Use of an electronic consultation system in an inner city general practice: a mixed-methods service evaluation.

Background: The COVID-19 pandemic propelled the uptake of electronic consultation (e-consultation) tools. Such tools promise to increase access and improve efficiency. Previous research has highlighted unintended consequences associated with e-consultation use.

Aim: To explore patient and staff views, experiences and usage of an e-consultation tool in a general practice setting, 2 years after the start of the COVID-19 pandemic.

Design and setting: A mixed-methods service evaluation of an e-consultation tool (eConsult) in an inner city general practice.

Methods: E-consultations submitted between June and August 2022 (n=972) and associated electronic medical records were quantitatively analysed for the reason for query, type of response and whether it was followed by a reconsultation within 14 days. Reflexive thematic analysis on qualitative interviews with patients and staff (n=18).

Results: 76% of e-consultations were followed by a face-to-face or telephone encounter as the primary response type. 21% of e-consultations were followed by a reconsultation for the same problem within 14 days.E-consultations brought advantages for some patients in terms of access and convenience; however, other patients described a negative impact on expression, recognition of symptoms and the patient-doctor relationship. The access provided by eConsult surpassed practice capacity, leading to reports of clinician burnout. There was an incongruous view on the purpose of e-consultations among patients and staff.

Conclusion: Evaluation of e-consultation tools is essential to ensure staff and patient needs are met. Although some benefits of e-consultations were identified, a number of unintended consequences were reported, including negative impacts on workload, patient communication and the patient-doctor relationship.