Patient Perception of remote, digital NHS healthcare during the COVID-19 pandemic: a UK-wide survey (Preprint)

BACKGROUND During the early spring of 2020, the use of remote healthcare services in the UK saw a dramatic increase in usage as services transitioned away from face-to-face delivery due to the risk of contracting COVID-19. While by far the largest shift was to telephone access which has been studied in recent years pre-COVID (Campbell, 2014), we wanted to determine the impact on patients of any shift to digital access (via an online consultation using a webcam, laptop, mobile phone application). We therefore commissioned a UK-wide representative survey of patient use and attitudes towards digital remote healthcare during the peak of the 2020 COVID-19 Pandemic in the UK. This report predominantly focuses on primary care as it accounts for 300 million NHS patient contacts each year. OBJECTIVE To rapidly assess patient attitudes towards the use of digital healthcare methods during the COVID-19 pandemic via a representative UK-wide survey. METHODS 2,138 survey responses were analysed against the respondents’ protected characteristics, social status, working status, location (UK region), social media usage and number of children (if any) in their household. Inferential statistics were used to compare these variables and survey responses. The survey consisted of three questions. 2,129 free text responses were thematically analysed from the survey, using an inductive, rapid coding method. RESULTS Initially, 14 themes arose from the data. These were collapsed into 7 parent themes with a smaller number of subtopics. These themes represent patient concern and experience of digital, remote healthcare, (1) Remote healthcare is a lesser service, (2) Useful but only for certain conditions, (3) No preference between face-to-face and remote healthcare. (4) Ease of Access to remote healthcare, (5) Speed of Access to Remote Healthcare. (6) Safety Concerns and Remote Healthcare, and (7) Remote healthcare is better than face-to-face. In summary, current patient perception of remote healthcare is that it is a lesser service, compared to face-to-face delivery. Quantitative results indicate 26% of respondents had used a digital, remote consultation. Users were more likely to be females and in a higher social grade. The largest correlation (Cramer’s V 0.51) between variables was across patients who did not see the benefits of digital, remote consultation but who were willing to use it for safety reasons due to the COVID-19 pandemic. CONCLUSIONS Patient preference for using digital, remote healthcare comes with a series of caveats that practitioners and commissioners should be aware of as the active engagement of patients in remote working appears to be more complex than simple measures of technical ability. The survey data intimates issues around willingness, trust, user-preference and more basic behavioural traits that may not have been factored into the delivery of digital care so far. In short, capacity to act is not well equated to willingness or free will of individuals, least of all acceptance of digital, remote healthcare in any universal form. Our data indicates the need for a psychology-based understanding of the frictions and enablers to remote healthcare, rather than a more narrow assessment of technical capacity if we are to drive behaviour change and help shape effective policy. CLINICALTRIAL n/a