Remote video consultations –the future way to ‘see’ your GP?
On 6 October, Trisha Greenhalgh delivered CHSS’ 3rd Annual Open Lecture to a full house in the University’s Darwin Conference Suite. Trisha is Professor of Primary Care Health Sciences at the University of Oxford.
She discussed her NIHR-funded VOCAL study (Virtual Online Consultations – Advantages and Limitations) of remote video consulting in the NHS. Just seven years ago funders rejected her original application, saying ‘it will never happen’! Skype and Facetime are already commonly used in remote and sparsely populated areas such as Australia. It is in favour with many politicians, but is it the future for British patients?
Audience participation
Prof Greenhalgh was “delighted and humbled” that patients had been invited and sought audience participation. Using videos of consultations with patients, she outlined the emerging pros and cons of ‘seeing’ patients remotely, from practitioner and patient perspective. The study analyses text and body language from remote consultations, including staff and patient feedback and the conditions that have to be in place to implement such a massive change in working practice and attitudes.
The videos clips from the VOCAL study showed patients with diabetes and heart failure. It was interesting to hear how the patients adapted to the medium of video, for example using the camera to show swollen ankles.
Limitations include connection and technology issues (evident in 50% of cases), less personal interaction and missing something the GP spots during a face to face encounter. Some illnesses seem better suited to remote consultations than others.
Advantages were shorter consultation times, the reassurance of the patient’s own environment (one had their dog alongside them) and saving on patient journeys. Diabetic clinic attendance was much better online (90%) when compared with travelling to the surgery (50%). In some cases it saved patients a three bus trip. There are also benefits of increased self-management and patient awareness of their condition and symptoms, but this tends to be dependent on how well or sick a patient is feeling.
Outcomes
Outcomes of the video consultations tended to be good when the technology worked without hitch, but there was stress on both sides when connection problems occurred. In one video the patient was unable to get their ipad set up properly and their blood pressure monitor not working caused more problems.
A big question is around doctor-patient relationships, and whether patients need to Skype with a known and trusted GP for it to work well. How would it work when the parties have not met in person? There are plenty of questions around this whole area and Trisha’s research is still in progress.
The audience – a mix of researchers, practitioners and patients was highly engaged throughout and many people took to Twitter to join in the debate. View the Storify here and see the video of the event here
For more information see: www.nets.nihr.ac.uk/projects/hsdr/135926
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