Findings identified in the included studies
| Outcomes relating to clinical decision-making | Key themes of findings related to clinical decision-making | Effect on clinical decision-making | References |
| Patient clinical outcomes | Treatment | ||
| Clinicians are comfortable to adjust medication for an ongoing issue (eg, in response to patient reporting side effects) | Positive | 16 28 29 33 34 | |
| Clinicians are able to reduce the time to make a decision in response to patient completing a form with their concerns | Positive | 9 28 33 34 | |
| Clinicians may delay decision to treatment/referral (eg, when patient is downplaying their symptoms to avoid calling emergency) | Negative | 28 29 32 | |
| Clinicians offering urgent appointments unnecessarily (eg, when patients are gaming the systems) | Negative | 9 29 32 33 | |
| Primary care practitioner experience | Confidence in information supplied and impact on decision-making | ||
| Clinicians were able to make decisions remotely using photos attached to the patient completed form | Positive | 9 25 31 33 | |
| Increased confidence in managing request (eg, clinician has time to read and plan appropriate action) | Positive | 9 16 28 29 | |
| Clinical decisions are limited to textual information provided by the patients and their medical records | Negative | 16 26 28 31 32 | |
| Clinical decision-making is more challenging without in-person appointment cues | Negative | 9 16 33 | |
| Clinical decisions are challenged as clinicians find it difficult to identify the patient key concern due to incomplete information given by the patient and clinician finding it difficult to identify patient expectations | Negative | 9 16 25 30 31 | |
| Level of detail and quality of information provided by the patient/patients’ complaints did not necessarily fit the specified form leading clinicians to hesitate to make any clinical decision without calling the patient or arranging an appointment | Negative | 16 25–27 30 31 | |
| Clinicians feel reduced confidence in prescribing drugs remotely (eg, antibiotics or addictive drugs) | Negative | 31 33 | |
| Healthcare system outcomes | Workload | ||
| Reduced face-to-face and telephone appointments particularly in interactions with limited clinical value | Positive | 16 35 36 | |
| Replaced short (5 min) telephone appointments such as prescription review | Positive | 9 29 33 | |
| Reduced administrative burden (some clinical decisions are instructed to admin staff to communicate with the patient directly; clinicians can start filling the consultation notes ahead of the appointment) | Positive | 9 16 26–31 34 | |
| Empowering the patient by allowing them to take a more active role and reduce the workload of the clinician (patients responsible to articulate their issues independently freeing up time of the clinicians to focus on making clinical decisions) | Positive | 9 25–28 33 | |
| Additional stage of workflow (most patients need telephone or face-to-face follow-up; staff needs to manually transfer information from the patient form to the patient records) | Negative | 9 16 26–28 30 33 34 | |
| Double workload (patients using multiple routes (eg, both telephone and the online form) concurrently for the same issue) leading to cases potentially being left unattended or attended twice | Negative | 9 25 30 | |
| Triage algorithm inappropriately highlights urgent need leading to escalated clinical decision for minor issue (eg, safeguarding issues) | Negative | 26 | |
| Frequency of primary care appointment | |||
| Improved continuity of access for patients with long-term conditions and frequent attenders (potentially freeing up waiting time for appointment) | Positive | 25 33 | |
| Increased demand as triage is an additional point of access to primary care (patients raising concerns might have not raised using traditional appointment system) | Negative | 16 28 33 |