Inequalities in general practice remote consultations: A systematic review

Background COVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.

Aim To explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.

Design & setting Systematic review

Method We undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.

Results Based on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.

Conclusion Remote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.