Real-time remote outpatient consultations in secondary and tertiary care: a systematic review of inequalities in invitation and uptake

Janet E. Jones, Sarah L. Damery, Katherine Phillips, Ameeta Retzer, Pamela Nayyar, Kate Jolly, Carsten Bogh Juhl (Editor)

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Background Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered. Aim To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics. Methods Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively. Results Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001). Conclusions Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities.

Original languageEnglish
Article numbere0269435
Number of pages17
JournalPLOS One
Issue number6
Publication statusPublished - 3 Jun 2022

Bibliographical note

Funding Information:
This research is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The study was sponsored by the University of Birmingham. The study sponsor had no role in study design, data collection, analysis and interpretation of the data, in the writing of the report, and in the decision to submit the article for publication.

Publisher Copyright:
Copyright: © 2022 Jones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Aged
  • Delivery of Health Care
  • Female
  • Humans
  • Male
  • Outpatients
  • Pandemics
  • Remote Consultation
  • Tertiary Healthcare


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