ABSTRACT
BackgroundThe widespread shift to remote healthcare consulting prompted by Covid-19 is stimulating much-needed research into remote consulting practices and outcomes. Recognising that the challenges and implications vary across consultation types, we are focusing on the use of telephone consulting for ‘Care and Support Planning’ (CSP) consultations for people with long term conditions (LTCs). CSP consultations are distinctively designed to ensure healthcare professionals and patients work collaboratively to plan actions oriented to patients’ priorities.Our study aims to understand healthcare professionals’ perspectives on conducting CSP consultations by telephone, and to investigate how and to what extent the core purposes of CSP can be achieved.MethodsIn-depth, semi structured interviews with primary care professionals in England and Scotland, exploring how remote CSP consulting works in practice. Interviews are audio-recorded, transcribed and analysed thematically.ResultsPreliminary analysis of the first 11 interviews highlights that the use of telephone consultations and the settings in which patients receive their calls, can impinge on aspects of CSP consultations and hinder fulfilment of their purpose. For example, in telephone consultations, it is harder to ‘look together’ at patients’ test results, the absence of visual cues can make recognition of emotions and interpretation of silences difficult, and the establishment of rapport can seem harder, especially when the patient and health professional have not met before. Health professionals also expressed concerns about the inability to ‘eyeball’ patients when not seeing them in-person, limiting their scope to identify any potential concerns. There were also common challenges with patients joining consultations from situations in which they lacked privacy, had not read their test results or ‘not in the right headspace’ to discuss their concerns and ideas. In these circumstances, health professionals worry that, especially for patients with more complex needs, the benefits of the CSP structure can feel lost as conversations tend to ‘drift’ into a chat, or revert to professionally directed reviews. They report having developed various strategies to strengthen their spoken signalling of the structure of the CSP consultation to the patient but described how ‘draining’ this can be when they continue to experience difficulties eliciting patients’ reflections, concerns and ideas, and developing patient-led plans.ConclusionThis study is identifying both issues of concern and strategies to help ensure CSP is delivered as well as possible remotely. The challenges of achieving ‘equivalence’ to in-person consultations should not be neglected with moves towards more ‘hybrid’ approaches to healthcare consulting.