Inequalities in general practice remote consultations: a systematic review.

Area of Science:

• General practice and primary care research.
• Health services research.
• Digital health and telemedicine.

Background:

• The COVID-19 pandemic accelerated the adoption of remote consultations in general practice.
• The impact of these remote consultations on health inequalities remains largely unknown.
• Understanding differential utilization is crucial for equitable healthcare delivery.

Purpose of the Study:

• To compare the utilization and clinical outcomes of remote versus face-to-face consultations in primary care.
• To examine the impact across various socioeconomic and disadvantaged groups.
• To identify potential disparities in access and outcomes related to remote consultation modalities.

Main Methods:

• A systematic review of electronic databases (MEDLINE, EMBASE, Web of Science) was conducted.
• Included studies compared remote (telephone, internet) with face-to-face consultations in primary care.
• Outcomes were assessed using PROGRESS Plus criteria, with risk of bias evaluated by ROBINS-I. Data synthesis was narrative.

Main Results:

• Thirteen studies indicated telephone consultations were used by younger, working-age individuals, the very old, and non-immigrants.
• Internet-based consultations were more common among younger individuals, with some evidence suggesting higher use in affluent areas.
• Women consistently used remote consultations more than men; impacts on quality of care or clinical outcomes were not reported.

Conclusions:

• Remote consultations in general practice are predominantly used by younger, working individuals, non-immigrants, older patients, and women.
• Internet-based options appear more utilized by younger, affluent, and educated populations.
• Further research is essential to understand the health inequalities associated with remote consultations and their impact on clinical outcomes and quality of care before widespread implementation.