Patients’ experiences with remote consultations in primary care during the COVID-19 pandemic

a qualitative study of this alternative to in-person care

Abstract

Introduction: Teleconsultation was abruptly introduced in Brazil as an alternative to in-person care during the COVID-19 pandemic. Objective: We sought to understand how patients perceive remote consultations—whether they consider them comparable to face-to-face encounters or merely an exceptional measure imposed by the pandemic. Methods: This qualitative study used video interviews guided by a semi-structured script with patients from primary care in Florianópolis. Patients who had undergone remote consultations with the same physicians conducting the study were invited to participate. We inquired about previous experiences with telehealth, technical aspects, feelings about teleconsultation, comparisons with in-person visits, and future perspectives. The interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: Remote consultations and other virtual interactions with the primary care service were well received, showing quality comparable to in-person care and no significant technical limitations. This tool appears to be enduring and promising, though not suitable for all conditions or demands. According to patients, it is up to the health care professional to decide whether in-person or remote care is more appropriate at the time of consultation. Patients tend to prefer remote modalities for punctual issues and in-person visits for more complex conditions requiring physical examination. Inspection—possible through video—was not considered a physical examination. We observed that there is a conventional “consultation process” consisting of a trigger (a problem or complaint), followed by dialogue between doctor and patient, physical examination, complementary tests, and management. When all these components are present, and in this order, the interaction is unanimously interpreted as a “consultation.” When one of these four components is absent, the interaction is not always perceived as a “consultation,” and the management provided is often interpreted merely as guidance or “triage.” Conclusions: Remote consultations were well evaluated and tend to remain as a complement to in-person care, especially for simple demands. However, they do not replace in-person consultations in situations that require physical examination or more complex assessment. The notion of a “consultation” remains linked to a traditional process, and interactions that do not include all of its elements are not always recognized as such by patients. Thus, teleconsultation appears to be a promising tool, provided that it is used with clear clinical criteria and accompanied by adequate communication between professional and user.