ABSTRACT
BACKGROUND: The COVID-19 pandemic significantly impacted primary care, resulting in rapid uptake of telehealth. Patients with chronic conditions like Type-2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) relied heavily on telehealth consultations during this period. It is important to assess whether tasks observed during T2DM or CVD in-person consultations are translatable to telehealth. AIM: To explore the extent to which in-person GP consultations are translatable to telehealth for patients with T2DM or CVD. DESIGN & SETTING: This study screened 281 GP consultations conducted in 2017 within the UK general practice setting for consultations pertaining to T2DM or CVD. Seventeen in-person consultations (in de-identified video and transcript) were selected for further analysis. METHOD: Detailed reporting of tasks, physical artefacts, and physical examinations observed during in-person GP consultations. A new scoring method applying two key metrics, supporting definitions and examples was designed to assess translatability of clinical tasks, to telehealth. RESULTS: Across 17 T2DM or CVD in-person consultations analysed, 23 clinical tasks, 21 physical artefacts, and nine physical examinations were observed. 60% of tasks analysed were deemed easily translatable to telehealth. 26% of tasks were rated as 'translatable to telehealth' but may require a patient obtaining their own equipment. 13% of tasks were rated as 'potentially translatable to telehealth'. No clinical tasks for these cohorts were rated as untranslatable to telehealth. CONCLUSION: Majority of tasks observed during T2DM or CVD in-person GP consultations are translatable to telehealth. Further research is warranted to investigate emergent safety concerns from increased uptake of telehealth.
ABSTRACT
BACKGROUND: Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. OBJECTIVE: The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. METHODS: This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. RESULTS: A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. CONCLUSIONS: Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. TRIAL REGISTRATION: PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.