The benefits, challenges and acceptability of video-consultation with patients via the internet in general practice; a qualitative study.
People increasingly communicate online, at work, in college and socially, using visual communication mediums such as Skype and FaceTime. Growing demands on primary-care services mean that new ways of providing patient care are being considered. Video-consultation over the internet is one such mode. However, it is not known for which type of patients and for which types of problems video consulting may be appropriate, nor is it clear how it differs in content from face-to-face or telephone consultations in general practice.
Primary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet or video-enabled computer. Clinicians invited eligible patients who required a follow-up consultation to choose from a telephone, face-to-face or online video-consultation. Semi-structured interviews were conducted with patients (n=21) who had had a video-consultation and the primary care clinicians (n=13) conducting them. Interviews were audio-recorded and transcribed. We took an inductive thematic approach to data collection and analysis. Final themes were developed by the team using constant comparison and tested by looking for confirming and disconfirming cases. Finally, the themes were discussed with the wider research team and sent to participants for comment.
Participants choosing video-consultations were younger and more experienced with technology than those choosing face-to-face or telephone consultations. They reported positive experiences of video-consultation. Video-consultation were reported as being helpful for working patients, as well as those with mobility or mental health problems. Video-consultations offered benefits relative to telephone consultations by providing visual cues, building rapport, reassurance, and improving communication. However, for complex problems, or consultations where personal support was required, face-to-face consultations were seen as superior. Technical problems were common and reduced the quality of some consultations. Clinicians felt, for routine use and implementation at scale, video-consultations need to be more reliable and seamlessly integrated with clinical appointment systems which would require upgrading of current NHS IT systems. We concluded that the visual component of video-consultations offers advantages over telephone consultations. When integrated with current systems video-consultations can provide an alternative to face-to-face consultations when formal physical examination is not required and is more convenient for patients than face-to-face consultations, especially for working people.
This work shows that video-consulting may offer distinct advantages in some situations to telephone and face-to-face consultations in terms of improved communication, rapport and convenience. As experience with services such as Skype and FaceTime increases, demand for video-consulting services in primary care is likely to rise, but improved technical infrastructure is required to allow video-consulting to become routine.