King’s College London: Switch to telephone GP consultations during pandemic widened inequalities among multimorbidity patients
The study, published in BMC Medicine, by researchers from the Faculty of Life Sciences & Medicine assesses how the use of primary care by individuals with multimorbidity was impacted by the COVID-19 pandemic.
People with multimorbidity have two or more long-term conditions and have complex healthcare needs and an increased risk of worse outcomes if they contract COVID-19. Many of this group was classified ‘vulnerable’ by the NHS and asked to shield at home at the beginning of the pandemic. Primary care providers were asked to roll out remote consultations to this group as a priority to limit risks associated with COVID-19.
Researchers analysed anonymised primary care records of 460,084 individuals in 41 GP practices in South London from February 2018 to March 2021. Face-to-face consultations declined at the start of the pandemic but this was seen largely among individuals without multimorbidity.
As the pandemic persisted, the data shows Black, Asian and Other ethnic groups switched to telephone consultations at a higher rate compared to white ethnicity groups. The difference was particularly seen among people with Asian ethnicity.
Despite the emphasis on telephone consultations, face-to-face appointments were still available and encouraged where appropriate, such as when patients needed a physical examination. These in-person consultants can be essential for people with multimorbidity, such as blood pressure checks and diabetes checks, which are not possible over telephone.
Patients from ethnic minority groups were at an increased risk of severe COVID-19 and may have felt a face-to-face consultation an unnecessary risk. However, less frequent monitoring of long-term conditions or new diagnoses can increase the risk of future health complications.
Practices adapted quickly to remote consultations in line with the NHS’ recommendation to reduce face-to-face contact. However, the shift towards remote consultations likely increased barriers to access for particular groups, including those who lack the appropriate technology, lack private space in their household and those with low spoken English skills. A reduction in face-to-face consultations may negatively impact the quality of care received by these patients.
– First author Alice McGreevy, from the School of Life Course & Population Sciences
Author Professor Mark Ashworth, Professor in Primary Care from King’s College London, said: “It has been a tough time in primary care as we work through the back-log from the COVID-19 pandemic. We know that people with multiple long-term conditions have a greater need for primary care and more research is needed to understand the consequences of late or missed diagnoses during the pandemic, especially among ethnic minority groups.”