title: Experiences of using email for general practice consultations: a qualitative study.
abstract: BACKGROUND
  Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice.
  
  
  OBJECTIVE
  To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts.
  
  
  METHODS
  A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs.
  
  
  METHODS
  A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved.
  
  
  RESULTS
  In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance.
  
  
  CONCLUSIONS
  Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.
authors.affiliation: Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Atherton
authors.forename: Yannis
authors.initials: Y
authors.lastname: Pappas
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016494:Computer Security; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D019114:Remote Consultation / Q000379:methods*; D016526:Workload; D055815:Young Adult