Atherton, Helen and Ziebland, S. (2016) What do we need to consider when planning, implementing and researching the use of alternatives to face-to-face consultations in primary healthcare? Digital Health, 2 . doi:10.1177/2055207616675559 ISSN 2055-2076.

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Abstract

Objectives:
Communications technologies are variably utilised in healthcare. Policymakers globally have espoused the potential benefits of alternatives to face-to-face consultations, but research is in its infancy. The aim of this essay is to provide thinking tools for policymakers, practitioners and researchers who are involved in planning, implementing and evaluating alternative forms of consultation in primary care.

Methods:
We draw on preparations for a focussed ethnographic study being conducted in eight general practice settings in the UK, knowledge of the literature, qualitative social science and Cochrane reviews. In this essay we consider different types of patients, and also reflect on how the work, practice and professional identities of different members of staff in primary care might be affected.

Results:
Elements of practice are inevitably lost when consultations are no longer face-to-face, and we know little about the impact on core aspects of the primary care relationship. Resistance to change is normal and concerns about the introduction of alternative methods of consultation are often expressed using proxy reasons; for example, concerns about patient safety. Any planning or research in the field of new technologies should be attuned to the potential for unintended consequences.

Conclusions:
Implementation of alternatives to the face-to-face consultation is more likely to succeed if approached as co-designed initiatives that start with the least controversial and most promising changes for the practice. Researchers and evaluators should explore actual experiences of the different consultation types amongst patients and the primary care team rather than hypothetical perspectives.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Primary care (Medicine), Periodic health examinations, Communication in medicine, Physicians (General practice)
Journal or Publication Title:	Digital Health
Publisher:	SAGE Publications Ltd.
ISSN:	2055-2076
Official Date:	November 2016
Dates:	Date Event November 2016 Published 23 September 2016 Accepted 26 May 2016 Submitted
Volume:	2
DOI:	10.1177/2055207616675559
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	2 December 2016
Date of first compliant Open Access:	8 December 2016
Funder:	National Institute for Health Research (Great Britain). Health Services and Delivery Research (NIHR HS&DR), National Institute for Health Research (Great Britain). School for Primary Care Research (NIHR SPCR)

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