The studies involving human participants were reviewed and approved by NHS East Midlands Leicester Central Research Ethics Committee (REC ref 20/EM0128; IRAS ID: 283196 and subsequent amendments). The search strategy and extracted data contributing to the narrative synthesis are available as Supplementary Data. For this reason, the asynchronous nature of online consultations, while effective for some clinical problems, posed a risk of inadequate assessment (and hence incorrect diagnosis). An official website of the United States government. and transmitted securely. Through successive waves of the COVID-19 pandemic, enthusiasm for remote consultation services has fluctuated. Chang, E. M., Bidewell, J. W., Huntington, A. D., Daly, J., Johnson, A., Wilson, H., Lambert, V. A., & Lambert, C. E. (2007). This work is independent research supported by the National Institute for Health and Care (NIHR) Research Applied Research Collaboration Northwest London. The site is secure. Both the RCGP guidance and a similar resource from the General Medical Council21 offer detailed advice on how to choose between remote and face-to face consultations. (HFVC06 GP). The delivery of general practice consultations across countries has changed substantially because of COVID-19. Personalised care, which aims to give people more say in their healthcare, and Digital First Primary Care, a move towards remote consulting, are both important NHS England policies, but they can be in tension. Hannah Wheat, Sarah Griffiths, +9 authors R. Byng Medicine, Psychology Impact of remote consultations on antibiotic prescribing in - PSNet 2021 Aug;27(8):881-897. doi: 10.1089/tmj.2021.0145. Patients and machines: does technology help or hinder empathy and Some patients reported feeling stressed when asked to examine themselves during a consultation and report back to the GP. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. These changes, in turn, were linked to risks in the different domains of general practice. Silva AB, Sindico SRF, Carneiro AC, Henrique SM, Fernandes AG, Gomes JP, Marinho TP, Fernandes VR. Mental health; primary care; remote consultation; teleconsultation; telehealth; telemedicine. Although in general, digital consultation is used more by younger, more affluent people, there are many other characteristics that affect what patients prefer. (PDF) The impact of remote consultations on the health Tel: +44 (0)117 928 9000 Methods: Although in general, digital consultation is used more by younger, more affluent people, there are many other characteristics that affect what patients prefer. The .gov means its official. Evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for inperson consultations is limited and weak and recommends there is research further to inform practice and influence future care. Clinicians were also concerned about missed diagnoses owing to loss of non-verbal cues, which could alert them to clinical problems (risk 3A) or safeguarding concerns (risk 3B) that went unreported by patients. Healthcare assistants and nurses were trained to conduct these assessments. British Medical Association. Research regarding the impact of COVID-19 on remote healthcare consultation is emerging, and initial quantitative findings describe the high uptake of remote consultations, specifically also for frail older adults. So there has to be flexibility for patients to choose what will work best for them. This research was funded from the following sources: Scottish Government (TECHNOLOGY ENABLED CARE PROGRAMME) National Institute for Health Research (BRC-1215-20008), UK Research and Innovation via ESRC (ES/V010069/1), Wellcome Trust (WT104830MA), and The Health Foundation, an independent charity committed to bringing about better healthcare for people in the UK (2133488). It is possible that use of e-consultations increases primary care workload and costs, and online consultation systems could be developed to improve efficiency both for staff and patients. Keywords: Patient satisfaction with telephone and video consultations and the therapeutic alliance was high across the studies. Remote versus face to face: which to use and when? Federal government websites often end in .gov or .mil. By clicking accept or continuing to use the site, you agree to the terms outlined in our. COVID-19 Remote Consultation Services and Population in Health Inequity-Concentrating Territories: A Scoping Review. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. Methods Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases' inception to February 2020. In some cases this created a risk that patients might withhold or distort the clinical or personal information provided (risk 2A). Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review. Achieving spread, scale up and sustainability of video consulting services during the COVID-19 pandemic? Methods: A mixed methods sequential explanatory study with FCPs was conducted. The authors report no conflicts of interest in this work, This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/). In general, remote consultations focus on one problem only. SAd. Another risk was the disruption of the care routines that involved explaining to patients what was wrong in an adaptive and supportive way (risk 4B). Remote consultations offer a convenient alternative for patients, but may add to FCP stress particularly in areas of high socioeconomic deprivation. Conclusions: Risk of bias was assessed using the Mixed Methods Appraisal Tool. The https:// ensures that you are connecting to the First Contact Physiotherapists (FCPs) were introduced to reduce demands on GPs by providing improving access to expert musculoskeletal care. A mixed methods sequential explanatory study with FCPs was conducted. A new report aims to explore this tension and understand how remote consulting could be best set up to support personalised care. Can personalised care be delivered remotely. This qualitative sub-study on clinical risk in general practice drew on data selected from the wider datasets of three large, multi-site, mixed-method studies of remote care before and during the COVID-19 pandemic in the UK,1012 all collected by members of the research team (summarised in Table 1 below). Follow-up interviews with 16 FCPs revealed 4 themes: (1) Remote consultations provide logistical benefits to the patient; (2) Compromised efficacy is the key challenge of remote consultations; (3) Challenges for FCPs working in areas of high deprivation; and (4) Remote consultations impact the health, wellbeing and work satisfaction of FCPs. These data highlight the importance of a range of clinical, organisational, technical, and educational factors to reduce risk and an urgent need to identify and address inequalities in access to general practice and wider services. The main limitation is that because of the COVID-19 pandemic, the authors were unable to observe or record consultations directly, so can only report on risks as recounted by particpants. 8600 Rockville Pike Patient Satisfaction with Tele- and Video-Consultation in the COVID-19 Era - A Survey of Vascular Surgical Patients. Personalised care, which aims to give people more say in their healthcare, and Digital First Primary Care, a move towards remote consulting, are both important NHS England policies, but they can be in tension. What this study adds This systematic review investigates the impact of remote consultations on the quality of primary care. Pauline Foreman, Clinical Director, Personalised Care Institute, said: We are delighted with the report which highlights key priorities for the future implementation of remote consultations to support the delivery of personalised care. Continued monitoring of job satisfaction and resilience levels is important to ensure FCPs remain in their role. To evaluate the impact of telephone or video consultations compared to those conducted face-to-face on key patient-relevant outcomes and healthcare utilisation in primary care, mental health and allied health services, which have had a critical role in the management of the wider and longer-term consequences of COVID-19. Qualitative Research in Psychology, 18(3), 328-352. A survey of role stress, coping and health in Australian and New Zealand hospital nurses. But a lot of things I can think of that it is investigation that picks up so and fills in some gaps to the lack of face to face. Aim: 2022 Jun;52(6):E5. An initial in-person consultation was considered important to assess patients holistically, including the family and home situation, in order to establish rapport. An online survey measured the usage and impact of remote consultations. Cindy Mann, Research Fellow at the Centre for Academic Primary Care, said: Our research showed that remote means of consulting are not inherently good or bad for personalised care. Is remote consulting compatible with personalised care or does The studies were led from the University of Oxford and overseen by an external advisory group with a lay chair and patient representation. General practice has undergone a rapid transformation from face-to-face to remote consultations, but the impact on inequalities remains unknown. They found that remote consultations are not inherently good or bad and may benefit some people for some situations but disadvantage others. Accessibility The in-depth conversation needed for this is difficult to achieve in a remote consultation if the health professional does not already know the person well. In others, video infrastructure was in place but if a glitch occurred, some staff struggled to cope and created workarounds, causing stress for patients and staff alike (see below, risk 6A). Im really tired from these Zoom meetings, because its very different to have this sort of like overload of, you know, concentration and physically trying to do it, overload of information.' Method The authors undertook an electronic search of MEDLINE, EMBASE, and Web of Science from inception to June 2020. Clinical risk in remote consultations in general practice: findings Additional training in using remote consultations may be helpful. Evidence was largely heterogeneous, often focussing on interventions delivered in secondary care facilities or by specialists only. The identification of risks to efficiency and a potential increase in workload associated with telephone assessment mirrors conclusions by Newbould and colleagues,17 while accounts of double-touch encounters and increased demand support the findings of modelling work by Salisbury and others,18 which predicts an overall increase in workload associated with remote consulting. Disclaimer. One GP, for example, described how they drew pictures of the bowel to explain diverticulitis to an older man with poor hearing so they could understand what was causing their symptoms. After this initial subset analysis, data were shared and discussed with the wider research team, who then searched for interviews that included data related to risk from the wider RBD study (RB and SRB); the Near Me study (JW and TG); and the Health Foundation video study datasets (GH, LM, and SS). Background: Identifying and managing osteoporosis before and after COVID-19: rise of the remote consultation? Developing a strong evidence-base capitalising on real-world data as well as clinical trials is crucial for the future development of remote consultations and tailoring them to patient needs and preferences. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. BMJ 2020; 371: m3945. (RBD GP KS). Evidence for the impact of remote consultations on antibiotic prescribing in primary care is currently unclear. . Goodwin R, Moffatt F, Hendrick P, Stynes S, Bishop A, Logan P. Physiotherapy. NHS. Personalised care is when healthcare decisions and future care and support plans are made jointly by people receiving care and their health professionals. It can support them to maintain the best quality of life possible with their health conditions. One reason for this is the changing balance between benefits and harms as the situation moved from one dominated by the risk of infection4 to a new normal concerned about the impact of remote consulting on, for example, adequacy of assessment, equity, continuity of care, the therapeutic relationship,57 and overall use of NHS services. A new report aims to explore this tension and understand how remote consulting could be best set up to support personalised care. Data were analysed thematically, taking account of an existing framework of domains of clinical risk. How abdominal symptoms are communicated during primary care consultations is explored, and characteristics of patients descriptions that underpin variation in the accuracy and completeness with which they are documented in medical records are identified. 1 INTRODUCTION. The researchers aimed to answer the following questions: They conducted a rapid review of evidence on remote consulting. Ministero della Salute. The impact of remote consultations on the health and wellbeing of first NOTE: Your email address is requested solely to identify you as the sender of this article. Please enable it to take advantage of the complete set of features! 2022 Jul 14:1-12. doi: 10.1007/s00482-022-00659-5. Background: There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Because you havent seen the patient you are going to prescribe amoxycillin antibiotics for a cough in case its a chest infection. In this article, data is presented from clinicians and patients to support a taxonomy of different kinds of clinical risks associated with the new normal of remote general practice and the article considers how these might be mitigated. The COVID-19 pandemic drove a sudden increase in remote consulting, with research reporting mostly telephone consulting, limited use of video, and a substantial increase in text messaging. That is no small part of what we do as GPs and its all a bit unspoken and difficult to quantify.' government site. A new report aims to explore this tension and understand how remote consulting could be best set up to support personalised care. Epub 2021 Jul 7. The finding that remote checks are perceived to be safe accords with other research, but there is as yet no evidence on the effectiveness or safety of this model.14. MeSH Thank you for your interest in spreading the word about medRxiv. Those of lower socioeconomic status were more likely to use consultations delivered via telephone than videoconference. The majority of remote consultations in general practice occurred by phone. Published by Oxford University Press. Data collection methods more bespoke to the primary care context, better accounting for patient characteristics and needs, and inclusive of its intended end-users, are necessary to generate a stronger evidence base to inform future remote care policies. Disclaimer. Impact of the COVID-19 pandemic on remote mental healthcare and 2023 Jul;55(7):102642. doi: 10.1016/j.aprim.2023.102642. A related, more long-term risk is that without the depth of information and understanding gained from an initial face-to-face consultation, building and maintaining the therapeutic relationship becomes more difficult (risk 2C). Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight. The clinical consultation is a dialogue, in which every utterance of one party is in response to, and in anticipation of, an utterance from the other party. Personalised care, which aims to give people more say in their healthcare, and Digital First Primary Care, a move towards remote consulting, are both important NHS England policies, but they can be in tension. In primary care, Digital First means that appointments are booked online or healthcare requests are responded to after the patient completes an online form. The authors of this systematic review conclude that there is insufficient evidence to determine whether remote prescribing in primary care changes antibiotic prescribing practices. Impact of Remote Consultations on Antibiotic Prescribing in Primary Further research is required to understand how remote consultations can be enhanced when communication barriers and lower levels of digital literacy exist. And also just that building that trust and relationship in the first instance.' GPs are best placed to understand the needs of their patients and remote consultations offer safety during a public health crisis. A new report aims to explore this tension and understand how remote consulting could be best set up to support personalised care. This report was commissioned and paid for by the NHS Personalised Care Institute and supported by NIHR ARC West, in partnership with the Centre for Academic Primary Care at the University of Bristol. Bookshelf The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Objectives The recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in-person to remote patient contact. Kodjebacheva GD, Culinski T, Kawser B, Amin S. Front Public Health. General practice in the context of coronavirus (COVID-19). London NW1 2FB In Table 3, a range of practical initiatives are suggested that have been inspired by interview data, workshop suggestions, and published reports, which could help to mitigate risk in the organisation and delivery of remote general practice. Contact us, The impact of remote consultations on personalised care: evidence briefing (PDF), Bristol Medical School Population Health Sciences. The British journal of general practice : the. Federal government websites often end in .gov or .mil. This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. What is already known on this topic Existing literature reviews exploring remote consultations have primarily been confined to assessing their impact on effectiveness, efficiency, or specific clinical conditions whilst utilising a broad definition regarding what constitutes remote services. Those who did attempt to access care were sometimes unsuccessful (risk 1C), for a variety of reasons relating to the following: digital exclusion, including inability to use the required technology; blocked phone lines, owing to the high call volumes (and unwillingness to persist in attempts to connect); limitations on patients telephone data package (lack of phone minutes or bandwidth for video consultation); and not having a lifestyle that accommodates a remote callback service, as the following quote illustrates: 'They [patients experiencing homelessness] dont hang around and wait for the phone call at [name of hostel] And of course you cant reach them on a mobile because they normally dont have one. Given that England has one of the highest prevalence rates of COVID-19 in . Methods Six databases were searched. McKinstry and colleagues19 concluded that remote consultations tend to be shorter and provide less rich information than face-to-face encounters. The loss of nonverbal communication and ability of HCPs to sense led to remote consultations being perceived as riskier by all groups, and issues arising from communication and cognitive impairment were addressed. HHS Vulnerability Disclosure, Help PMC Risks of remote consulting during the COVID-19 pandemic related to practice set-up, communication, clinical care, patients' role, population health, and professional development are summarised in Table 2. Before this change becomes permanent, it is important to consider its effects on the quality of and access to care. Six domains of risk were evident in relation to the following: (1) practice set-up and organisation (including digital inequalities of access, technology failure, and reduced service efficiency); (2) communication and the clinical relationship (including a shift to more transactional consultations); (3) quality of clinical care (including missed diagnoses, safeguarding challenges, over-investigation, and over-treatment); (4) increased burden on the patient (for example, to self-examine and navigate between services); (5) reduced opportunities for screening and managing the social determinants of health; and (6) workforce (including increased clinician stress and fewer opportunities for learning). In the context of telephone consultations using the LanguageLine interpreting service, with no visual clues available, some patients struggled to describe their condition and GPs were sometimes uncertain about whether they had understood a patients problems correctly. Qualitative Research in Psychology, 3(2), 77-101. Hohenschurz-Schmidt D, Scott W, Park C, Christopoulos G, Vogel S, Draper-Rodi J. Schmerz. The impact of remote consultations on personalised care Evidence briefing Cindy Mann 2021 The context in which healthcare is delivered has changed dramatically over the past year.
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