Telemedicine during COVID-19: a survey of Health Care Professionals’ perceptions

The National Health Service (NHS) has rapidly adopted telemedicine solutions as an alternative to face-to-face consultations during the COVID-19 pandemic. The majority of HCPs (Healthcare Professionals) were unfamiliar with Telemedicine prior to the current pandemic. Remote consultation is expected to continue for the foreseeable future, thus we designed this survey. A survey designed to evaluate the use of telephone consultation by HCPs, assessing its implementation, challenges and drawbacks. A web link survey conducted through SurveyMonkey was sent to HCPs across six UK Trusts the period of May 2020. The survey received 114 responses (84%) being doctors. 95% of respondents had not received training prior to engaging in telemedicine consultations. 64% were unaware of the updated General Medical Council guidance concerning remote consultations. The most common barrier in remote consultation was the inability to access patient records raised by 37% of respondents. However, 73% of respondents felt that patients understood their medical condition and the instructions given to them over the phone, and 70% agreed that videoconference consultations would add to patients care. Telemedicine can be used for selected groups of patients in the post COVID-19 era, and the HCPs carrying that should have the sufficient experience and knowledge expected to operate these clinics.

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Patient and clinician satisfaction with video consultations during the COVID-19 pandemic: an opportunity for a new way of working

Journal of Orthodontics ◽

10.1177/1465312520973677 ◽

2020 ◽

pp. 146531252097367

Author(s):

Emer Byrne ◽

Simon Watkinson

Keyword(s):

Teaching Hospital ◽

Service Evaluation ◽

Remote Consultation ◽

Cross Sectional ◽

Face To Face ◽

Level Of Satisfaction ◽

The Future ◽

Clinician Satisfaction ◽

High Level ◽

Remote Consultations

Objective: To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised. Design: Service evaluation involving descriptive cross-sectional questionnaire. Setting: Orthodontic Departments at Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital. Participants: Patients and clinicians involved in video consultations. Methods: Patient- and clinician-specific questionnaires were designed and those involved in virtual clinics were invited to complete these at the end of their consultation. The questionnaires focused on setting up and connecting to the virtual clinic, assessing if the correct types of patients were involved in the clinics and satisfaction with these types of remote consultations. Results: A total of 121 questionnaires (59 patient and 62 clinician) were completed. Of the patients, 93% found the instructions provided to access the consultation easy to follow and 70% of clinicians did not report any connection issues. In 90% of cases, a virtual appointment was seen to be appropriate by the clinician. Respondents showed a high level of satisfaction with 76% of patients saying a remote consultation was more convenient than face-to-face, and 66% reporting they would, if appropriate, like more appointments like this in the future. Conclusion: The overall satisfaction among patients with virtual clinics introduced during the COVID-19 pandemic was generally high. The majority of patients would, where appropriate, prefer more virtual appointments in the future in comparison to face-to-face appointments and it was found to be more convenient for the patient.

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Experiences of remote consulting for patients and neurologists during the COVID-19 pandemic in Scotland

BMJ Neurology Open ◽

10.1136/bmjno-2021-000173 ◽

2021 ◽

Vol 3 (2) ◽

pp. e000173

Author(s):

Maria Stavrou ◽

Eva Lioutas ◽

Joanna Lioutas ◽

Richard J Davenport

Keyword(s):

Significant Proportion ◽

Model Of Care ◽

Remote Consultation ◽

Web Based ◽

Face To Face ◽

Training Interventions ◽

Consultation Skills ◽

Neurological Conditions ◽

Remote Consultations

BackgroundRemote consulting is an emerging model in managing chronic neurological conditions and has been widely implemented during the COVID-19 pandemic. The objective of this national survey was to investigate the initial experiences of remote consulting for neurologists and patients with established neurological conditions under follow-up during the first COVID-19 phase.MethodsIn collaboration with the Scottish Association of Neurological Sciences and the Neurological Alliance of Scotland, we conducted a web-based survey of neurologists and patients between October and November 2020.FindingsData was available for 62 neurologists and 201 patients. The consensus among neurologists was that remote consulting is a satisfactory way of delivering healthcare in selected groups of patients. For practical and technical reasons, there was preference for phone over video consultations (phone 63% vs video 33%, p=0.003). The prevailing opinion among clinicians was that considerable training interventions for remote consultation skills are required (‘yes’ 63% vs ‘no’ 37%, p=0.009) to improve clinician consultation skills and successfully embed this new model of care.Most patients perceived remote consultations as safe, effective and convenient, with 89% of patients being satisfied with their remote consultation experience. Although traditional face-to-face consultations were the favoured way of interaction for 62% of patients, a significant proportion preferred that some of their future consultations be remote.InterpretationAlthough not a replacement for face-to-face consultations, this survey illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations for doctors and patients. More research is required to identify overall safety and applicability.

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Handling concerns raised about doctors: time for local changes

British Journal of Healthcare Management ◽

10.12968/bjhc.2019.0085 ◽

2020 ◽

Vol 26 (4) ◽

pp. 1-11

Author(s):

Andrew Graeme Rowland ◽

Keerthi Mohan

Keyword(s):

Health Education ◽

Healthcare Professionals ◽

General Medical Council ◽

Medical Council ◽

Just Culture

NHS organisations must be assured that appropriate protections and support are in place for their employees, especially when incidents occur or concerns arise. These assurances are an essential part of fostering a just and inclusive culture under an overarching banner of compassionate leadership, while also ensuring that any concerns are properly investigated. In mid-2019, the General Medical Council published their Hamilton review into Gross Negligence Manslaughter. As a result, NHS Improvement wrote to NHS trusts about managing local investigation processes for disciplinary investigations of all types. Employers and educators of healthcare professionals have a responsibility to consider how they will put these recommendations and requirements into practice, yet there is currently no clear implementation guidance. The authors make implementation recommendations that should be considered by NHS organisations and Health Education England as part of their compassionate leadership and just culture processes.

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The use of Microsoft Excel as an electronic database for handover and coordination of patients with trauma in a District General Hospital

BMJ Innovations ◽

10.1136/bmjinnov-2016-000182 ◽

2017 ◽

Vol 3 (3) ◽

pp. 130-136

Author(s):

Nik I Bakti ◽

Mark Williamson ◽

Ranjit Sehjal ◽

Michael Thilagarajah

Keyword(s):

Healthcare Professionals ◽

General Medical Council ◽

Junior Doctors ◽

Medical Council ◽

Electronic Database ◽

Communication Tool ◽

Missing Information ◽

Microsoft Excel ◽

Acute Trauma ◽

Trauma Service

Communication between healthcare professionals is a key aspect in patient safety especially when dealing with patients with musculoskeletal trauma. The change of junior doctors’ working patterns within the last decade and a multidisciplinary approach has resulted in more healthcare professionals being involved in any one patient’s care. A robust handover and communication tool is essential in ensuring patients’ safety and to allow efficient service coordination. We compared the use of a simple traditional template-based handover system with an electronic interactive database developed using Microsoft Excel specifically designed as a handover tool and to coordinate acute trauma referrals to the orthopaedic department in our hospital. We compared the adequacy and accessibility of patient details and clinical information as well as assessing these systems as tools to facilitate coordination of patients with trauma. Data from both handover systems were collected prospectively over the period of 12 weeks and analysed for the degree of missing information based on the General Medical Council and British Medical Association guidelines for safe handover. A questionnaire was also handed to members of the multidisciplinary team to assess their impression of each handover system on coordination and management of the trauma service. Our study showed a significant reduction in missing information in the electronic database handover system in multiple domains (p<0.001). Our survey of 29 healthcare professionals also showed a significant improvement in their perceived ability to manage acute trauma referrals, coordinate patients awaiting surgery and in accessing previous handover discussions (p<0.001).

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Alcohol dependence and driving: knowledge of DVLA regulations

BJPsych Bulletin ◽

10.1192/pb.bp.113.045963 ◽

2015 ◽

Vol 39 (1) ◽

pp. 35-38

Author(s):

Andrew Collier ◽

Maggie Watts ◽

Sujoy Ghosh ◽

Peter Rice ◽

Neil Dewhurst

Keyword(s):

Alcohol Abuse ◽

Alcohol Dependence ◽

Medical Condition ◽

General Medical Council ◽

Alcohol Problems ◽

Clinical Implications ◽

Medical Council ◽

Medical Practitioners

Aims and MethodsThe UK's Driver Vehicle Licensing Authority (DVLA) requires individuals to report if they have a medical condition such as alcohol dependence. General Medical Council guidance indicates that medical practitioners should ensure patients are aware of their impairment and requirement to notify the DVLA.ResultsIn a survey of 246 people with known alcohol dependence, none were aware of advice on driving given by medical practitioners and none had self-reported. In addition, 362 doctors, either attending a college symposium or visiting a college website, were asked about their knowledge of DVLA regulations regarding alcohol dependence: 73% of those attending the symposium and 63% of those visiting the website answered incorrectly. In Scotland, over 20000 people have alcohol dependence (over 1 million people with alcohol abuse), yet only 2548 people with alcohol problems self-reported to the DVLA in 2011.Clinical implicationsIf the DVLA regulations were implemented, it could make an enormous difference to the behaviours of the driving public.

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Patients’ Experiences of Remote Neurology Consultations during the COVID-19 Pandemic

European Neurology ◽

10.1159/000511900 ◽

2020 ◽

pp. 1-4

Author(s):

Mary Clare McKenna ◽

Mahmood Al-Hinai ◽

David Bradley ◽

Elisabeth Doran ◽

Isabelle Hunt ◽

...

Keyword(s):

Standard Deviation ◽

Continuity Of Care ◽

Chronic Illnesses ◽

Telephone Consultation ◽

General Neurology ◽

Face To Face ◽

Global Pandemic ◽

Neurology Clinic ◽

The Mean ◽

Remote Consultations

Telemedicine has been widely implemented during the COVID-19 global pandemic to enable continuity of care of chronic illnesses. We modified our general neurology clinic to be conducted using remote audio-only telephone consultations. We included all patients over a 10-week period who agreed to both a telephone consultation and a questionnaire afterwards in order to ascertain the patient’s perspective of the experience. There were 212 participants consisting of men (43.8%) and women (56.2%). The mean ± standard deviation of age was 47.8 ± 17.0 (range 17–93) years. For the most part, patients found remote consultations either “just as good” (67.1%) or “better” (9.0%) than face-to-face consultations. Those who deemed it to be “not as good” were significantly older (52.3 ± 17.9 years vs. 46.6 ± 16.6 years, p =0.045) or were more likely to have a neurological disorder that required clinical examination, namely, a neuromuscular condition (66.7%, p = 0.002) or an undiagnosed condition (46.7%, p = 0.031). At the height of the COVID-19 global pandemic, most patients were satisfied with remote consultations. The positive feedback for remote consultations needs to be verified outside of this unique scenario because the results were likely influenced by the patients’ apprehension to attend the hospital amongst other factors.

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The Use of Telephone Consultation in Primary Health Care During COVID-19 Pandemic, Oman: Perceptions from Physicians

Journal of Primary Care & Community Health ◽

10.1177/2150132720976480 ◽

2020 ◽

Vol 11 ◽

pp. 215013272097648

Author(s):

Said Al Hasani ◽

Thamra Al Ghafri ◽

Hussain Al Lawati ◽

Jamshid Mohammed ◽

Ameena Al Mukhainai ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Lessons Learned ◽

Current Evidence ◽

Telephone Consultation ◽

Implementation Challenges ◽

Face To Face ◽

Primary Health ◽

Building Activities ◽

Privacy And Confidentiality

Introduction: To enforce physical distancing measures during COVID-19, Telephone Consultation (TC), a form of telemedicine, was initiated as an alternative technology to face to face consultation in primary health care (PHC) in Muscat, Oman. This study aims to explore the perceptions of physicians about the use of TC with respect to process of implementation; challenges and limitations; lessons learned and the way forward. Method: This was a qualitative study using interpretive phenomenological analysis. Physicians who were actively conducting TC in PHC were purposively selected and individually interviewed until no new responses were obtained. All interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results: Twenty-two participants were interviewed. Participants were predominantly females (98%) and qualified family physicians (77.3%). Overall, all participants accepted this initiative as a possible method to continue health services during COVID-19. Perceptions about the process of implementing TC in PHC were themed to; inconsistent implementation of the guideline, variability in roles and responsibilities, and Semi-supportive infrastructure. Five themes were identified as challenges and limitations: limited staff training on TC, suboptimal patient-physician interaction, insufficient technical support, ensuring privacy, and confidentiality of the communication, and different ways to document the TC. Physicians expressed that TC worked better in following COVID-19 cases, chronic conditions, and, in general, simple cases. They also expressed a reduction in the crowdedness in PHC facilities and the risk of acquiring COVID-19 and other types of infections. Tailoring the existing structural clinical setting, capacity building activities on the use of TC, and improving the quality of the TC are viewed as essential steps for the future sustainability of TC in PHC. Conclusion: Given the exceptional situation of COVID-19, the current evidence suggests that the use of TC in PHC, especially in chronic cases, is promising. However, measures including training of staff, improving the structural setting, and selecting suitable cases for TC are the main elements for high quality and sustainable TC services in PHC from physician’s perspective.

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Survey of remote consultations in psychiatry during the SARS-CoV-2 outbreak

BJPsych Open ◽

10.1192/bjo.2021.704 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S264-S265

Author(s):

Nusra Khodabux ◽

Satheesh Gangadharan ◽

Samuel Tromans ◽

Avinash Hiremath

Keyword(s):

Mental Health ◽

Qualitative Data ◽

Healthcare Professionals ◽

Mental Healthcare ◽

Technical Quality ◽

Face To Face ◽

The Mean ◽

Detrimental Impact ◽

Remote Consultations

AimsTo compare the usage of remote consultations before and after the first wave of the SARS-CoV-2 outbreak and explore mental health workers’ views on the usage of telemedicine.MethodAn online questionnaire survey was developed, and disseminated to mental healthcare professionals via e-mail and social media. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using Braun and Clarke's six step procedure for thematic analysis.1ResultThere were 40 responses from mental healthcare professionals of varying grades from different sub-specialties, predominantly from the UK. Compared to before the SARS-CoV-2 outbreak, there was an increase in usage of telephone (9(22.5% to (29)72.5%) and video consultations (4(10%) to 17(42.5%)). Respondents reported an increase in virtual MDTs (35(87.5%) during the pandemic, 9(22.5%) pre-pandemic).Based on a 5-point Likert scale, the mean technical quality of telephone consultations was 3.56/5 (Range 2-5), with 75% rating telephone consultations as not being as good as face-to-face consultations. The mean technical quality of video consultations was 3.58/5 (Range 2-5), with 63% rating video consultations as not being as good as face-to-face consultations. 25 (62.5%) respondents felt comfortable using telephone consultations during the pandemic, 20(50%) felt comfortable using video consultations. Recurring themes identified from the qualitative data regarding reasons for the technical quality ratings were: connection issues, poor infrastructure and security concerns.Nine (23%) respondents felt that using video conferencing consultations had a detrimental impact on the mental health of patients while 14(35%) felt that telephone consultations had a detrimental impact on patients’ mental health. Recurring themes for health practitioners’ perceived effect of the use of telemedicine on patients’ mental heath were the loss of personal touch and reduced patient engagement.ConclusionThere was a substantial increase in usage of remote consultations during the first wave of the SARS-CoV-2 pandemic among mental healthcare professionals. The results reported in the present study suggest there are numerous barriers to the use of telemedicine in psychiatry, which require future exploration, ideally through interview or ethnographic studies.

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Survey of CAMHS clinicians about their experience of remote consultation: brief report

BJPsych Open ◽

10.1192/bjo.2020.160 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Anupam Bhardwaj ◽

Anna Moore ◽

Rudolf N. Cardinal ◽

Carol Bradley ◽

Lauren Cross ◽

...

Keyword(s):

Mental Health ◽

National Health Service ◽

Mental Health Services ◽

Health Service ◽

Health Services ◽

Remote Consultation ◽

Face To Face ◽

Remote Consultations ◽

Safe Care ◽

Roll Out

The Covid-19 crisis necessitated rapid adoption of remote consultations across National Health Service (NHS) child and adolescent mental health services (CAMHS). This study aimed to understand practitioners’ experiences of rapid implementation of remote consultations across CAMHS in one NHS trust in the east of England. Data were collected through a brief questionnaire documenting clinicians’ experiences following remote delivery of services. The questionnaire began before ‘lockdown’ and focused on assessment consultations (n = 102) as part of a planned move to virtual assessment. As the roll-out of remote consultations was extended at lockdown, we extended the questionnaire to include all remote clinical contacts (n = 202). Despite high levels of initial concern, clinicians’ reports were positive overall; importantly, however, their experiences varied by team. When restrictions on face-to-face working are lifted, a blended approach of remote and face-to-face service delivery is recommended to optimise access and capacity while retaining effective and safe care.

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To prescribe or not to prescribe: enhancing safety in remote prescribing

Journal of Prescribing Practice ◽

10.12968/jprp.2019.1.3.139 ◽

2019 ◽

Vol 1 (3) ◽

pp. 139-144

Author(s):

Alison Burton Shepherd

Keyword(s):

Health Professionals ◽

General Medical Council ◽

Access To Healthcare ◽

Medical Council ◽

Face To Face ◽

Video Link ◽

The Uk ◽

Nurses And Midwives

From time to time, it may be appropriate to use a telephone, or other non-face-to-face medium to prescribe medicines and treatment for patients. Non face-to-face media include telephone, fax, email, video link, or websites. This concept is known as remote prescribing and refers to prescribing for patients who are physically ‘remote’ or not in the same vicinity as the clinician ( Broadhead, 2011 ). Secondly, the term can also refer to an area of the UK described as being geographically ‘remote’, where direct face-to-face access to healthcare can be poor ( General Medical Council, 2017 ). Remote prescribing has been described as an important facility in healthcare, providing patients with greater accessibility to their medications and treatment ( Griffiths, 2018 ). However, remote prescribing is only acceptable in exceptional circumstances. The aim of this article is to identify and discuss clinical situations in which remote prescribing is acceptable, with an onus on safety. Broadhead (2011) proposes that the medical guidance for remote prescribing is analogous for other health professionals, including nurses and midwives who prescribe remotely using different forms of technology. Therefore, these guidelines will be referred to throughout this article.

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