Translatability of physical examination to teleconsultation in primary care settings

Abstract

Background

Telehealth has been widely accepted and investigated however little is known about virtual physical examination (VPE) in primary care settings. In order to understand and improve patient and clinician experience during VPE, we need to analyse the physical examination during in-person general practitioner (GP) consultations.

Objective

We aim to analyse the characteristics of physical examination (PE) during in-person GP consultations including topics of consultations, types of physical examinations, equipment used and body area examined. We then evaluate how translatable these PE are over telehealth.

Methods

Eligible consultations were extracted from a dataset archive named HaRI, which contains 281 in-person GP consultations in de-identified transcript and video format. Eligible consultations were processed with data extracted. Finally, an evidence-based scoring system was used on each PE, determining its likelihood of being translated to telehealth.

Results

We analysed 169 in-person GP consultations, in which 79% (133 out of 169) required physical examination (PE). A total of 307 physical examinations, 224 counts of equipment and 331 counts of body parts were observed. Out of 52 physical examination components we have observed, 79% were translatable but only 8% of these were deemed easily translatable over telehealth. 21% of the physical examinations were considered ‘untranslatable over telehealth’.

Conclusion

Over half (54%) of the physical examinations were at least moderately translatable, especially for vital signs, musculoskeletal, neurological and cardiovascular exams. However, more research is warranted to increase the accuracy, reliability and translatability of virtual physical examinations and when VPE is not feasible, safety netting should be applied.