General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study

  1. Edmond Li
  2. Rosy Tsopra
  3. Geronimo Jimenez
  4. Alice Serafini
  5. Gustavo Gusso
  6. Heidrun Lingner
  7. Maria Jose Fernandez
  8. Greg Irving
  9. Davorina Petek
  10. Robert Hoffman
  11. Vanja Lazic
  12. Ensieh Memarian
  13. Tuomas Koskela
  14. Claire Collins
  15. Sandra Milena Espitia
  16. Ana Clavería
  17. Katarzyna Nessler
  18. Braden Gregory O’Neill
  19. Kyle Hoedebecke
  20. Mehmet Ungan
  21. Liliana Laranjo
  22. Saira Ghafur
  23. Gianluca Fontana
  24. Azeem Majeed
  25. Josip Car
  26. Ara Darzi
  27. Ana Luisa Neves

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Abstract

With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June–September 2020. GPs’ perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients’ preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.

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  1. Version published to 10.1371/journal.pdig.0000029
  2. ScreenIT

    SciScore for 10.1101/2021.07.28.21261021: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: As participants did not provide consent for further contact, it was not possible to ask them to provide feedback on the findings.
    IRB: Ethics: Overall ethical approval for this project was granted by the Imperial College Research Ethics Committee (ICREC) (Reference 20IC5956).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Summary of key findings: Benefits for quality of care were identified for the six dimensions of quality of care, including safety (reduction of exposure risks for COVID-19 transmission); effectiveness and equity (ensuring access and continuity of care to those who need it, including those who had previously limitations to access face-to-face care); efficiency (remote triage), improved timeliness and patient-centredness (convenience, communication, and patient empowerment). Benefits for healthcare providers included a greater work flexibility and more control over schedule. Benefits for healthcare systems included a transformative effect, hastening the digital transformation (increasing awareness, trust, adoption, skills, and technical capacity) and driving changes in legal and regulatory frameworks. Important challenges have also been noted for six domain of quality of care, including patient-centredness (patients’ preference for face-to-face care, potential negative impact on communication), equity (lack of equipment, internet access and digital skills of some patient groups), safety (clinical uncertainty and potentially inappropriate decision making), timeliness (delays in diagnosis and treatment), effectiveness (unsuitability for certain consultations) and efficiency (overuse and misuse). Challenges specific for healthcare providers included the lack of guidance and support, higher workload, and remuneration issues. From the health systems’ perspective, the long-establishe...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.28.21261021v1 on medRxiv