Patient Safety of Remote Primary Care: Expanding Recent Evidence into Practice Recommendations

Olivia Lounsbury, Edmond Li, Ana Luísa Neves

Background:

The recent rapid proliferation of virtual consultations to support primary care delivery introduced both benefits and risks. Moving forward, it is expected that virtual consultations will remain an integral means of access to primary care services in many health systems. Hence, it is imperative to ensure that its use is safe and effective for both providers and patients.

Research questions:

What are the safety risks associated with virtual primary care from patient and provider perspectives?
What are patient- and provider-informed strategies to mitigate the risks identified?

Method:

Focus groups and interviews with patients, carers and general practice clinicians were performed over six months. The resulting transcripts were coded and thematically analysed. A total of 42 subjects participated in the study, of which 19 were patients or caregivers.

Results:

We identified three main risk themes: (1) suboptimal clinical decision-making, (2) negative impact on patient access, and (3) worsening the healthcare workforce crisis. Participants highlighted potential solutions to mitigate these risks, including: (1) providing more comprehensive information to patients prior to their appointments, (2) enhancing training for triage personnel, (3) making technical support more readily available, (4) standardising care escalation guidelines, (5) setting up more robust systems for feedback, (6) emphasising better patient communication, and (7) improving continuity of care and safety netting.

Conclusions:

Existing policies need to be updated and new ones devised to minimise risks and better support patient and provider workflows. We anticipate that if the recommendations above are implemented, we may expect the following benefits to patients and providers:
Improved shared expectations about appropriateness of each modality of appointment, clearer thresholds for escalation of care to an in-person appointment, and clarity regarding next steps should the condition not improve after the virtual visit
Enhanced tools and systems to conduct physical patient assessments virtually
Continuously optimised systems based on more robust user feedback mechanisms.

Points for discussion:

As virtual care consultations evolve, what is the best way to capture new risks on an ongoing basis?

How can we better engage populations typically excluded from research in primary care?

How can we expedite translation of these findings into practice?

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