Background: Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. Objective: With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. Methods: In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). Results: In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. Conclusions: This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care.

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中文翻译：

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在初级保健中实施电子咨询的障碍和推动因素：范围界定审查

背景：电子咨询通常被宣传为满足日益增长的需求、改善患者可及性和提高整体效率的一种方式，在初级保健中变得越来越普遍，特别是考虑到当前的 COVID-19 大流行。然而，尽管它们的使用越来越多，但对支持和抑制其有效实施的因素的理论上的理解却受到严重限制。目标：通过这次范围审查，我们试图找出支持和阻碍初级保健中实施电子咨询的因素。方法：系统地检索了 5 个电子数据库（PubMed、Medline、Embase、CINAHL 和 PsycINFO），以查找 2009-2019 年发表的研究，这些研究探讨了电子咨询在初级保健中的影响和/或实施。数据库检索以参考文献列表和灰色文献检索为补充。使用归纳主题分析对数据进行分析，并使用归一化过程理论（NPT）进行合成。结果：初步确定了 227 篇文章，其中 13 篇纳入本次综述。发现阻碍实施的主要因素包括意识和期望；参与度低；对所有患者群体、病情和人口统计数据的感知适合性；成本; 和其他背景因素。关于信息技术可靠性和临床工作量重复（而不是减少）的报告似乎也有害。相反，制定协议和指南；患者和员工教育；战略营销；患者和公众的参与都被认为有利于促进电子咨询的实施。结论：本次审查强调需要与患者和工作人员积极互动，以促进理解和认识、流程优化以及提供连贯的培训和教育，从而最大限度地提高影响和成功。尽管在 COVID-19 大流行期间使用在线方法的必要性可能会提高人们的认识，但对工作量重复和访问不平等的担忧可能仍然存在。未来的研究应该从多个角度（例如患者、专业人员和专员）探讨电子咨询中的健康不平等及其经济影响，以确定其潜在价值。随着健康和社会护理的快速数字化，还需要进一步开展工作，以确定患者有意义的参与在数字创新、实施和评估中的作用。

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