PDF(Pubmed)
Abstract：
BACKGROUND: 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.
RESULTS: 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.
CONCLUSIONS: 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.
UNASSIGNED: 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.
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.
RESULTS: 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.
CONCLUSIONS: 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.
UNASSIGNED: 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.
摘要：
背景：远程（数字和/或电话）访问和咨询模型是由国家政策驱动的，目标是到2029年，国家卫生服务在远程优先（数字优先）的基础上运行。先前的研究表明，远程获得护理和咨询的方法可能会扩大某些患者和/或群体的健康不平等，例如少数民族。南亚（SA）患者是英格兰最大的少数民族。了解这一群体的经验和需求对于确保一般做法能够提供公平、优质的医疗保健。
方法：定性研究。37名参与者(来自印度人，巴基斯坦和/或孟加拉国背景）被招募参加面对面的首选语言焦点小组或英语远程半结构化面试。进行了专题分析，以确定定性数据中的主题。
结果：确定了三个相互关联的主要主题：（1）减少访问，（2）减少患者的选择和（3）质量和安全方面的关注。调查结果强调了以下问题：（i）通过任何远程方式进行预约访问的一般问题，以及（ii）与语言障碍有关的具体问题，为访问和护理带来了额外的障碍。一些患者重视远程访问的便利性，但也提出了有关预约可用性和减少患者选择的担忧。面对面的协商是可取的，但较少。这些发现强调了参与者如何认为远程护理质量较低且安全性较低。对于英语水平有限（LEP）的人来说，问题最大。消除了沟通的非语言方面和“动手”护理，导致人们对心理社会安全性降低的看法。
结论：SA患者对远程主导的初级保健服务和护理服务的体验是负面的，只有少数人积极地看待它，并且在某些有限的情况下。面对面的护理模式仍然是首选的咨询模式，特别是对于那些有LEP。混合接入模式为患者提供了最大的选择，并可能满足未来南亚患者人群的不同需求。作为一种理想的服务，远程初级保健方法可能是可以实现的，但它的局限性需要得到承认和考虑，以确保初级保健可以是公平的服务，现在和将来。
■公众参与了研究的所有阶段。这包括在整个研究过程中共同合作，包括，查看面向患者的文件，招募参与者，数据促进，翻译工作,本手稿的数据解释和合著者。我们研究成功的关键是团队合作，其中涉及经验丰富的公众成员，他们具有SA文化知识，与研究团队一起工作并成为所有组件的组成部分。
方法：定性研究。37名参与者(来自印度人，巴基斯坦和/或孟加拉国背景）被招募参加面对面的首选语言焦点小组或英语远程半结构化面试。进行了专题分析，以确定定性数据中的主题。
结果：确定了三个相互关联的主要主题：（1）减少访问，（2）减少患者的选择和（3）质量和安全方面的关注。调查结果强调了以下问题：（i）通过任何远程方式进行预约访问的一般问题，以及（ii）与语言障碍有关的具体问题，为访问和护理带来了额外的障碍。一些患者重视远程访问的便利性，但也提出了有关预约可用性和减少患者选择的担忧。面对面的协商是可取的，但较少。这些发现强调了参与者如何认为远程护理质量较低且安全性较低。对于英语水平有限（LEP）的人来说，问题最大。消除了沟通的非语言方面和“动手”护理，导致人们对心理社会安全性降低的看法。
结论：SA患者对远程主导的初级保健服务和护理服务的体验是负面的，只有少数人积极地看待它，并且在某些有限的情况下。面对面的护理模式仍然是首选的咨询模式，特别是对于那些有LEP。混合接入模式为患者提供了最大的选择，并可能满足未来南亚患者人群的不同需求。作为一种理想的服务，远程初级保健方法可能是可以实现的，但它的局限性需要得到承认和考虑，以确保初级保健可以是公平的服务，现在和将来。
■公众参与了研究的所有阶段。这包括在整个研究过程中共同合作，包括，查看面向患者的文件，招募参与者，数据促进，翻译工作,本手稿的数据解释和合著者。我们研究成功的关键是团队合作，其中涉及经验丰富的公众成员，他们具有SA文化知识，与研究团队一起工作并成为所有组件的组成部分。
