‘Total Change?’: Exploring the use and experience of total triage V1.
Research type
Research Study
Full title
‘Total Change?’: Exploring the use and experience of total triage and remote consultations
IRAS ID
306164
Contact name
Sudeh Cheraghi-Sohi
Contact email
Sponsor organisation
The University of Manchester
Clinicaltrials.gov Identifier
NA, NA
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Summary of Research
During COVID-19, when we have tried to book a GP appointment, we have all had to go through a system, called a ‘triage’ system, that decides how we are seen and who we are seen by. Decisions as to who got an appointment, when and what type of appointment (face-to-face, telephone or video-call) were made either by receptionists, Nurse Practitioners and/or GPs. These decisions were made either over the phone or alternatively by patients, (or their carers), filling in a form online.
Past research has shown that patients from ethnic minority backgrounds have faced inequality when accessing healthcare services. We want to explore how people from such backgrounds have experienced accessing care in general practice during total triage and whether they have experienced any issues more, or different to, those reported for the general population. General Practice staff have also had to get used to these new ways of working and there is little understanding of how GP staff are making triage decisions under total triage, or how doing most of your work by telephone for example, might affect their feelings towards their work, how they are working with the potential for impact(s) on patient safety of particular concern.
Aims
Using qualitative methods (semi-structured interviews and focus groups), this study aims to find about patient and General Practice staff routine use of total triage systems. In particular:
1) How GP staff have implemented total triage
2) How patients are being triaged under total triage and why
3) What the advantages and disadvantages of using total triage are for South Asian patients and General Practice staff with including any perceived impact on patient safety.The study is funded by the NIHR School for Primary Care research (2021-2026-519). We will work with the Greater Manchester Clinical Research Network to recruit general practices and staff participants.
Summary of Results
Abstract Introduction Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operate on a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care.
Methods
Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data.Findings
Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choice and (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and ‘hands-on’ care leading to perceptions of reduced psycho-social safety.Conclusion
SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future.Public Contribution
Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.REC name
East of Scotland Research Ethics Service REC 2
REC reference
22/ES/0011
Date of REC Opinion
24 Mar 2022
REC opinion
Further Information Favourable Opinion