Awareness and use of online appointment booking in general practice: analysis of GP Patient Survey data

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

N.1

Presenter:

Gary Abel

Twitter:

@garyabel

Co-authors:

Mayam-Gomez Cano, John Campbell, Abi Eccles, Leon Poltawski, Jeremy Dale, Helen Atherton

Author institutions:

University of Exeter Medical School, University of Warwick

Problem

General practices are required to provide online booking to patients in line with policy to digitise access. Online booking services offer the option of booking an appointment 24/7 using the internet. However, uptake of online booking by patients is currently low and there is little evidence about awareness and use by different patient groups.

Approach

As part of the OBoE study, we performed a secondary analysis of GP Patient Survey data (2018) making use of two questions, one asking about awareness of online booking of appointments and another asking about use. Multivariate logistic regression was used to examine associations between both awareness and use in relation to age, gender, ethnicity, deprivation, the presence of a long-term condition, long-term sickness and being deaf. Comparison of models accounting for and not accounting for clustering by practice was used to illustrate the extent to which disparities reflect the clustering of certain types of patients in practices where awareness and use of online booking is high or low for all patient groups.

Findings

Of 647,064 patients answering the relevant question, 277,278 (43.3%) reported being aware of being able to book appointments online. In contrast, only 14% (93,671 /641,073) reported having actually booked an appointment online. There was evidence of variation by all factors considered. In particular, strong deprivation gradients in both awareness and use were evident (e.g. most vs. least deprived quintile OR for use=0.63 95%CI 0.61-0.65). There was a strong drop off in both awareness and use in patients over 75 (e.g. 85+ vs. 65-74 years OR for awareness=0.33 95%CI 0.32-0.35). Patients with long-term conditions were more aware and more likely to use online booking, however, deaf patients were less likely to be aware, but more likely to use online booking (not-deaf vs deaf OR for awareness= 0.78, 95%CI 0.70-0.86, OR for use= 1.29, 95%CI 1.14-1.46). Adjustment for practice suggest that around a third of the deprivation gradient in awareness and a fifth of the deprivation gradient in use is attributable to deprived patients being clustered in practices with low awareness/use for all patients.

Consequences

Whilst over 40% of patients know that they can book appointment online, the number that actually do so is far lower. Furthermore, awareness and use of online appointment booking varies by patient group. Some of this variability is reassuring, for example that patients with long-term conditions are using the service, whilst other variability is more concerning, for example the strong deprivation gradient and drop off in old age. With the constant push for online services within the NHS, practices need to be aware that not all patient groups will book appointments online and that other routes of access need to be maintained to avoid widening health inequalities.

Submitted by:

Gary Abel

Funding acknowledgement:

This presentation presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG- 1217-20033). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.