Virtual Consultations for People With Intellectual Disabilities in General Practice and Community Care: Mixed Methods Qualitative Study

Background: Virtual consultations (VCs) using video or telephone were embraced at speed in general practice (GP) and community care during the COVID-19 pandemic. People with intellectual disabilities, their families, and support workers (SWs), along with health care professionals (HCPs), had to adapt quickly to this change in provision, but little is known about how this new way of working was experienced. Objective: This study aims to explore the views and experiences of people with intellectual disabilities, their families, SWs, GP, and community care professionals on the quality and safety of VCs. Methods: This paper reports on users’ experiences of VCs, as part of a larger Experience-Based Co-design study. This paper relates to 2 stages of data collection. Observed video consultations in GP and community care (n=3), and semistructured interviews with people with intellectual disabilities, their family members or SWs, GP, and community care professionals (n=34). The 30-month study was conducted from November 2021 ending in April 2024. Data were analyzed using framework analysis. Results: Integrated results are presented through 5 themes, encompassed under an overarching theme of safety and quality. The five themes highlight critical factors in planning, delivery, and aftercare of VCs in GP and community services for people with intellectual disabilities in the United Kingdom: (1) context, space, and purpose—showing the importance of safe spaces to talk, and having clear consultation objectives and purpose; (2) choice—facilitating choice over time about modality of health care contact; (3) familiarity, online relationships, and trust—the building blocks for quality consultations; (4) prepare and personalize—to ensure that HCPs are aware of reasonable adjustments, and recognition of caregiver involvement; and (5) continued connection—where patients or families are offered continued contact with a named or same HCP enhancing access to regular or ongoing care. All participants were aware of the limitations of VC, which may impact safety, such as gaps in home monitoring due to the absence of appropriate equipment or recording, inability to identify vital risk indicators, and limited field of vision on screen. However, participants were also aware of the distinct benefits they offer in terms of quality provision, such as timeliness of care, building and sustaining comfortable relationships, support for more frequent attendance, and continuous connection to health teams. Conclusions: VCs offer an opportunity to improve digital inclusion in health care for people with intellectual disabilities. However, the quality and safety of VCs for this population are dependent on continuous review of patients’ needs over time and ensuring that their choices and preferences are considered when planning and providing ongoing care.