Triage before the screen: structuring teleconsultations in primary healthcare

Abstract Background To address the growing need for improvements in the effectiveness and access to telemedicine services, the expectations of various stakeholders, including healthcare providers, should be explored. This study was designed to provide an in-depth understanding of clinical experts’ perspective of the underlying challenges and criteria at the clinical level - as per WHO's levels of challenges in telemedicine services [1] - that guide decision-making of primary care physicians when assessing patient eligibility for a teleconsultation (TC). Methods The study used a qualitative approach with a dual moderator focus group. Data collection was based on note-taking and participant observation with a purposefully selected group of six clinical experts - teaching physicians specializing in family medicine/primary health care and general practitioners with over 20 years of work experience, versed in current clinical standards and guidelines. Results Key clinical-level criteria guiding physicians’ decisions on patient eligibility for TC were identified, most notably “type of visit": urgent, planned, or coordinated care; followed by “patient type": known, unknown, with a chronic disease. All respondents declared they considered it essential to inquire about “alarm symptoms” in patients to decide whether to provide/continue TC. Conclusions To optimize telemedicine services in primary health care, consideration should be given to system regulations and the introduction of a triage system (equivalent to that in emergency care settings) before / at the initial state of teleconsultations when patient eligibility for TC or an in-person visit is assessed. References [1] Support tool to strengthen telemedicine: resource for assessment, strategy development, and strengthening of telemedicine services. Copenhagen: WHO Regional Office for Europe; 2024 Key messages • Teleconsultations in primary care should be rearranged. • A triage system should be introduced as a key stage to assess patient eligibility for a remote visit.