Expert panel debates role of virtual healthcare consultations
Virtual sessions “are one of the great healthcare successes of the last 18 months” but they can also exclude patients and create problems, an expert panel has concluded.
'Virtual healthcare consultations and their place in a post-COVID world' was the topic of Connect Health’s latest Change webinar on Wednesday (13 October). The session reflected on the rapid expansion of virtual consultations in healthcare services since spring 2020, underlining positive proven outcomes – effective peer support within group consultations, for example – while examining issues of patient inequality and how virtual consultations may worsen this for some.
One panel member, clinical specialist, John Paul Gowland, likened virtual appointments to "Marmite", suggesting that both patients and clinicians ought to try them before forming a strong opinion on their effectiveness. The option of blended care, where patients have direct contact with a clinician alongside virtual consultation, was also discussed.
Bhavna Patel, gave a personal account of the challenges of virtual appointments, highlighting the potential dangers of placing too much onus on patients – particularly those from already marginalised groups.
Following an address from webinar chair Andrew Cuff, Consultant Physiotherapist and Head of MSK, Connect Health, the session began with Anthony Gilbert, Postdoctoral Research and Improvement Physiotherapist, Royal National Orthopaedic Hospital NHS Trust, asking ‘Can you put video consultations in the NHS?’.
Gilbert argued that their suitability must be ascertained on a patient-by-patient basis. He said that clinicians need to be aware of how much they are delegating to patients through self-management treatments and virtual consultations, outlining how patients may become disengaged if the ‘burden of treatment’ is too great. Gilbert highlighted the need for patients to be offered a preference, and that this can be a constantly changing picture.
“For some patients, [virtual consultations] are absolutely fine, for others they see in-person care as more beneficial. We know that MSK (musculoskeletal) problems can flare up – one day things can be great and they can tolerate an hour-long journey to come to clinic, but on other days, they can’t make it. The context of preferences is situational and we need to understand that.”
Stating that the expansion of virtual consultations is “one of the great successes in healthcare in the last 18 months”, he recommended that patients are given upfront knowledge about virtual appointments and that discussions on what is best for the patient are a “two-way dialogue”.
Gail Sowden, Consultant Physiotherapist and Head of Pain at Connect Health discussed blended care. She said: "There is much we do not know. For example, it is unclear what is clinically appropriate and acceptable and what type of 'blend' works for whom, and why. We also need to try and ensure provision doesn’t exacerbate or create new inequalities and consider how we ensure the pace of change brings staff and patients on board."
She added that we should have open clinical doors and accessible online and ehealth care.
John Paul Gowland, Upper Limb Clinical Specialist, Tyneside Integrated Musculoskeletal Service (TIMS) and academic tutor, Sunderland University described his recent experiences of managing patients via a virtual group consultation.
He said: “I might have eight patients waiting for a 30-minute appointment, all with atraumatic shoulder pain…potentially the patients might feel rushed, they might all bring up the same questions and be given the same information…so if we have one 90-minute appointment for all patients to attend together, can we enhance patient care, improve outcomes and make savings and efficiencies as well? The quick answer is yes.”
Gowland outlined how research has shown positive outcomes from group consultations in patients with diabetes and COPD, and that peer support among those with the same condition plays a key part – one patient in his own group consultation said “I realised I wasn’t suffering alone.”
He concluded: “[Virtual group consultations] are a bit like Marmite – some will love them some won’t. My take-home message to patients and clinicians alike is ‘you don’t know unless you give it a try.’”
Life coach Bhavna Patel, who suffers from fibromyalgia and other conditions, spoke of her own experiences of virtual consultation, saying she struggled to be understood and wasn’t able to physically show her conditions; this led to her being hospitalised, with her mental health also significantly impacted by the frustration she felt. “[Sometimes, healthcare professionals] actually have to prod and probe [within an in-person appointment].”
She explained the barriers facing marginalised groups, such as South Asian communities, to using virtual consultations. “We need to help people help themselves,” she said, outlining the need for patients to have the ability to explain symptoms accurately, and how there is the potential for serious issues to be missed due to language barriers. She recommends the introduction of ‘toolkits’ to assist patients within these groups in accessing virtual appointments, helping to minimise frustrations and ultimately reduce pressure on the NHS.
The final speakers of the session were Devon Elliott, Senior Programme Manager, BestMSK Health Programme, NHS England and NHS Improvement, and Melanie Martin, Senior Delivery Manager at NHSX, who outlined how digital consultations can help physical and mental health for MSK patients on a national scale.
Melanie said: “It’s not about digitising for digitising’s sake, but to add value and impact, to connect services and level out opportunities… and transform care.” She underlined the importance of not making assumptions about elderly patients and other communities not wanting to use technology - rather, they need to be asked, and emphasised that all channels need to remain open to offer patients a choice.”