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

Problem

General practices are required to provide online booking of appointments, repeat prescriptions, and access to medical records for patients in line with policy to digitise access. Uptake of online GP services by patients is currently low. In a previous study we examined awareness and use of online appointment booking. Here we expand on that work to examine other forms of digital access.

Approach

As part of the Di-Facto study, we performed a secondary analysis of GP Patient Survey data (2018, 2019) making use of two questions, one concerning awareness of online booking of appointments, repeat prescriptions and medical record access, and another concerning use of these services. Mixed effects logistic regression was used to examine associations between both awareness and use of online-services, and age, gender, ethnicity, deprivation, the presence of a long-term condition, long-term sickness and hearing impairment; to compare the reported ease of use of the practice website with the reported use of online services; and to consider whether easy-to-use websites were associated with increased uptake of online services.

Findings

There were 1,327,693 GPPS responders who reported attempting to make an appointment in the previous 12 months. Awareness of online appointment booking, repeat prescriptions and medical record access was 45%, 42% and 15% respectively. In contrast, 16%, 17% and 4% respectively, reported using these services.There was evidence of variation by most patient factors considered. In particular, strong deprivation gradients in both awareness and use were evident for all three services (e.g. most vs. least deprived quintile OR for use of online repeat prescription =0.57 95%CI 0.56-0.59). A strong drop-off was seen in both awareness and use of all three services in patients over 75 (e.g. 85+ vs. 65-74 years OR for awareness of online medical record access=0.29 95%CI 0.26-0.31). Patients with long-term conditions were more likely to be aware of/use online services and there were large differences by ethnicity.For all services considered, the practice that a patient was registered with was the strongest predictor of both awareness and use. Furthermore, we found that easier to use practice websites were associated with higher likelihoods of awareness/use of online services.

Consequences

Awareness and use of online GP services varies by patient group. Some of this variability is reassuring, for example that patients with long-term conditions are using the services, whilst other variability is more concerning, for example the strong deprivation and ethnicity gradients and the drop off in old age. With the constant push for online services within the NHS, practices need to be aware that easy-to-use websites are associated with increased uptake of their online services, and that not all patient groups will use their online services. Other routes of access need to be maintained to avoid widening health inequalities.