General practitioners' experience about synchronous teleconsultation in primary care: a mixed-method systematic review.

Abstract

BACKGROUND: General practitioners (GPs) extensively used synchronous teleconsultation (STC) during the COVID-19 pandemic. Although this utilization decreased after the state of sanitary emergency was lifted, it remains higher than pre-pandemic levels. METHODS: The aim is to summarize the scientific evidence on the factors influencing GPs’ decision to conduct STC instead of face-to-face consultation. We conducted a systematic review and reported our results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched four electronic databases: MEDLINE, Cumulative Index of Nursing Literature and allied health, Web of Science and the Cochrane Central Register of Controlled Trials and conducted the last search on March 23, 2023. Two independent reviewers selected English/French articles reporting on GPs’ use, attitude, satisfaction, and experience with STC. We assessed the studies’ quality using the Mixed Methods Appraisal Tool, and a narrative approach was performed to synthesize findings. RESULTS: The screening of 9,288 references resulted in the inclusion of 34 studies, for a total of 5,563 participants. Results show that GPs’ decision to use STC is influenced by six categories of factors: (1) consultation, such as consultation purpose (e.g., follow-up care, administrative requests); (2) information and communication technology, such as quality of equipment and bandwidth (internet connection and the effectiveness of the hardware and software); (3) GP, such as convenience (the flexibility offered by the STC); (4) patient, such as access barriers (ex., physical, geographical, financial); (5) GP-patient relationship, such as ease of diagnosis; and (6) the institution, such as organizational and peer support. Lack of a reliable internet connection, need for physical exams, and limited visual cues were the main barriers to using STC. CONCLUSIONS: GPs’ utilization of STC depends on the interplay of six categories of factors, the most important being the purpose of consultation. Equity in access and a fair payment model are key elements to consider in designing health policies aimed at supporting adoption and appropriate use of STC. REVIEW’S PROTOCOL REGISTRATION: PROSPERO CRD42024505744