Patient safety measures for virtual consultations in primary care: a systematic review
Clinical Snapshot
PICO Framework
| P — Population | Patients receiving primary care consultations |
| I — Intervention | Virtual consultations (telehealth, video consultations, remote consultations) |
| C — Comparator | Face-to-face consultations in primary care settings |
| O — Outcomes | Patient safety measures, adverse events, health outcomes, patient perception of safety |
Bottom Line
This systematic review of 47 studies (2.2 million patients) provides the first comprehensive framework for evaluating virtual consultation safety in primary care. The authors identify safety measures across six domains: provider-related factors (clinical skills, technology competence), patient-related factors (digital literacy, clinical complexity), system-related factors (technology reliability, workflow integration), adverse events, health outcomes, and patient safety perceptions. While methodologically sound with PROSPERO registration and PRISMA compliance, the review lacks quantitative synthesis and formal quality assessment. The framework offers valuable guidance for Australian primary care, particularly relevant given Medicare telehealth expansion, but requires further validation through consensus studies before implementation as standardised safety metrics. The work addresses a critical gap in virtual care safety evaluation but stops short of providing ready-to-implement tools.
Key Findings
Effect Size: Not applicable - qualitative synthesis
Primary Outcome: Identification of safety measures for virtual consultations categorised into provider-related, patient-related, and system-related factors
Nnt Or Sensitivity: Framework identifies three tangible outcome domains: adverse events, health outcomes, and patient perception of safety
Confidence Interval: Not reported
Clinical Application
Framework provides foundation for safety monitoring but requires further validation and consensus development Highly relevant to Australian primary care given Medicare telehealth expansion post-COVID-19 and ongoing RACGP telehealth guidelines development Primary care patients and providers using virtual consultation platforms
Abstract
OBJECTIVES: With the growing adoption of virtual consultations in primary care, the need for tailored metrics to evaluate their safety became increasingly urgent. This systematic review seeks to identify and review existing safety measures that could be used for safety evaluation of virtual consultations in primary care. METHODS: This has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and followed a published protocol. A systematic literature search was performed in Ovid MEDLINE/PubMed, Embase and Cochrane Library databases from 2014 to 2024. Studies comparing virtual consultations with face-to-face consultations in the primary care setting were included. An inductive thematic analysis was performed to systematically extract and group the safety measures into overarching themes, with a narrative synthesis to summarise the results. RESULTS: A total of 47 studies (31 experimental and 16 observational studies) were included (n=2 223 697 patients). All studies assessed the safety of virtual versus face-to-face consultations via one or both of the following domains: (1) factors that influence the safety of virtual consultations and (2) tangible outcomes of virtual care safety. The former were categorised into provider-related, patient-related and system-related factors. Tangible outcomes were evident through three subthemes-adverse events, health outcomes and patient perception of safety. CONCLUSIONS: This review provides a systematic synthesis of measures for the safety evaluation of virtual consultations. Further research into patient and physician perspectives is needed to identify aspects and indicators not captured in this study, followed by a consensus study to finalise safety metrics. Ultimately, having a robust methodology for safety evaluation of virtual consultations in place will enable safety monitoring, root cause analyses and safety improvement. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42023464878.
References
- 1.Lunova, T., Hurndall, K. H., Kirk, U. B., Franklin, B. D., Darzi, A., & Neves, A. L. (2026). Patient safety measures for virtual consultations in primary care: a systematic review. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2025-018712
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