Mental health statusc <0.001 0.687 0.229 Good mental health 0.84 0.80 to 0.87 <0.001 0.16 0.14 to 0.18 <0.001 2.61 2.25 to 3.03 <0.001 Poor mental health 1.06 1.01 to 1.10 0.022 0.17 0.14 to 0.19 <0.001 2.97 2.56 to 3.44 <0.001 Shielding statusc <0.001 0.032 0.644 Non shielding 0.86 0.81 to 0.91 <0.001 0.16 0.14 to 0.18 <0.001 2.67 2.29 to 3.11 <0.001 Shielding 1.09 1.03 to 1.16 0.004 0.20 0.17 to 0.23 <0.001 2.81 2.41 to 3.27 <0.001 Sexc 0.411 0.776 0.718 IMD quintilec 0.895 0.867 0.940 Ethnicityc 0.636 0.076 0.108 Nurse/paramedic consultations IRR 95% CI P -value IRR 95% CI P-value IRR 95% CI P-value Change in consultation rates by variable (2020 versus 2019)b 0.83 0.76 to 0.91 <0.001 0.54 0.49 to 0.59 <0.001 5.51 3.81 to 7.97 <0.001 Age category, yearsc 0.003 <0.001 0.835 0–4 1.00 0.85 to 1.17 0.975 0.83 0.70 to 0.98 0.026 5.71 3.98 to 8.18 <0.001 5–17 0.62 0.53 to 0.73 <0.001 0.29 0.25 to 0.35 <0.001 4.71 3.32 to 6.68 <0.001 18–49 0.87 0.74 to 1.02 0.081 0.53 0.45 to 0.62 <0.001 6.66 4.79 to 9.27 <0.001 50–69 0.89 0.76 to 1.04 0.154 0.57 0.48 to 0.67 <0.001 5.74 4.13 to 7.98 <0.001 70–84 0.86 0.74 to 1.01 0.064 0.56 0.48 to 0.66 <0.001 5.54 3.97 to 7.73 <0.001 ≥85 0.83 0.71 to 0.97 0.021 0.51 0.44 to 0.61 <0.001 5.51 3.90 to 7.78 <0.001 Mental health statusc 0.017 0.012 0.966 Good mental health 0.83 0.75 to 0.92 <0.001 0.54 0.49 to 0.59 <0.001 5.78 4.24 to 7.87 <0.001 Poor mental health 0.99 0.90 to 1.10 0.890 0.65 0.58 to 0.72 <0.001 5.72 4.17 to 7.86 <0.001 Shielding statusc 0.001 0.001 0.222 Non shielding 0.83 0.73 to 0.94 0.003 0.53 0.46 to 0.60 <0.001 5.28 3.75 to 7.44 <0.001 Shielding 1.15 1.01 to 1.31 0.031 0.73 0.63 to 0.84 <0.001 7.13 4.99 to 10.19 <0.001 Sexc 0.390 0.873 0.727 IMD quintilec 0.958 0.926 0.879 Ethnicityc 0.163 0.111 0.924 ↵a Table 2 shows output from the negative binomial models.
↵b The overall changes in consulting in 2020 compared to 2019 are presented.
↵c P-values for the interaction between consulting year and patient characteristics are presented. Changes in consulting rates are only presented by the different levels of a patient characteristic for characteristics if the interaction P-value is <0.05 for at least one of the three outcome models. IMD = Index of Multiple Deprivation. IRR = incidence rate ratio.
Supplementary Data
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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