Family physician perspectives on managing indirect patient care activities in the electronic inbox: a systematic mixed studies review

INTRODUCTION: Family physicians spend approximately half their professional time on indirect patient care activities (IPCA). Essential to patient care, inbox IPCA includes renewing prescriptions, checking lab results, and reviewing messages. However, IPCA detracts time from direct patient care and has been linked to burnout, potentially contributing to the family medicine crisis in Canada. Our objective was to understand the range of family physicians' experiences and perspectives regarding electronic inbox management. METHODS: We conducted a systematic review of peer-reviewed articles, published in English between 1 January 2012, and 22 April 2024, that addressed family physicians' perspectives on tasks related to the electronic inbox and used any method of primary data collection and analysis. Data analysis used a constant comparative method. RESULTS: Fifty-four articles were included. The combination of fragmented technical systems and an overwhelming volume of complex tasks has created a system where family physicians struggle to manage the administrative work of patient care. Selected impacts include excessive time spent on duplicated or unnecessary tasks, inadvertently making uninformed clinical decisions, and perceived tension between patient accessibility and workload. Strategies for management were described, including the re-design of electronic medical record systems, task delegation, and synchronizing prescription renewals with patient visits. CONCLUSIONS: The intersection of inefficient systems and high workloads makes inbox management labour-intensive and frustrating, lowering job satisfaction and efficacy. Downloading administrative tasks to family physicians, combined with the growing complexity of patient management, has generated a tremendous burden. Solutions are needed to improve the sustainability and appeal of family medicine.