N. Walsh1, B. Jones1, R. Thomas1, A. Berry1, Z. Anchors1
1University of the West of England, Centre for Health and Clinical Research, Bristol, United Kingdom
Background: First Contact Physiotherapy (FCP), whereby a patient with a musculoskeletal disorder consults directly with a physiotherapist without the need for medical referral, is a mainstay of UK primary care practice. Prior to COVID-19 almost all consultations were in-person, but imposed restrictions on care during the pandemic meant only remote (phone or online) consultations were permitted. 'Digital first' strategies now encourage the continued use of this consultation format which makes healthcare more convenient and accessible for patients. However previous research with General Practitioners suggested they experienced anxiety due to uncertainty in diagnosis, increased administration workload, and feelings of isolation, all of which contribute to staff dissatisfaction and willingness to continue in their role. There is now an emerging concern that the well-being and job satisfaction of FCPs may be impacted by remote ways of working.
Purpose: The aim of this study was to explore the benefits and challenges of remote consultations, and to identify the impact on FCP staff wellbeing.
Methods: A mixed methods sequential explanatory study was conducted. Phase 1 included an online survey which measured current usage of remote consultation methods, challenges and benefits of these methods, stress appraisals and engagement with training. Phase 2 included semi-structured interviews that explored in-depth, the lived experiences of using remote consultation methods.
Results: The online survey received n=109 responses from FCPs. Data revealed that despite the push for ‘digital first’ consultations, 62% of FCPs used them for less than a quarter of their appointments; phone was the most readily used format (98%). FCPs considered remote consultations were ‘rewarding’ and ‘satisfying’ for patients in terms of providing them with easier access to appointments. The key challenge was the stress associated with IT issues. Other highlighted challenges were perceived poor efficacy, anxiety over missing important diagnostic details, feelings of isolation, and increased workload. Although the work demands were considered fairly high, FCPs reported sufficient resilience to deal with this level of demand at present. Nearly two thirds (64%) of the FCPs had not received training in remote consultations, yet over half (55%) were interested in receiving relevant training. Follow-up interviews with n=16 FCPs revealed additional challenges when working in areas of high socioeconomic deprivation. These included lack of patient access to technology and digital literacy, language barriers, and poor health literacy. In response to these challenges, FCPs employed coping strategies including, a default face to face appointment, managing their own and the patient consultation expectations, and increasing their use of other community based resources for further information.
Conclusions: FCP remote consultations offer a convenient alternative for patients, but may add to role stress for staff particularly in areas of high socioeconomic deprivation. Further research is required to understand how remote consultations can be enhanced when language barriers and lower levels of health literacy exist. Understanding patient perspectives of remote consultations will also lead to further service improvements.
Implications: There is a necessity for better training to support FCPs to deliver remote consultations. Continued monitoring of job satisfaction and resilience levels is important to ensure FCPs remain in their role.
Funding acknowledgements: This work was funded by the NIHR Health and Social Care Services Delivery Research Programme 16/116/03
Keywords:
First Contact Physiotherapy
Remote consultations
First Contact Physiotherapy
Remote consultations
Topics:
Professional issues
Primary health care
Professional practice: other
Professional issues
Primary health care
Professional practice: other
Did this work require ethics approval? Yes
Institution: UWE Bristol
Committee: Faculty Research Ethics Committee
Ethics number: HAS.19.06.204
All authors, affiliations and abstracts have been published as submitted.
