Table 1.

Summary of the state of evidence for alternatives to face-to-face consultations (summarised from Shaw et al., 2018).

Telephone

•The literature largely consists of small, heterogeneous primary studies, with methodological flaws. •Systematic reviews have concluded that telephone contact may allow minor problems to be dealt with (and sometimes with apparent cost savings), but may miss rare but serious conditions, and/or lead to higher rates of subsequent face-to-face visits. •Consultations have a more linear format, a narrow range of pre-planned themes and fewer opportunities for patients to raise issues.

Text and email	•Used to support people with chronic conditions, facilitating adherence and/or attendance, conveying test results, or sending health promotion messages •Systematic reviews have indicated text messaging can be effective in facilitating short-term behaviour and medication adherence, but the quality of studies is often poor. •Popular with varied groups of patients who use it both to send questions and to receive messages sent by health professionals and administrators.
Online portals	•Used to facilitate prescription ordering, appointment booking and can be used by patients to access their online records •Evaluative studies have demonstrated proof of concept.
Telemedicine	•Many proof of concept studies, especially for use in remote regions •Issues of cost, patient preferences and impact on professional roles, interactions and work routines.
Telehealth	•Proof of concept studies •Some randomised trials, criticised as small, unrepresentative and methodologically flawed) have demonstrated improved outcomes (reduced hospital admission and mortality rates) •Potentially at significant cost.