Translatability of physical examination to teleconsultation in primary care

While telehealth has gained widespread acceptance and considerable investigation, there remains a concern of the inability to undergo virtual physical examination (VPE), especially during the high demand period of the COVID-19 era.

This thesis aims to explore the implementation of VPE amid the COVID-19 pandemic and evaluate the viability of adapting physical examination (PE) observed in in-person general practitioner (GP) consultations to the teleconsultation environment.

This thesis has three phases:

• Phase 1 of this study will involve a scoping review of recent literature pertaining to VPE applied in all healthcare settings during the COVID-19 period.

• Phase 2 will analyse video recordings of in-person GP consultations to examine whether these in-person PE are indeed translatable to teleconsultation.

• Phase 3 is a synthesis of Phase 1 and Phase 2 to provide insights to future research work.

Phase 1 scoping review has identified:

1. Twenty-five studies from 15 specialities, predominantly observational studies (16/25, 64%) were included. Seven main types of VPE were identified during COVID-19, with higher proportion in musculoskeletal exam (8/25, 32%) and head and neck exam (6/25, 24%). Others included chest exam, neurological exam, skin exam, body composition and vital signs.

2. Technological issues constituted a large proportion of barriers in implementing VPE. Others included patient safety, data privacy, financial reimbursement, health literacy, patient conditions and clinician experience.

Phase 2 secondary analysis on a dataset of in-person GP consultation in UK has identified:

1. 133 consultations (133/169, 79%) required PE. The PEs that were performed most often were vital signs, head and neck, musculoskeletal and respiratory exam.

2. The types of PE that were categorised as moderately translatable or above to teleconsultation were vital signs (100%, 3/3), musculoskeletal exam (80%, 8/10) and neurological exam (80%, 4/5).

3. The most frequently discussed topics that required PE was respiratory system (25%, 76/307), general (15%, 47/307) and musculoskeletal system (13%, 41/307).

Phase 3 synthesis has identified:

1. More qualitative studies on VPE specific to primary care settings are warranted.

2. Future research should target on ways to support VPE for respiratory issues, where respiratory-related PEs were frequently observed during in-person GP consultations.

3. The challenges inherent in VPE during COVID-19 in various settings are likewise applicable to the context of PE in GP teleconsultation.

Half of the PEs observed during in-person GP consultations were deemed translatable to telehealth. However, when VPE could not provide enough information, safety netting should be in place. To facilitate VPE, resolving technical barriers is essential, as well as increasing patients’ health literacy and enhancing clinicians’ ability to conduct VPE during teleconsultation. More qualitative research will help to better understand patients’ and GPs’ preference and acceptance of VPE in teleconsultation.