Scottish Social Attitudes Survey 2021/22: public views of telephone and video appointments in general practice

5. Discussion

This section will now discuss the results above in more detail. As the survey questions were not open-ended, there are no definite reasons as to why people chose their answer. Thus, the discussions here are based on exisiting and relevant literature as well as assumptions.

5.1 Comfort accessing healthcare by video/phone compared with face-to-face

A higher percentage of the public thought they would be 'very/fairly comfortable' with face-to-face in comparison to phone and video.

One key finding of the Public Understanding and Expectations of Primary Care in Scotland: Survey Analysis Report showed that satisfaction was highest for face-to-face appointments and lowest for video appointments among the respondents of that study. In relation to the results of remote appointments linked to doctors knowing their patients less well, this could indicate that there is also a missed relationship or physical interaction between patient and clinician.

5.2 Ease accessing healthcare by video/phone compared with face-to-face

A higher proportion of people said phone appointments were easier to access than those who said the same for face-to-face or video appointments in this study.

The ability to attend a phone appointment more quickly than getting to a face-to-face appointment or setting up a device for a video appointment, impacts the availability and flexibility of appointment times, thus reducing time spent in waiting rooms or travelling to and from appointments. As mentioned in the introduction of this report (and in the section below), other research reports that clinicians find telephone appointments easier for follow up appointments and non-acute emergencies.

5.3 What impacts people's chosen method of accessing healthcare?

How worried people were about their condition and how quickly they could get an appointment were the two main factors that influenced people to accept/decline a remote appointment.

This could be linked to the above response where people found it easier to attend phone appointments than face-to-face or video. Clinicians have also reported that they find face-to-face appointments are not necessary when the patient can be seen over the phone or video where the condition does not present as high risk.

5.4 Thoughts towards more use of remote health services (in place of face-to-face)?

Doctors not knowing their patients well and ensuring that people who needed a face-to-face appointment could get one were the top two scenarios that people were most likely to agree with when asked what they thought of remote replacing face-to-face appointments. This was closely followed by the attitude that remote appointments would be more convenient for most patients.

A Scottish case study examining the impacts of COVID-19 on video consultations, showed that respondents considered video appointments based on "home and work commitments, travel and transport access, the nature of the clinical problem, a desire (or not) to establish or strengthen a personal relationship with the clinician, and sheer convenience". This highlights similar themes to this survey's findings, where remote appointments may ease the pressures brought on by arranging and attending face-to-face appointments, yet may also mean losing a clinical-patient relationship. Further research would be required to understand these results in more depth.

5.5 Respondents' Characteristics – Significant Differences

5.5.1 Age

Age was found as a significant difference between comfort levels with face-to-face appointments, where those aged over 65 were more likely to find these appointments 'very comfortable' in comparison to other age groups. No significant differences were found for either of the remote appointments. As mentioned in the background to this report, a mixed methods case study suggested that older populations are more likely to be given face-to-face appointments as they are considered to be less digitally literate than younger generations. The Public Understanding and Expectations of Primary Care in Scotland: Survey Analysis Report also highlighted that those aged 65+ were less likely to use the internet to decide what their health problem would be than any other age group. Therefore, this question could suggest that older populations are more likely to be comfortable with face to face than other age brackets as they have more experience of this type of appointment and are less likely to turn to online resources to explore a potential medical issue. This report did not capture that data, yet it is interesting to note when seeking to understand how public attitudes towards remote appointments may be based on previous actual experience.

5.5.2 Gender

Males were more likely to say they would be 'very/fairly comfortable' with video appointments than females. According to the Office of National Statistics in 2019, men were higher users of the internet than women which was in keeping with previous years. Findings related to gender and internet use were not produced for the most recent ONS report. This may suggest that men are more comfortable with remote appointments as they use the internet more frequently than women.

5.5.3 Level of Satisfaction with the NHS

Higher satisfaction with the NHS correlated with how easy or difficult people perceived all three appointment methods. Those with higher satisfaction rates (very/quite) were more likely to say that face-to-face or remote consultations were 'very/fairly easy'. Those who said they were very or quite satisfied with the NHS were more likely to say they would be 'very/fairly comfortable' with appointments over the phone or through video. This could be linked with respondent characteristics such as general health. If the respondent is in good health and only attends appointments for minor illnesses they may not have to access the NHS as frequently and thus may have a better satisfaction rate with them. Again, this report did not capture concrete evidence for this and further research would be required.

5.5.4 Frequency of Internet Use

Frequency of internet use was highlighted as a factor linked to higher comfort levels and ease of access for appointments via phone or video. Those who use the internet several times a day mostly likely access it through a smart phone and/or are more comfortable with using technology and/or have a portable mobile phone.

As less than 25 of the 1130 respondents reported having no internet access, no meaningful statistical tests could be drawn. Therefore this report cannot make conclusions for attitudes about remote appointments that could be impacted by not having access to the internet. Equally, issues such as poor connection or quality, lack of private space or those with little technological literacy were not discussed yet may impact attitudes towards remote appointments.

5.5.5. General Health and Long-Term Illnesses

Those with very good/good general health were more likely to be comfortable with and find it easier to attend remote appointments. Those that reported they did not have a long-term illness were also more likely to say that attending an in-person or video appointment would be easy. No significant differences were reported for the use of phone appointments and long-term illness.

According to the results of the overall 'Primary Care Understanding and Expectations of Primary Care in Scotland: Survey Analysis Report', "Respondents with a limiting long-term illness were more likely than the overall total to report that their most recent mode of treatment/advice was by telephone". The Near Me Evaluation found that 66% of clinicians interviewed preferred video appointments for follow-up consultations of long-term conditions. Rosen et al also suggests that clinical staff found remote appointments resulted in better management of long-term illnesses as patients did not have to travel into and wait in the practice, although this was based on a small sample size combined with previous evidence about remote consultations.

Those with poor general health were more likely to agree strongly that increasing remote appointments (in replace of face-to-face) would result in their doctor knowing them less well. This is interesting in relation to the point made by Rosen et al that clinicians prefer management of long-term illnesses over the phone. Thus, there may be a contradiction between the clinicians' management of long-term illnesses through remote appointments and the clinical-patient relationship that is impacted by this. Although this will be influenced by multiple factors such as patient specific conditions, preference, location of their practice, and ability to access remote appointments.

5.5.6. Respondents with Children under 16

Based on the results of this study, there is significant difference between convenience of remote appointments and having children under 16 to care for. Those with children under 16 were more likely to agree that remote appointments were more convenient. This is perhaps due to travel/time limitations when being offered a face-to-face appointment, as remote consultations offer the opportunity to have appointments within the home without the need to arrange childcare. Although this will be largely dependent on the type of consultation being discussed.