RT Journal Article
SR Electronic
T1 The impact of remote care approaches on continuity in primary care: a mixed-studies systematic review
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e374
OP e383
DO 10.3399/BJGP.2022.0398
VO 73
IS 730
A1 Emma Ladds
A1 Maaedah Khan
A1 Lucy Moore
A1 Asli Kalin
A1 Trish Greenhalgh
YR 2023
UL http://bjgp.org/content/73/730/e374.abstract
AB Background The value of continuity in primary care has been demonstrated for multiple positive outcomes. However, little is known about how the expansion of remote and digital care models in primary care have impacted continuity.Aim To explore the impact of the expansion of remote and digital care models on continuity in primary care.Design and setting A systematic review of continuity in primary care.Method A keyword search of Embase, MEDLINE, and CINAHL databases was used along with snowball sampling to identify relevant English-language qualitative and quantitative studies from any country between 2000 and 2022, which explored remote or digital approaches in primary care and continuity. Relevant data were extracted, analysed using GRADE-CERQual, and narratively synthesised.Results Fifteen studies were included in the review. The specific impact of remote approaches on continuity was rarely overtly addressed. Some patients expressed a preference for relational continuity depending on circumstance, problem, and context; others prioritised access. Clinicians valued continuity, with some viewing remote consultations more suitable where there was high episodic or relational continuity. With lower continuity, patients and clinicians considered remote consultations harder, higher risk, and poorer quality. Some evidence suggested that remote approaches and/or their implementation risked worsening inequalities and causing harm by reducing continuity where it was valuable. However, if deployed strategically and flexibly, remote approaches could improve continuity.Conclusion While the value of continuity in primary care has previously been well demonstrated, the dearth of evidence around continuity in a remote and digital context is troubling. Further research is, therefore, needed to explore the links between the shift to remote care, continuity and equity, using real-world evaluation frameworks to ascertain when and for whom continuity adds most value, and how this can be enabled or maintained.