ABSTRACT
Background: Since COVID-19 pandemic started, there have been changes in clinical practice to limit transmission, such as switching from face-to-face to remote consultations. Our department switched to delivering remote consultations without suspending service. Patients were offered the preference of either video or telephone consultation. It is unclear what factors including clinician-related factors significantly influence remote consultations in Rheumatology. Objectives: We aimed to study the influence of senior (substantively employed) vs trainee status of clinicians on remote consultations in our experience during the pandemic. Methods: Between 15/10/2020 and 09/11/2020, 12 clinicians in our department completed data collection forms after each remote consultation, recording the technology used (video vs phone);technical problems encountered;discharge and subsequent appointment status;and technical aspects of the consultation itself using 11-point numerical rating scales (NRS) (Time Adequate;Relevant History;Physical Exam;Management Plan;and Communication Quality). Data were collated on an MS Access 2016 database, and transferred to SPSS version 25 for statistics. Results: Nine senior clinicians (3 consultant rheumatologists, 3 Specialist Nurses, 1 Advanced Rheumatology Practitioner and 2 Senior Rheumatology Pharmacists) and 3 trainee clinicians (2 Specialty Trainee Registrars and 1 Foundation Year 2 doctor) completed forms. 285 forms were validated for analysis. The majority of consultations were completed by senior clinicians (266, 93.3% vs 19, 6.7%). Senior and trainee clinicians had a similar proportion of new patients compared to follow-up patients (18%, n=48 vs 15.8%, n=3;p=0.80);of female patients (68%, n=181 vs 63.2%, n=12;p=0.66);and video consultations (17.3%, n=43 vs 10.5%, n=2;p=0.45);and similar mean age of their patients (59.5 vs 56.7years;p=0.72) respectively. Senior clinicians accounted for all the technical issues reported (20%, n=48 vs 0%, n=0;p=0.03). Senior clinicians had lower mean scores compared to the trainee clinicians on NRS for Relevant History (8.68 vs 9.68;p<0.001), Physical Exam (1.49 vs 2.95;p=0.045), and Communication Quality (8.02 vs 9.37, p=0.002);and had no signifcant differences in scores for Time Adequate (8.46 vs 9.00;p=0.10) and Management Plan (7.17 vs 7.84;p=0.16). Senior and trainee clinicians and a similar proportion requests for subsequent face-to-face appointments (21.9%, n=51 vs 25%, n=4;p=0.77). Conclusion: There were no signifcant differences between senior and trainee clinicians in distributions of patients and proportion of video consultations. While no technical issues were reported by the trainee clinicians, this may in part be a refection of their smaller proportion of overall consultations. Although senior clinicians rated their consultations somewhat lower in some of the NRS, there was no signifcant difference in management plan scores and subsequent face-to-face appointment status compared to trainee clinicians. While the lower scores may partly refect the technical issues reported by the senior clinicians, longer clinical experience and greater knowledge may also be an underlying factor for this. Further studies with larger numbers may clarify these issues.
ABSTRACT
Background/Aims The COVID19 pandemic significantly altered healthcare provision. Our department switched immediately to remote consultations without suspending service, including telephone and video consultations. In this analysis we aimed to explore the role of patient-related factors in influencing the process and outcome of remote consultations with a view to improving the quality of service provision. Methods A data collection form was developed and offered to all clinicians to complete after each remote consultation. Information on age, gender, new or follow up status and interpreter use were collected. Clinicians were asked to rate the effectiveness of specific components of the consultation process (time adequate, relevant history, physical examination, management plan and communication quality) as compared to the usual face to face appointments on Numerical Rating Scales (NRS, 00). Data were collated in a Microsoft Access database. Statistical analysis was performed using SPSS version 25. Results In total, 285 valid forms were evaluated. 193 (67.7%) were women. Patients registered for new appointments (n=51, 18%) were significantly younger (mean±SD 52.9 ± 19.7 vs 60.6 ± 17.2 years, P=0.012). There were no significant correlations with age or any significant differences with gender in mean scores of NRS. New patients scored lower on NRS for relevant history (8.0 ± 1.1 vs 8.9 ± 1.2, P<0.001), management plan (4.8 ± 2.5 vs 7.8 ± 2.0, P<0.001) and communication quality (6.6 ± 2.0 vs 8.4 ± 1.6, P<0.001). Interpreter usage (n=9, 3.4%) had lower scores for relevant history (7.1 ± 2.4 vs 8.8 ± 1.1, P=0.012) and communication quality (5.4 ± 2.6 vs 8.1 ± 1.8, P=0.002). There was no significant association of age or gender with subsequent follow up appointment requested as face-to-face or remote. New patients were significantly more likely than follow-up patients to be offered a face-to-face follow up appointment (univariate regression, odds ratio (OR) 5.49, 95% CI 2.7-11.1, P<0.001). However, once adjusted for management plan in multivariate regression, new patients were no longer significantly associated with subsequent follow up face-to-face appointment (adjusted OR 1.19, 0.48-2.92, P=0.71). Conclusion Our study is one of the first in the UK to explore patient-specific factors influencing remote consultations in rheumatology. In our cohort, patient age or gender was not a limiting factor in utilising remote consultation. New consultations and interpreter use pose challenges for remote consultations, and further studies are needed to address these to see if any measures such as appropriate selection at triaging new appointments may be possible, to improve outcomes.