According to a new review by researchers at Imperial College London, including some supported by the NIHR Imperial BRC, virtual GP and other primary care consultations can be as effective as face-to-face appointments for a range of health conditions.
It found health outcomes for patients who saw doctors remotely at least matched those for in-person care for mental illness, alcohol misuse, weight management and advice on quitting smoking.
The findings were based on a review of previous research involving more than 5.4 million patients in countries across the world. The study was funded by the NIHR.
Increase in virtual appointments
Efforts to minimise the transmission of COVID-19 from 2020 led to a rapid increase in the use of virtual rather than in-person primary care consultations – to around 70% of the total in the UK and 65% in the US.
Video and phone-based appointments were already on the rise before the pandemic. Some see them as a way to improve efficiency and access to care. Others, however, have raised a variety of concerns including confidentiality, data security, the accuracy of diagnosis, patient safety and the potential to widen inequalities for those with limited access to technology or the skills to use it.
Dr Ana Luisa Neves, from the School of Public Health at Imperial College London, says: “COVID-19 caused a huge and rapid expansion in the use of virtual consultations in Primary Care. As part of an emergency response, it wasn’t possible to properly consider the impacts at the time”.
“Now, it is really important that we better understand what this immense change means, especially for patient outcomes, safety and equity. Based on the evidence we analysed, it seems that remote care is equally beneficial to health outcomes for certain conditions including mental health, alcohol misuse and smoking cessation. For these conditions, evidence shows patients can get the same effectiveness of care as they would in face-to-face appointments.”
Following a search of databases of previous research, the Imperial group identified 30 studies that compared video or phone-based primary care consultations with those carried out face-to-face published between 2017 and 2022.
Some of the studies covered general primary care such as GP appointments while others focused on specific conditions or groups of conditions. Most of the research was carried out in the US, while others took place in the UK, Canada, Sweden, New Zealand, Singapore, UK, Japan and Kenya.
The researchers reviewed the studies, recording whether virtual care was superior, equal to or inferior to face-to-face care on costs, health outcomes, safety, patient satisfaction, waiting times and equity.
They found some evidence that remote consultations reduced financial costs and saved time for doctors.
The studies that compared health outcomes found remote appointments to be as effective as in-person ones for the areas the studies looked at – mental health problems including depression and anxiety, as well as reducing alcohol consumption, quitting smoking and weight management. One study found virtual care to be superior for treating ulcers.
There was some evidence that remote consultations saved time for doctors, reduced waiting times, and were seen as more convenient, but also that patients seen virtually felt less well supported in making informed choices autonomously.
There was insufficient evidence to enable the researchers to assess the impact of virtual consultations on patient safety, and the researchers say there is a need to further explore their impact on equity.
The researchers emphasised the need for future research on whether the shift towards remote primary care might increase safety risks for some conditions and for certain patient sub-groups, such as those with lower literacy and lower access to technology.