With the onset of the pandemic, face to face (F2F) consultations were cancelled and an alternative model of care was required that included telephone clinics and later video consultation.

As part of a quality improvement project, we initiated video consultation for the management of some Parkinson’s disease and movement disorder patients. This group of patients were suitable to be seen in the F2F clinic (but it had not re-started), but were not appropriate for the telephone clinics. 

We wanted to receive patient’s feedback on our new initiative of video consultation to see what needed to improve as this could be the model of care for many clinics in the future.

Method

The feedback form was developed following a literature search with the help of the librarian. Between 2017 & 2020, we identified 23 articles of interest, which resulted after searching Medline, Embase, Google scholar & Google with the keywords video-consultation, telemedicine, telephone consultation, virtual clinics, patient feedback, patient satisfaction, and post-consultation feedback/ evaluation.

With the help of junior doctors (1 x Foundation 1 and 1 x IMT1), we devised a short feedback form with just seven questions which would be relevant and helpful. The feedback survey was conducted by telephone in October 2020.

Background

The video consultations were done from my office with the support of the Attend Anywhere clinic (AA clinic) initiative under the NHS transformation project. This was for a Parkinson’s disease and movement disorders clinic, a well-established clinic.

Six patients (one female and five male) had a video consultation and their age ranged from 69 years to 88 years, the average being 79 years. These took place from July 13 2020 to September 28 2020.

Of these, four patients were new patients in whom either a diagnosis needed to be established or they needed initiation of anti-PD medications. The other two were follow-up patients who had been seen in the face to face clinics in the past.   

All of them were living in their own homes at the time of the video consultation and things had not changed when the telephone feedback was taken.

Among them, five were either supported by family members or the family members joined in the original video consultation to get a better understanding of the consultation. One patient attended the video consultation alone.


Survey questions

 

1. How satisfied were you with the video consultation?

This was based on a linear scale from 1- 10

  • 1-3: not satisfied
  • 4-7: satisfied
  • 8-10: very satisfied

The answers ranged from 7 to 10 – average being 9

 

2. How effective could you communicate with the doctor?

This was based on the linear scale of 1-10 as mentioned above.

The answers ranged from 7 to 10 – average 8

 

3. How satisfied were you with the instructions for the setting up the consultations?

This was based on the linear scale of 1 to 10 as mentioned above.

The answers ranged from 7 to 10 - average being 9.5

 

4. Were your problems addressed?

This was either yes/ no/ don’t know

All of them said ‘Yes’

 

5. Have you since been admitted to the hospital with the same condition for which you had the consultation?

*this question was the crude indicator to see how effective is this service for the hospital avoidance 

None of the patients have been admitted to the hospital

 

6. Would you participate in the video consultation again?

All of them said ‘yes’

 

7. Do you have any suggestions to improve upon the service (it was a free text)?

The following words were captured during the feedback:

  • ‘No, it worked well’
  • ‘No’
  • ‘Nothing much’
  • ‘Video consultation went very well’
  • ‘It was quite good’
  • ‘It will be much better next time as there was a bit of apprehension with the first call’        

Discussion

F2F consultation is a well-established method of outpatient consultation in the NHS with a dedicated space, nursing staff, receptionist and a separate management system. However, with the start of the Covid-19 pandemic, for the safety of the patients and the staff, all F2F consultations were cancelled. The alternative method started in the form of telephone consultation.

Telephone consultation had a very good uptake with our older population and it did not need much effort to establish this. However, there was a group of patients who were not suitable for telephone consultation (i.e. diagnosis of Parkinson’s disease and movement disorders or initiation of relevant medication).

Triage was done on all those patients waiting on the partial waiting list. We identified 11 patients who would be suitable for video consultation and not suitable for the telephone consultation. My office rung each one individually to discuss the requirement set out in the AA clinic to see how many of them could join in the video consultation.

We found only six were willing to join the video consultation. Unlike watching television, a one way system, which is quite popular in our group of patients, video consultation is a two-way process which could be problematic for some patients. However, the majority of patients had already had some experience of the two-way process by either joining in the Skype, What’s app or Facetime application with either family members or friends.

The initial uptake for the video consultation was not very enthusiastic but those who attended had a good level of satisfaction and for the wider NHS it was also effective. The patients were satisfied with the diagnosis and also the management that was outlined to them. None of the patients were admitted to the hospital with the same condition, which was very reassuring. After initial reluctance, all were keen to do further video consultation. Overall, these consultations went well with nothing much to add from the patients or their families to improve the process.

It has its own limitations and would not eliminate the F2F consultation. However, good triage with identification of suitable patients especially those with long term conditions could be managed well with the help of video consultation. The alternative model of care is going to stay here and with time, patients and the clinicians will become more attuned to it. As this is a new system, a bit of information from the office helped and encouraged patients to join the video consultation.

Conclusion

We have already restarted F2F clinics, but it is still very limited. It appears that it will continue to be limited for some time as we are now braving the second wave of the Covid-19 pandemic. These video clinics could become very popular and it might be the new normal. This would also depend on other factors such as good triaging, appropriate clinical questions, targeted examination, good information on the video consultation, involvement of the family members and availability of user friendly smart phones, iPads or laptops.

Video consultation has started at an extraordinary time, but it will be adapted and accepted much more as we get used to it. There is  potential that could be tapped with good cost savings to the NHS. And I suspect, NHS managers will be looking carefully on wider application of this process.

 


Dr Anil Kumar, Consultant Physician and Geriatrician County hospital, Stafford and Honorary Clinical Lecturer, School of Medicine Keele University

Dr Rob Smith, FY1, County hospital, Stafford

Dr Abdul Rahman, IMT1, County hospital, Stafford

anilkumaruk@hotmail.com

*Junior doctors devised the feedback form, Dr Anil Kumar is the main author).

Acknowledgments:

Mrs Louisa Fullbrook, Librarian at PGMC, County hospital, Stafford, England

Mrs Christine Hyland, Secretary to Older Peoples department at County hospital, Stafford, England

Mr Chris Cloughton, manager for OPD at University hospital of North Midlands, overseeing County hospital, Stafford.