A quality improvement project evaluating patient and clinician experience of video consultations in outpatient dermatology

ABSTRACT

The COVID-19 pandemic has brought about unprecedented changes to healthcare delivery. Balancing infection-control practices with the provision of safe specialist care has led to the introduction of video consultations (VCs). Consequently, NHS England has collaborated with Attend Anywhere® (AA) to offer a VC platform to National Health Service trusts. We present the first evaluation of a VC platform in dermatology, at a time when minimizing the substantial indirect impact of the pandemic on patients' lives is vitally important in improving long-term accessibility to dermatology care for vulnerable groups. We are performing a quality-improvement project to evaluate patient and clinician experience of using AA in a U.K. dermatology secondary care outpatient centre during the current pandemic (at the time of writing, June 2020). The clinician survey and final outcomes will be assessed in September 2020. Prospective online surveys for patients and clinicians were designed. The patient survey was integrated into the platform to initiate automatically at the end of each VC. Seventeen questions qualitatively and quantitatively assessed several domains, including patient satisfaction and views on potential long-term use of the platform. Similarly, 12 questions were designed to evaluate clinicians' opinions about the platform, its use for training, ease of organizing prescriptions and potential future use. Data were recorded using a 5-point scoring system (ranging from 'strongly agree' to 'strongly disagree'). Key themes from patient and clinician free-text responses were categorized according to common properties. In total, 149 patient responses have been collected over a 4-week period to date. Patients included were of all ages < 18 years (27%), 18-30 years (26%), 31-69 years (31%) and > 70 years (14%). Fifty-five per cent of consultations were first attendances (45% follow-ups), 31% for a lesional skin problem and 33% for systemic treatment monitoring. The main findings were that 91% had a 'very good' or 'good' overall experience of AA, with 90% feeling that they were able to communicate everything they wanted and 87% feeling comfortable being examined over a VC. Eighty-seven per cent would choose VC over telephone consultation during the current pandemic. Sixty per cent would choose VC over face-toface consultation after the pandemic. A common theme from free-text responses was that subgroups of patients who would find hospital attendances difficult had greater satisfaction with AA, including patients with physical or cognitive impairment, on long-term systemic/biological medication and who are carers for family members. We demonstrate that AA is a patientfriendly platform that can have a pivotal role in the short and long term in the dermatology outpatient setting.