scholarly journals Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic

10.2196/19232 ◽  
2021 ◽  
Vol 23 (9) ◽  
pp. e19232
Author(s):  
Sarah Damery ◽  
Janet Jones ◽  
Elaine O'Connell Francischetto ◽  
Kate Jolly ◽  
Richard Lilford ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Liver Transplant ◽  
Usual Care ◽  
Real Time ◽  
Process Evaluation ◽  
Face To Face ◽  
Transplant Patients ◽  
Qualitative Process Evaluation ◽  
Remote Consultations

Background Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. Objective This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. Methods Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. Results Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that—according to patients—remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. Conclusions Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. Trial Registration ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2953-4

scholarly journals Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic (Preprint)

2020 ◽  
Author(s):  
Sarah Damery ◽  
Janet Jones ◽  
Elaine O'Connell Francischetto ◽  
Kate Jolly ◽  
Richard Lilford ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Liver Transplant ◽  
Usual Care ◽  
Real Time ◽  
Process Evaluation ◽  
Face To Face ◽  
Transplant Patients ◽  
Qualitative Process Evaluation ◽  
Remote Consultations

BACKGROUND Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. OBJECTIVE This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. METHODS Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. RESULTS Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (<i>P</i>&lt;.001) and usual care (<i>P</i>=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (<i>P</i>=.10). The qualitative process evaluation showed that—according to patients—remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. CONCLUSIONS Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. CLINICALTRIAL ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-018-2953-4

scholarly journals Telephone versus face-to-face neuro-oncology consultations: comparing patient satisfaction, convenience, family support and clinician attitude during the COVID-19 pandemic

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv14-iv14
Author(s):  
Emma Toman ◽  
Claire Goddard ◽  
William Garratt ◽  
Frederick Berki ◽  
Zenab Sher ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Family Member ◽  
Telephone Consultation ◽  
Face To Face ◽  
Oncology Service ◽  
Level Of Satisfaction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Remote Consultations

Abstract Aims During the first wave of the COVID-19 pandemic, to limit the number of patients attending hospital, the neuro-oncology department selected a large number of appointments to be conducted via the telephone. This project aimed to determine how patients and clinicians perceived telephone consultations in the neuro-oncology service compared to traditional face to face appointments. Method A 20-question patient satisfaction survey combined quantitative and qualitative questions and was distributed between June and August 2020. These were distributed by email to 88 patients who attended neuro-oncology clinic in person ("face-to-face"), or by telephone. Concurrently, a 15-question survey was distributed to all clinicians conducting telephone and face-to-face consultations for the neuro-oncology service. Questions included in the clinician survey were designed to mirror the patient satisfaction questionnaire where possible. Fisher's exact test was used to determine significance, which was set at p&lt; 0.05. Results 51.1% (n=45) of patients returned the questionnaire. Of those who received telephone appointments, 89.5% (n=17) felt the consultation was convenient, 94.7% (n=18) were satisfied and 80.0% (n=16) were able to have a family member/friend present. Of those who attended face-to-face appointments, 96.0% (n=24) felt their consultation was convenient, 100% (n=25) were satisfied and 87.5% (n=21) were able to have a family member/friend present. There was no significant difference in patient convenience, satisfaction or family/friend presence (p=0.395, p=0.432 and p=0.498 respectively) between face-to-face and telephone clinics. Overall, the clinicians reported undertaking a mean of 9.5 telephone consultations per week. Only 42.8% (n=3) use telephone appointments for first-time neuro-oncology consultations, whereas 100.0% (n=7) use them for results and follow-up appointments. Only 51.7% (n=4) felt that undertaking telephone consultations is convenient and 42.8% (n=3) have experienced difficult situations with patients during telephone consultation. Conclusion This project suggests that neuro-oncology telephone consultations provide patients with the same level of satisfaction and convenience as face-to-face appointments. We have also demonstrated that using the telephone does not provide a significant barrier to having family or friends present to support the patient. We have shown that clinicians are universally utilising neuro-oncology telephone appointments for follow-up and results whereas much fewer use the telephone for performing initial consultations. Given the high-level of satisfaction demonstrated in the patient questionnaires this reflects effective patient-selection for remote consultations. The COVID-19 pandemic has forced oncology services to evolve and results of this project suggest that telephone neuro-oncology consultations are widely accepted by patients and clinicians. We therefore propose that remote consultations should continue beyond the pandemic in select cases.

scholarly journals P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mia Rodziewicz ◽  
Terence O'Neill ◽  
Audrey Low
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Management Plan ◽  
Service Development ◽  
Telephone Consultation ◽  
Face To Face ◽  
Communication Difficulties ◽  
Strongly Agree ◽  
The Uk

Abstract Background/Aims  Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods  All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results  233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion  Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure  M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

Epidemic Response: Follow-up and lessons learned from the US response to the evolving and conflicting risk information, focusing on education and clinical environments

2021 ◽  
Vol 65 (1) ◽  
pp. 1584-1587
Author(s):  
Alison G. Vredenburgh ◽  
Gail L. Sunderman ◽  
Rodrigo J. Daly Guris ◽  
Sreekanth R. Cheruku
Keyword(s):  
Real Time ◽  
Lessons Learned ◽  
Face To Face ◽  
The Us ◽  
Hospital Systems ◽  
Clinical Environments ◽  
New Type ◽  
Response Decisions ◽  
Epidemic Response

In this follow-up panel, we discuss what we have learned over the last year about responding to an epidemic or pandemic that has demonstrated a level of transmission unprecedented in the modern era. Two medical doctors that have worked on the front of this pandemic share their experiences transitioning from the “sharp end” of the response. Decisions about how to mitigate hazards have occurred at the personal, institutional, and health policy levels, in real-time, with frequent adaptation, and often in advance of concrete evidence. Over the course of the pandemic, hospital systems revised existing protocols to manage perceived risks in real time using emerging information from other centers. With the introduction of vaccines, there is a new type of risk perception. Is the vaccine perceived to be safe? Is there a disparity in perception among different population groups? That said, analyses are also complicated by emerging viral mutations with unclear implications. What factors increase or decrease public compliance with precautions? How are US education policymakers deciding about face-to-face classroom instruction? This panel includes a warnings expert, an expert on education policy, and two practicing physicians.

scholarly journals Process evaluation and exploration of telehealth in motor neuron disease in a UK specialist centre

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e028526 ◽  
Author(s):  
Esther Hobson ◽  
Wendy Baird ◽  
Mike Bradburn ◽  
Cindy Cooper ◽  
Susan Mawson ◽  
...  
Keyword(s):  
Motor Neuron ◽  
Usual Care ◽  
Motor Neuron Disease ◽  
Process Evaluation ◽  
Communication Systems ◽  
Secondary Outcome ◽  
Specialist Care ◽  
Face To Face ◽  
Specialist Centre ◽  
Informal Carers

ObjectivesTo evaluate the processes involved in using a novel digitally enabled healthcare system (telehealth in motor neuron disease (TiM)) in people living with motor neuron disease (MND) and their informal carers. We examined TiM implementation, potential mechanisms of impact and contextual factors that might influence TiM implementation or impact.DesignAn 18-month, single-centre process evaluation within a randomised, pilot and feasibility study.InterventionTiM plus usual care versus usual care alone.SettingA specialist UK MND care centre.Participants40 patients with MND and 37 primary informal carers.Primary and secondary outcome measuresPatient, carer and staff outcomes and experiences using semistructured interviews. Descriptive data on implementation and use of TiM.ResultsThe TiM was acceptable and accessible to patients, carers and staff. Intervention uptake and adherence were good: 14 (70%) patients completed a TiM session at least fortnightly. Barriers to TiM use (such as technology experience and disability) were overcome with well-designed technology and face-to-face training. Reported potential benefits of TiM included improved communication and care coordination, reassurance, identification of complications and the potential for TiM to be an alternative or addition to clinic. Benefits depended on patients’ current level of needs or disability. The main challenges were the large number of alerts that were generated by TiM, how the clinicians responded to these alerts and the mismatch between patient/carer expectations and nurses actions. This could be improved by better communication systems and adjusting the alerts algorithm.ConclusionTiM has the potential to facilitate access to specialist care, but further iterative developments to the intervention and process evaluations of the TiM in different services are required.Trial identifier numberISRCTN26675465.

Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis

2016 ◽  
Vol 31 (5) ◽  
pp. 625-638 ◽  
Author(s):  
Michelle A Cottrell ◽  
Olivia A Galea ◽  
Shaun P O’Leary ◽  
Anne J Hill ◽  
Trevor G Russell
Keyword(s):  
Usual Care ◽  
Physical Function ◽  
Real Time ◽  
Meta Analysis ◽  
Healthcare Delivery ◽  
Eligibility Criteria ◽  
Musculoskeletal Conditions ◽  
Face To Face ◽  
Conventional Methods ◽  
Mean Differences

Objective: To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population. Data sources: Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions. Review methods: Two reviewers screened 5913 abstracts where 13 studies ( n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black ‘Checklist for Measuring Quality’ tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI). Results: Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I2=93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I2=58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I2=10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI −0.10–0.37, I2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI −0.27–1.60, I2=96%) following intervention. Conclusions: Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.

Response of elevated Epstein-Barr virus DNA levels to therapeutic changes in pediatric liver transplant patients: 56-month follow up and outcome

2002 ◽  
Vol 74 (3) ◽  
pp. 367-372 ◽  
Author(s):  
Ronald D. Holmes ◽  
Kathy Orban-Eller ◽  
Frederick R. Karrer ◽  
David T. Rowe ◽  
Michael R. Narkewicz ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Epstein Barr Virus ◽  
Barr Virus ◽  
Transplant Patients ◽  
Pediatric Liver ◽  
Epstein Barr ◽  
Pediatric Liver Transplant

scholarly journals Immunosuppression induction with rabbit anti-thymocyte globulin with or without rituximab in 1000 liver transplant patients with long-term follow-up

2012 ◽  
Vol 18 (7) ◽  
pp. 786-795 ◽  
Author(s):  
Richard S. Mangus ◽  
Jonathan A. Fridell ◽  
Rodrigo M. Vianna ◽  
Paul Y. Kwo ◽  
Jeanne Chen ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Transplant Patients ◽  
Long Term Follow Up
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