The use of networked communication in the community is becoming widespread. The NHS uses networked communication extensively except for clinical communication with patients. However there is patient and clinician interest in using digital, networked media. The use of digital, networked communication has the potential to improve health outcomes and reduce the care burden on people with long-term conditions, particularly for young people, carers, and others who find it difficult to access care. However there is a danger of primary care being overwhelmed by requests for advice on acute self-limiting illness and minor self-care issues. Furthermore most primary care providers do not have systems in place for this form of clinical communication within NHS Information Governance regulation. This research explored current practice and potential future practice of using digital, networked communication media for patient-clinician clinical communication in NHS primary health care. Examples include email contact with patients about adjustment of medication, text messages about blood glucose results and discussion of symptoms via social media.
The research involved three strands described below:
1 Realist review of published literature
Realist synthesis focuses on how interventions/programmes/phenomena operate in particular contexts. This review focussed on two key questions:
- What impact does the use of digital and networked technologies have on access to healthcare by groups considered to be hard-to-reach by healthcare?
- What impact does the use of digital and networked technologies have on access to healthcare by groups potentially marginalised by their ability to use IT?
Evidence suggests that, as digital and networked communication technology removes the need for face-to-face interaction with healthcare staff and other patients, barriers related to embarrassment and fear of negative reactions from others (stigma and discrimination) would be ameliorated. Practical access issues would also be improved, as there would be reduced need to travel to and wait for the consultation. Digital and networked communication technologies are unlikely to impact issues relating to lack of candidacy for healthcare and lack of knowledge about health services, and it is unclear how this technology would affect cultural and language-related access barriers. Older people and people with no educational qualifications would potentially be marginalised by their ability to use IT, but these groups do have good access to face-to-face consultations with their GP.
2 Public and Patient (PPI) Involvement activity
PPI engagement with primary care patients through (face-to-face and virtual) consultation with GP patient panels, attendance at local patient conferences, and engagement with young people through the Warwick Young Researcher Scheme. Results suggest that patients are concerned about confidentiality and the possibility of misunderstandings occurring between patient and clinician. It was also suggested that digital communication might be useful for people who are unable to come into the surgery, but many of these people will be those who do not have or know how to use technology, such as the elderly. Young people, in contrast, use a wide range of technology and saw benefits to using technology to contact health professionals.
3 Exploring professional perspectives
GPs were consulted via local Protected Learning Time events and at a local Royal College of General Practitioners conference, and GP practices returned brief surveys on their use of, and opinions about, digital communication. Physiotherapists were consulted about their use of digital technology.
Professionals thought that email consultations would be useful for triage prior to face-to-face consultation and that video-based technology such as Skype would be useful for housebound patients or people living with chronic conditions (those who need long-term routine care). Physiotherapists saw lots of scope for using technology more in future and had fewer concerns than GPs (concerns included time commitment and workload, confidentiality and patient safety/risk).
The research team was:
Prof Frances Griffiths (Principal Investigator)