Online consultations for asthma care in the UK general practices: a focused ethnographic study (ID 546)
The University of Edinburgh
Funding: NU is supported by a University of Edinburgh College of Medicine PhD Studentship within the Asthma UK Centre for Applied Research (AUKCAR), and JS is supported by National Institute for Health Research Applied Research Collaboration (ARC) North Thames.
Abstract
Aim: To explore and understand online consultations (OLCs) for asthma care from the perspectives of healthcare professionals (HCPs) and patients in UK primary care.Methods: Using a focused ethnography, we conducted non-participant observations of HCPs involved in OLCs and semi-structured interviews with HCPs and asthma patients in general practices in the UK. We used inductive and deductive codes and framed our synthesis using normalisation process theory (NPT).
Results: We observed 10 HCPs and interviewed 17 HCPs and six patients in four practices, two in Scotland and two in England. The practices varied in size (5,500-43,596 registered patients). All but one practice provided OLCs for unscheduled asthma care. The Scottish practices did not use OLCs for routine reviews, whereas one English practice conducted online reviews, and the other used an online asthma control test alongside telephone and in-person reviews. All practices offered in-person and telephone triage, with one practice (Practice-2) providing complete triage through eConsult.
HCPs perceived that OLCs improved patient access and offered flexibility, however, they discussed that the quality of information in OLCs requests is crucial for successful completion; otherwise, they needed to revert to phone calls or in-person consultations. HCPs in all practices described task redistribution, with no significant increase in their workload, except for Practice 2, where every request went directly to GPs. While HPCs understood the purpose of OLCs (NPT-1), their cognitive participation (NPT-2) and collective action (NPT-3) varied between practices. Most HCPs agreed that OLCs have a place in the NHS if used appropriately with defined organisation processes by professionals and patients (NPT-4).
Conclusion: OLCs can provide non-emergency asthma care by addressing the increasing demand and promoting the uptake of annual reviews, particularly for non-engaged individuals. Practices need to ensure organisational procedures, motivation for HCPs, and patient education about the purpose and use of OLCs.
Conflicts of interest: None.
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