Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England.
OBJECTIVES
Evaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.


DESIGN
15-month observational study.


SETTING
Primary care practices in South West England.


RESULTS
36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an 'e-consultation' (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30-50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice's response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.


CONCLUSIONS
Use of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.
['Edwards|Hannah B|HB|', 'Marques|Elsa|E|', 'Hollingworth|William|W|', 'Horwood|Jeremy|J|', 'Farr|Michelle|M|', 'Bernard|Elly|E|', 'Salisbury|Chris|C|', 'Northstone|Kate|K|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001071:Appointments and Schedules D003142:Communication D004739:England D005260:Female D058006:General Practice D017048:Health Care Costs D006801:Humans D020407:Internet D008297:Male D008875:Middle Aged D009862:Online Systems D010817:Physician-Patient Relations D010865:Pilot Projects D010818:Practice Patterns, Physicians' D011320:Primary Health Care D012017:Referral and Consultation D013222:State Medicine D017216:Telemedicine D013689:Telephone D014218:Triage D055815:Young Adult
primary care online consultations evaluation general practice e-consultations