CLINICIAN-RELATED FACTORS MAY INFLUENCE REMOTE CONSULTATIONS in RHEUMATOLOGY-ANALYSIS of SENIOR VS TRAINEE CLINICIANS' OUTCOMES from A COVID-19 INITIATIVE

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.