title: Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice.
abstract: BACKGROUND
  Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice.
  
  
  OBJECTIVE
  To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK.
  
  
  METHODS
  Realist review in general practice.
  
  
  METHODS
  A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses.
  
  
  RESULTS
  Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship.
  
  
  CONCLUSIONS
  Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction.
authors.affiliation: Warwick Medical School, University of Warwick, Coventry.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Huxley
authors.affiliation: Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford.
authors.forename: Helen
authors.initials: H
authors.lastname: Atherton
authors.affiliation: Warwick Medical School, University of Warwick, Coventry.
authors.forename: Jocelyn Anstey
authors.initials: JA
authors.lastname: Watkins
authors.affiliation: Warwick Medical School, University of Warwick, Coventry.
authors.forename: Frances
authors.initials: F
authors.lastname: Griffiths
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D054521:Cultural Competency; D055317:Evidence-Based Practice; D058006:General Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology
keywords: access to health care; communication; doctor-patient relations; general practice