Ana Luísa Neves is a General Practitioner, a Research Fellow at Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation and a member of the Executive Board of the European General Practice Research Network.

Kelsey Flott is a Policy Fellow and the Patient Safety Lead at the Institute of Global Health Innovation. She is the Centre Manager for the NIHR Patient Safety Translational Research Centre and leads the operational management of the WHO Global Patient Safety Collaborative.

Saira Ghafur is a consultant Respiratory Physician at Imperial College Healthcare NHS Trustthe, Lead for Digital Health at Institute of Global Health Innovation, Imperial College London and and co-founder of mental health start-up Psyma.

Ara Darzi is an Honorary Consultant Surgeon at Imperial College Healthcare NHS Trust and holds the Paul Hamlyn Chair of Surgery at Imperial College London, the Royal Marsden Hospital and the Institute of Cancer Research. He is Director of the Institute of Global Health Innovation at Imperial College London and Chair of Imperial College Health Partners.

Erik Mayer is a Consultant Surgeon at Imperial College Healthcare NHS Trust & The Royal Marsden NHS Foundation Trust, a Clinical Senior Lecturer at at the Institute of Global Health Innovation, Transformation Chief Clinical Information Officer (Analytics & Informatics) at Imperial College Healthcare NHS Trust and Theme Lead at Imperial NIHR Patient Safety Translational Research Centre.

The COVID-19 pandemic has been one of the greatest health challenges of our time. Across many countries, primary care has been at the frontline responding to the crisis, while continuing to manage health problems unrelated to the pandemic.1 To adapt to these competing demands, “digital-first” models of care (i.e. telephone, video, online) have been implemented to minimise face-to-face contact between patients and providers.2,3

For many patients, the COVID-19 crisis may have represented their first experience of digital, remote care – but it is likely to remain as an increasingly common consultation method. More than an emergency solution to care provision, the adoption of these models during the crisis may have potential long-term effects on how primary care is delivered, both from an operational and cultural perspective. However, while the adoption of digital-first models has happened by diffusion, there is very little evidence about their actual impact on quality, safety and equity of care.

For many patients, the COVID-19 crisis may have represented their first experience of digital, remote care.

To facilitate safe, sustainable adoption of digital-first solutions, it is critical to listen to the end-user, and healthcare’s most important stakeholder: patients.4 We need to understand their perspectives on the impact of the care received, and whether these shifts in delivery of care widen the digital divide. The patients’ ability (or inability) to navigate the healthcare system in this new digital era can generate inequities between different groups of patients, with a potential increased opportunity for widening inequalities in both access to care and patient safety.5 These gaps in knowledge can be pre-empted with targeted public research about usage and perceptions of the impact of digital-first technologies.

Listen to … healthcare’s most important stakeholder: patients.

The COVID-19 pandemic has been a major driving force to accelerate primary care digital transformation. It is now urgent to understand the potential improvements and negative consequences and identify which key learnings need to be taken forward, in partnership with patients.

 

 

References

1. Gray DP, Freeman G, Johns C, Roland M. Covid 19: a fork in the road for general practice. BMJ. 2020 Sep 28;370:m3709. doi: 10.1136/bmj.m3709. PMID: 32988832.

2. Miller L. Remote Supervision in Primary Care during the Covid-19 pandemic – the “new normal”? Educ Prim Care. 2020 Aug 6:1-5. doi: 10.1080/14739879.2020.1802353. Epub ahead of print. PMID: 32757821.

3. Bokolo AJ. Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic. J Med Syst. 2020 Jun 15;44(7):132. doi: 10.1007/s10916-020-01596-5. PMID: 32542571; PMCID: PMC7294764.

4. Liaw WR, Jetty A, Coffman M, Petterson S, Moore MA, Sridhar G, Gordon AS, Stephenson JJ, Adamson W, Bazemore AW. Disconnected: a survey of users and nonusers of telehealth and their use of primary care. J Am Med Inform Assoc. 2019 May 1;26(5):420-428. doi: 10.1093/jamia/ocy182. PMID: 30865777.

5. Matheson J; RCGP Health Inequalities Standing Group. Video consultations: quality, access, and equity in COVID and post-COVID general practice. Br J Gen Pract. 2020 Jun 25;70(696):329. doi: 10.3399/bjgp20X710861. PMID: 32586805; PMCID: PMC7319663.

 

The authors are supported by the Imperial COVID-19 Response Fund, the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, the NIHR Imperial Biomedical Research Centre, and the Imperial Clinical Analytics Research and Evaluation (iCARE) environment.

 

Featured photo by Brett Jordan on Unsplash