Digital access to primary care for older people during COVID
Research type
Research Study
Full title
Impact of digitalisation on access to primary care for older people during the COVID-19 pandemic
IRAS ID
323753
Contact name
Chris Todd
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
0 years, 4 months, 30 days
Research summary
Summary of Research
For at least a decade, the World Health Organization and the NHS have been encouraging use of digital technology to improve health and care services. This has expanded during the COVID-19 pandemic, where lockdowns and social restrictions have been accompanied by rapid roll-out of digital technologies to maintain access to health and care services. Government policy outlines a ‘digital first’ vision that prioritises the development of digital access to health and care services, e.g., by the NHS App as the ‘front door’ to the NHS. However, there concerns that older people are being disadvantaged and excluded with the increased use of digital technologies.
The NIHR Older People and Frailty Policy Research Unit has conducted two evidence reviews exploring the impact of digital technologies on older people's access to health and care. The first, conducted before the pandemic, found a lack of evidence that digital technologies could support older people’s access to health and care. The second has looked at what research has been conducted on the digitalisation of health and care services since the start of the pandemic. Most research so far has been small-scale and has focused on telephone access. There is an urgent need for detailed analysis of the impacts of pandemic-driven digitalisation of health and care services on older people. In particular, there is a need for a focus on potential health inequalities among different groups of older people (e.g., socioeconomic and ethnic groups). In this study, we propose to analyse electronic medical records in England to explore the impact on older people of digitalised GP access during the pandemic. We will analyse data from adult patients aged at least 18 who were registered with GPs between January 2019 up to December 2022, with a specific interest in comparing consultation data for those aged under 65 and 65+.Summary of Results
This study looked at how remote GP appointments (telephone, video or online consultations) were used in England before and during the COVID-19 pandemic, especially comparing older and younger adults. The study used health data from around 19 million people between 2019 and 2022, accessed via a secure platform called OpenSAFELY.
Key findings:
• The number of remote appointments per year increased from 10 million before the pandemic (March 2019 - March 2020) to 32 million during the pandemic (March 2020 - March 2022).
• Before the pandemic, people aged 85 and over had the fewest remote appointments but were the most likely age group to have one. During the pandemic, younger adults (18–49) became the most likely group to have remote appointments, but the 85+ group had the second highest proportion.
• Women were more likely than men to use remote appointments both before and during the pandemic.
• Before the pandemic, people in more deprived areas were more likely to have remote consultations than those in wealthier areas. This pattern continued during the pandemic.
• White people were the most likely ethnic group to use remote consultations in each of the three years analysed.
These findings are important because government policy is to increase digital access to healthcare. While remote services can improve access, there are concerns that older people might be left out. The study findings show that there were significant variations in remote consultations by age, gender, socioeconomic status and ethnicity during the pandemic. However, digital access to services may also have contributed to a greater number of appointments overall, potentially reducing barriers to primary care. More research is needed to understand how these differences affect people’s health. The study also showed that the OpenSAFELY system is a feasible platform to conduct this kind of analysis.REC name
West of Scotland REC 3
REC reference
23/WS/0032
Date of REC Opinion
10 Feb 2023
REC opinion
Favourable Opinion