Validating a framework to guide the implementation of high-quality virtual primary care: an international eDelphi study

Edmond Li, Olivia Lounsbury, Ana Luisa Neves

Keywords: virtual consultations, remote consultations, primary care, delphi study, digital health, telemedicine

Background:

Digital technologies in the primary care settings have undergone an immense transformation globally during the COVID-19 pandemic, with virtual consultations having emerged as an innovative new care delivery modality. The post-pandemic context presents an opportunity to revisit the implementation of virtual consultations, and co-design strategies that support their better, safer, and more equitable use.

Research questions:

Based on previous research capturing the views of 1600+ primary care physicians (PCP) across 20 countries, we developed a prototype framework aimed at providing healthcare professionals and policymakers with a stepwise approach for the implementation of virtual consultations. However, there remains a need to bridge the gap between research and its real-world application by aligning the framework’s content with its intended users.

• What are PCP’s views regarding the appropriateness of each component of the prototype framework? What is most relevant, missing, or should be prioritised?
• Through this collaborative process, we aim to develop a practical, field-tested tool that truly reflects the needs, challenges, and perspectives of PCPs when using virtual consultation technologies.

Method:

Our study uses an online Delphi (e-Delphi) methodology, with the expectation to run up to four rounds to seek consensus amongst topic experts (PCPs who routinely perform virtual consultations). Data collected will be analysed using descriptive statistics.

Results:

The survey rounds are scheduled to take place from January-April 2024. At present, 107 PCPs from 18 countries have already agreed to partake in the first e-Delphi round.

Conclusions:

Virtual consultations will continue to play a vital role in enabling the efficient delivery of primary care in many health systems. Having developed a prototype framework previously, this study aims to seek consensus on components critical for its viability and use. Doing so would result in a meaningful tool that is practical for health professionals to use in their clinical settings when integrating new virtual care technologies.

Points for discussion:

Are any of the potential findings relevant for other medicine specialties performing virtual consultations in their respective outpatient settings?

Given the diverse range of countries involved in this study, are there elements which would be more applicable for health systems in either/both HIC and LMIC contexts?

Is this framework ‘futureproof’ enough to contend with emerging disruptive technologies which will also likely play part in the modern primary care setting in due time (e.g., artificial intelligence)?

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