@Article{info:doi/10.2196/55158,
author="Kristiansen, Eli
and Atherton, Helen
and Austad, Bjarne
and Bergmo, Trine Strand
and Norberg, B{\o}rge L{\o}nnebakke
and Salisbury, Chris
and Zanaboni, Paolo",
title="Patients' Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="8",
volume="27",
pages="e55158",
keywords="e-consultation; remote consultation; telehealth; primary care; general practitioner; patient experience; cross-sectional; digital health; survey",
abstract="Background: e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. Objective: This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? Methods: A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users' expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. Results: Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38{\%}). Overall, 68.7{\%} (8802/13,011) of respondents expected an answer within 24 hours, and 17.7{\%} (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5{\%} (5917/13,011) of respondents would have booked a GP appointment, and 44.9{\%} (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95{\%} CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95{\%} CI 1.18-1.40) were more likely to call the front desk. Only 2.5{\%} (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95{\%} CI 3.46-10.66) and with a new health problem (OR 2.71, 95{\%} CI 2.09-3.51) were more likely to choose this option. In addition, 4.7{\%} (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95{\%} CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95{\%} CI 1.27-3.80) or a new health issue (OR 1.74, 95{\%} CI 1.43-2.12) had higher odds for not seeking help. Conclusions: e-Consultations were often the patients' first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency. ",
issn="1438-8871",
doi="10.2196/55158",
url="https://www.jmir.org/2025/1/e55158",
url="https://doi.org/10.2196/55158"
}