Evidence map›Paper›PMID 39486829›Full record

ReviewBMJ open2024

Optimising digital clinical consultations in maternity care: a realist review and implementation principles.

Catrin Evans, Georgia Clancy, Kerry Evans, Andrew Booth, Benash Nazmeen, Candice Sunney, Mark Clowes, Nia Jones, Stephen Timmons, Helen Spiby

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Catrin EvansSchool of Health Sciences, University of Nottingham, Nottingham, UK catrin.evans@nottingham.ac.uk.ORCID 0000-0002-5338-2191
Georgia ClancySchool of Health Sciences, University of Nottingham, Nottingham, UK.
Kerry EvansSchool of Health Sciences, University of Nottingham, Nottingham, UK.ORCID 0000-0002-1381-9168
Andrew BoothSchool of Health and Related Research, University of Sheffield, Sheffield, UK.
Benash NazmeenSchool of Allied Health Professionals and Midwifery, University of Bradford, Bradford, UK.
Candice SunneyNotitngham Maternity Research Network, University of Nottingham, Nottingham, UK.
Mark ClowesSchool of Health and Related Research, University of Sheffield, Sheffield, UK.ORCID 0000-0002-5582-9946
Nia JonesSchool of Medicine, University of Nottingham, Nottingham, UK.
Stephen TimmonsBusiness School, University of Nottingham, Nottingham, UK.
Helen SpibySchool of Health Sciences, University of Nottingham, Nottingham, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe COVID-19 pandemic has led to increased use of digital clinical consultations (phone or video calls) within UK maternity services. This project aimed to review the evidence on digital clinical consultations in maternity systems to illuminate how, for whom and in what contexts, they can be used to support safe, personalised and equitable care.

designA realist synthesis, drawing on diverse sources of evidence (2010-present) from OECD countries, alongside insights from knowledge user groups (representing healthcare providers and service users).

methodsThe review used three analytical processes (induction, abduction and retroduction) within three iterative stages (development of initial programme theories; evidence retrieval and synthesis; validation and refinement of the programme theories).

resultsNinety-three evidence sources were included in the final synthesis. Fifteen programme theories were developed showing that digital clinical consultations involve different mechanisms operating across five key contexts: the organisation, healthcare providers, the clinical relationship, the reason for consultation and women. The review suggests that digital clinical consultations can be effective and acceptable to stakeholders if there is access to appropriate infrastructure/digital resources and if implementation is able to ensure personalisation, informed choice, professional autonomy and relationship-focused connections. The review found relatively less evidence in relation to safety and equity.

conclusionsDue to the complexity of maternity systems, there can be 'no one-size fits all' approach to digital clinical consultations. Nonetheless, the review distills four 'CORE' implementation principles: C-creating the right environment, infrastructure and support for staff; O-optimising consultations to be responsive, flexible and personalised to different needs and preferences; R-recognising the importance of access and inclusion; and E-enabling quality and safety through relationship-focused connections. Service innovation and research are needed to operationalise, explore and evaluate these principles, particularly in relation to safety and equity. PROSPERO REGISTRATION NUMBER: CRD42021288702.

Indexed as

Maternal Health ServicesTelemedicineCOVID-19FemaleHumansPandemicsPregnancyUnited KingdomHealth EquityMaternal medicineOrganisation of health servicesQuality in health careSystematic ReviewTelemedicine

Identifiers

PMID39486829
PMCPMC11529580

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.