Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 19:27:e65147.
doi: 10.2196/65147.

Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study

Gabriele Kerr  1   2 , Geva Greenfield  1   2 , Edmond Li  1   3 , Thomas Beaney  1 , Benedict W J Hayhoe  1   2 , Josip Car  1   4 , Ana Clavería  5   6 , Claire Collins  7   8 , Gustavo Gusso  9 , Robert D Hoffman  10 , Geronimo Jimenez  11 , Tuomas H Koskela  12   13 , Liliana Laranjo  14 , Heidrun Lingner  15 , Ensieh Memarian  16 , Katarzyna Nessler  17 , Davorina Petek  18 , Rosy Tsopra  19   20 , Azeem Majeed  1   2 , Ana Luisa Neves  1   2
Affiliations

Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study

Gabriele Kerr et al. J Med Internet Res. .

Abstract

Background: Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis.

Objective: This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability.

Methods: Primary care physicians (PCPs) from 20 upper-middle- and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V.

Results: A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001).

Conclusions: Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations.

International registered report identifier (irrid): RR2-10.2196/30099.

Keywords: chat consultation; chi-squared test; digital health; digital technology; healthcare delivery; high-income countries; online consultation; online survey; primary care; primary care physician; remote consultation; remote healthcare; teleconsultation; telehealth; telemedicine; telephone consultations; upper-middle income; upper-middle income countries; video consultation; virtual care; virtual consultation.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: BWJH also works for eConsult Health, provider of a platform for online consultations for primary, secondary and urgent or emergency care in the National Health Service.

Figures

Figure 1
Figure 1
Mean change in hours spent per week on virtual consultation technologies by primary care physicians during versus before the COVID-19 pandemic period, by country of primary care physician employment. The COVID-19 pandemic period was defined as the period from March 11, 2020, onwards to the date of survey completion by the primary care physician (between June and September 2020). Grey cells indicate where no data was available for change in hours of use.
Figure 2
Figure 2
Percentages of primary care physicians who reported virtual consultation technologies as available to them before versus during the COVID-19 pandemic period. The COVID-19 pandemic period was defined as the period from March 11, 2020, to the date of survey completion by the PCP (between June and September 2020). ***: adjusted P values <.001.
Figure 3
Figure 3
Absolute difference in percentage of primary care physicians from each country reporting the technology as available to them before versus during the COVID-19 pandemic. The COVID-19 pandemic period was defined as the period from March 11, 2020, to the date of survey completion by the primary care physician (between June and September 2020). PCP: primary care physician.
Figure 4
Figure 4
Effect size of primary care physician and practice factors on the reported availability of digital consultation technologies before and during the COVID-19 pandemic. The COVID-19 pandemic period was defined as the period from March 11, 2020, to the date of survey completion by the primary care physician (between June and September 2020). Effect sizes correspond to Cramer V measures of association; larger effect sizes indicate a stronger relationship between the predictor and availability. Estimates for nonsignificant relationships are not shown.
See this image and copyright information in PMC

References

    1. Car J, Koh GCH, Foong PS, Wang CJ. Video consultations in primary and specialist care during the covid-19 pandemic and beyond. BMJ. 2020;371:m3945. doi: 10.1136/bmj.m3945. - DOI - PubMed
    1. Neves AL, van Dael J, O'Brien N, Flott K, Ghafur S, Darzi A, Mayer E. Use and impact of virtual primary care on quality and safety: the public's perspectives during the COVID-19 pandemic. J Telemed Telecare. 2024;30(2):393–401. doi: 10.1177/1357633X211066235. https://journals.sagepub.com/doi/abs/10.1177/1357633X211066235?url_ver=Z... - DOI - DOI - PMC - PubMed
    1. Wherton J, Greenhalgh T, Hughes G, Shaw SE. The role of information infrastructures in scaling up video consultations during COVID-19: mixed methods case study into opportunity, disruption, and exposure. J Med Internet Res. 2022;24(11):e42431. doi: 10.2196/42431. https://www.jmir.org/2022/11/e42431/ v24i11e42431 - DOI - PMC - PubMed
    1. The COVID-19 pandemic and the future of telemedicine. OECD. 2023. [2025-02-14]. - DOI
    1. Murphy M, Scott LJ, Salisbury C, Turner A, Scott A, Denholm R, Lewis R, Iyer G, Macleod J, Horwood J. Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract. 2021;71(704):e166–e177. doi: 10.3399/BJGP.2020.0948. https://bjgp.org/lookup/pmidlookup?view=long&pmid=33558332 BJGP.2020.0948 - DOI - PMC - PubMed

LinkOut - more resources