Remote consulting for anxiety and depression
Research type
Research Study
Full title
Primary care practitioners’ and patients’ views on the benefits and challenges of remote consulting for anxiety and depression in general practice
IRAS ID
319673
Contact name
Charlotte Archer
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
0 years, 11 months, 27 days
Research summary
Research Summary
Primary care appointments that take place over the telephone or by videocall are called remote consultations. During the COVID-19 pandemic, most appointments moved from face-to-face to remote consulting. It is likely that many appointments will continue to be delivered this way. GPs and nurses report that telephone consultations can be useful for long-term conditions, or where physical examinations are not required. However, some patients may not have a private space to discuss sensitive issues, or prefer to do so in-person. Some may also struggle with the technology that is needed for remote consultations. \n\nWhilst there is research on the use of remote consulting across primary care generally, we do not know what the benefits and challenges are for the management of individuals with anxiety and depression. This is particularly important because 40% of primary care consultations focus on mental health, and this figure has increased since the pandemic. During these consultations, distressing issues may be discussed. Patients may find it difficult to have these conversations over the telephone. Additionally, GPs and nurses are unable to notice important physical cues. Alternatively, anxiety and depression can make it more difficult to attend appointments or discuss problems in-person. Therefore, these patients may find remote care easier than in-person appointments. Understanding the benefits and challenges of remote consultations for mental health will inform how best, and when, this method of consulting is used within primary care. \n\nTo understand GPs’, nurses’ and patients’ views and experiences of remote consultations for the management of anxiety and depression, to identify what elements are beneficial, what are the challenges, and how these consultations can be best used and delivered in the future. \n\nWe will interview up to 40 practitioners and patients on a one-to-one basis. Interviews will be analysed to identify common themes, to better understand people’s experiences.
Summary of Results
Background Primary care appointments that take place over the telephone or by videocall are called remote consultations. During the COVID-19 pandemic, most appointments moved from face-to-face to remote consulting. It is likely that many appointments will continue to be delivered this way. GPs and nurses report that telephone consultations can be useful for long-term conditions, or where physical examinations are not required. However, some patients may not have a private space to discuss sensitive issues, or prefer to do so in-person. Some may also struggle with the technology that is needed for remote consultations.Whilst there is research on the use of remote consulting across primary care generally, we do not know what the benefits and challenges are for the management of individuals with anxiety and depression. This is particularly important because 40% of primary care consultations focus on mental health, and this figure has increased since the pandemic. During these consultations, distressing issues may be discussed. Patients may find it difficult to have these conversations over the telephone. Additionally, GPs and nurses are unable to notice important physical cues. Alternatively, anxiety and depression can make it more difficult to attend appointments or discuss problems in-person. Therefore, these patients may find remote care easier than in-person appointments. Understanding the benefits and challenges of remote consultations for mental health will inform how best, and when, this method of consulting is used within primary care.
Aim
The aim was to understand practitioners’ (GPs, nurses, pharmacists and wellbeing coaches) and patients’ views and experiences of remote consultations for the management of anxiety and depression, to identify what elements are beneficial, what are the challenges, and how these consultations can be best used and delivered in the future.Methods
20 practitioners GP and 21 patients were recruited for interview through GP practices. Practitioners were informed about the study by their practice managers. Patients with anxiety and/or depression were invited for interview by GP practices posting invitation letters to patients.Practitioners and patients took part in a one-off individual interview with a researcher. Interviews were held either over the telephone or by videocall. Topic guides were used to ensure consistency across the interviews. After the interview, participants were asked to complete a brief demographic questionnaire, the information from which was then used to describe those interviewed.
All Interviews were audio recorded (with consent), transcribed and checked for accuracy. Data were analysed to understand themes in the interviews. The practitioner interviews were fully analysed before the patient interviews. Findings from the two datasets were then compared to identify similarities and differences between practitioners’ and patients’ accounts.
Key findings
The results from practitioner and patient interviews highlighted that offering remote consulting improves access to general practice care for many patients with anxiety and depression. However, it is not suitable for or preferred by every patient or appropriate for each situation. Both interview groups suggested that in-person appointments were important for the initial consultation, but that there were also differences in the types of patients who might prefer a telephone consultation (younger, parents, living in less deprived areas, less severe mental health). Patients said they thought remote modes were quicker for practitioners, and that was why there was increased use of telephone appointments and e-consults in primary care. However, practitioners said that remote modes for mental health are not necessarily more time-efficient, although it might increase the speed at which a patient could access a consultation or provider quicker access to practitioner advice.Practitioners said that risk could be harder to assess remotely, and patients also shared that they may choose to withhold information and/or find it harder to disclose sensitive information over the telephone. Therefore, the study highlighted that sometimes there might be greater risks for patients with mental health if the patient isn’t seen in-person, as there is increased risk that mental health might not be discussed and undiagnosed. Practitioners noted that remote consulting was brought in during the COVID, without any training specific to mental health. Both patients and practitioners identified a need for practitioner training around identifying risk in the absence of non-verbal cues and ‘knowing what questions to ask’. Further training in this area will be important as it can be harder to build rapport on the phone and patients also mentioned these factors as being more relevant in such situations: skilful questioning, good levels of empathy/listening, risk identification.
This study has helped us to understand the value of remote consultations in the management of patients with anxiety and depression. The results indicate when remote care is considered acceptable and appropriate by patients (and practitioners) and has identified the benefits and challenges of remote care and ways that these can be maximised/reduced. Findings from this study will provide suggestions on when and how these consultations should be used, to ensure that patients are able to access the help they need in a way that is appropriate for them.
REC name
South West - Frenchay Research Ethics Committee
REC reference
22/SW/0136
Date of REC Opinion
20 Oct 2022
REC opinion
Favourable Opinion