Remote visits, are they always the best option?

Glòria Galvez

By Healthwatch Dorset 

The coronavirus pandemic has had an explosive and profound impact on health care systems, especially concerning traditional care. Presently, in addition to caring for patients affected by a coronavirus, it’s necessary to continue caring for the "invisible patient", who is still there, affected by other pathologies evolving at their usual pace, some of them potentially severe. Remote visits, which in a short time has gone from being a rare modality to being the usual form of interaction with the patient, are presented as the best option to carry out their follow-up, thus avoiding crowded waiting rooms and the risk of infection.

According to a report promoted by Barcelona Health Hub, during the state of alert in Spain, 85% of hospital outpatient consultations were made electronically. This change towards a virtual care model requires an analysis of its impact on accessibility, quality of service and clinical outcomes, also taking into account the assessment of experience by patients and professionals. Both express their satisfaction: professionals because it allows them more flexibility in their agendas and patients for faster and more efficient accessibility, saving time on trips, waiting times and the visit itself, as well as reducing the risk of contagion.

Publications such as RCGP, Nuffield Trust and The Health Foundation provide some areas for improvement in the opinion of professionals. Thus, for example, they point to the need for better evidence of the long-term impact on clinical outcomes because they warn that some symptoms may go unnoticed during an online consultation or that, due to excessive caution, there may be an increase in drug prescriptions or referrals to other specialists. Professionals emphasize the importance of face-to-face interaction with patients for assessing situations requiring physical examination and warn that failure to do so could make diagnosis difficult. In addition to the clinical aspects, they also take into account the more human aspects and the mutual empathy, so necessary to create trust and difficult to achieve if, before the virtual meeting, there has been some contact between patient and professional.

Regarding patients experience, few studies have taken it into account. We do have satisfaction data that show that about 90% of patients would use it again and would also recommend a remote visit. One of the few published studies, with very valuable information to understand and give visibility to the patient experience, is "The Dr Will Zoom You Now", conducted by National Voices in partnership with Healthwatch England and Traverse and supported by PPL.

Thanks to the rapid advancement of everything related to remote medicine, we can now present a decalogue with the suggestions that patients bring from their own experience:

1. Inform the patients in advance so that they know what to expect from the visit and how to prepare.
2. Give yourself a reasonable amount of time to prepare for the visit.
3. Assess patients’ level of digital knowledge and make it easy to choose which type of remote appointment is best suited to their level (phone, video or email).
4. Ask if they have access to digital technology and if they want to receive care online.
5. Respect their personal life in scheduling visits and inform them of the time slot in which they will receive the call.
6. Whatever remote interview format is used, maintain optimal quality in communication.
7. Provide demonstration videos so patients can familiarize themselves with the process.
8. Consider the impact of this model of care if it’s for a disabled person.
9. Depending on their clinical needs, consider the option of a face-to-face consultation alternating with a remote one.
10. At the end of the visit, ask patients about their experience on it.

Patients and professionals agree that visits can be made virtually, but not all, not always. Beyond the practical aspects to ensure that remote consultations answer to the needs of care, it’s necessary to explore how we achieve the right balance so that virtual care is complementary to face-to-face, thus avoiding the danger of weakening our relationship with the patient.