ArticleBMJ open2018
Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
61 citing papers in PubMed, 7 syntheses or guidelines pooled it, 124 citations in OpenAlex.
- What patients want from access to UK general practice: systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Pooled it
- Patient-facing online triage tools and clinician decision-making: a systematic review.BMJ open · 2025Pooled it
- A theory-based analysis of the implementation of online asynchronous telemedicine platforms into primary care practices using Normalisation Process Theory.BMC primary care · 2025Pooled it
- The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review.BMC health services research · 2024Pooled it
- Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers.Journal of medical Internet research · 2022Pooled it
- Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics.International journal of environmental research and public health · 2021Pooled it
- Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review.BMC family practice · 2020Pooled it
- Article
- Access to general practice appointments and sustainable change: a focused ethnographic case study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Experiences of text-based synchronous computer-mediated communication in primary care: a qualitative study of registered nurses' experience.Frontiers in health services · 2026Article
- Cost minimization analysis of digital-first healthcare pathways in primary care.NPJ digital medicine · 2025Article
- Use of an electronic consultation system in an inner city general practice: a mixed-methods service evaluation.BMJ open quality · 2025Article
- Acceptability of Guided Symptom Entry and Asynchronous Clinical Communication Software Among Primary Care Staff: Qualitative Study.JMIR formative research · 2025Article
- Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study.Journal of medical Internet research · 2025Article
- Uses of Virtual Care in Primary Care: Scoping Review.Journal of medical Internet research · 2025Article
- Patients' Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study.Journal of medical Internet research · 2025Article
- Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic.The International journal of health planning and management · 2025Article
- Medical students' and educators' opinions of teleconsultation in practice and undergraduate education: A UK-based mixed-methods study.PloS one · 2025Article
- Nationwide trends of online consultations in China: a 10-year sequential cross-sectional study of 65 305 clinicians.BMJ public health · 2025Article
- Nurses who co-create care with clients experience lower levels of burnout through the perception of fewer emotional demands: an observational study.BMC nursing · 2024Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTo examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved.
designMixed-method evaluation of a primary care e-consultation system.
settingPrimary care practices in South West England.
methodsQualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients' records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients' and staff touchpoints.
resultsWe found different expectations between patients and staff on how to use e-consultations 'appropriately'. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation.
conclusionsWhere both patients and staff interact with technology, it is in effect 'co-implemented'. How patients used e-consultations impacted on practice staff's experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.