Electronic consultation in primary care between providers and patients: systematic review

Freda Mold, Jane Hendy, Yi-Ling Lai, Simon de Lusignan

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    Background: Governments and healthcare providers are keen to find innovative ways to more efficiently deliver care. Interest in e-consultation has grown, but evidence of benefit is uncertain.

    Objectives: To assess the evidence of delivering e-consultation using secure email/messaging or video links in primary care.

    Methods: A systematic review was conducted focusing on the use and application of e-consultations in primary care. A systematic review of seven international databases was searched (Medline, Embase, CINAHL, Cochrane Library, PsycINFO, Econlit and Web of Science) (1999-2017), identifying 52 relevant studies. The screening was conducted against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesised using thematic analysis.

    Results:  This review included fifty-seven (n=57) studies from a range of countries, mainly the USA (n=30) and the UK (n=13). Patient responses to e-consultation are mixed. Patients report satisfaction with services, and improved self-care, communication and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary healthcare staff, e-consultation delivers challenges around time-management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it impacts on health outcomes.

    Conclusions: E-consultations may improve aspects of care delivery, but the small, pilot nature of many of the studies and low adoption rates result in unanswered questions about usage, quality, cost and sustainability. The review findings have drawn attention to the need to improve future e-consultation implementation, and research to develop innovations which support equitable primary care access and delivery across user groups.
    Original languageEnglish
    Article numbere13042
    Pages (from-to)1-14
    Number of pages14
    JournalJournal of Medical Internet Research
    Issue number4
    Publication statusPublished - 3 Dec 2019


    • referral and consultation
    • health services accessibility
    • primary health care
    • general practice
    • patient access to records
    • patient portals
    • Web-based access


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