Abstract

Background

The COVID-19 pandemic has focussed attention on models of healthcare that avoid face-to-face contacts between clinicians and patients, and teleconsultations have become the preferred mode of primary care delivery. However, the effectiveness of remote consultations in this setting remains unclear.

Objective

To evaluate the impact of telephone or video consultations compared to those conducted face-to-face on key patient-relevant outcomes and healthcare utilisation in primary care, mental health and allied health services, which have had a critical role in the management of the wider and longer-term consequences of COVID-19.

Methods

A systematic review of primary studies comparing telephone or video consultations versus face-to-face visits, following the PRISMA guidelines.

Results

Overall, consultations delivered by telephone and videoconference were as effective as face-to-face in-person visits to improve clinical outcomes in adults with mental health conditions and those attending primary care services. Patient satisfaction with telephone and video consultations and the therapeutic alliance was high across the studies. However, high discontinuation rates in patients receiving teleconsultations indicate this may not be a suitable modality of healthcare delivery for all patients. Teleconsultations offer significant patient time savings in primary care, but appropriate implementation, including training of healthcare professionals and management of technical issues, is essential to ensure effective and valuable clinical interventions.

Conclusions

Teleconsultations via telephone or videoconference are an effective alternative to face-to-face consultations for many patients attending primary care and mental health services. Teleconsultations have the potential to deliver time-efficient and lower-cost interventions at a distance while improving access to healthcare.

中文翻译：

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远程会诊在初级保健中的有效性：系统评价

摘要

背景

COVID-19 大流行将注意力集中在避免临床医生和患者之间面对面接触的医疗保健模式上，远程会诊已成为提供初级保健服务的首选模式。然而，在这种情况下远程会诊的有效性仍不清楚。

客观的

评估电话或视频咨询与面对面咨询相比对初级保健、心理健康和联合医疗服务中关键患者相关结果和医疗保健利用的影响，这些在更广泛的疾病管理中发挥了关键作用和 COVID-19 的长期后果。

方法

根据 PRISMA 指南，对比较电话或视频咨询与面对面访问的主要研究进行系统评价。

结果

总体而言，通过电话和视频会议提供的咨询与面对面的面对面访问一样有效，以改善患有精神健康状况的成年人和接受初级保健服务的人的临床结果。患者对电话和视频咨询以及治疗联盟的满意度在所有研究中都很高。然而，接受远程会诊的患者的高停药率表明，这可能不是对所有患者都合适的医疗保健提供方式。远程会诊可显着节省患者在初级保健中的时间，但适当的实施，包括医疗保健专业人员的培训和技术问题的管理，对于确保有效和有价值的临床干预至关重要。

结论

对于许多接受初级保健和心理健康服务的患者来说，通过电话或视频会议进行远程咨询是面对面咨询的有效替代方法。远程会诊有可能在远处提供省时和低成本的干预措施，同时改善获得医疗保健的机会。