What has been learned so far from virtual telemedicine?
The rapid digitalisation and use of telemedicine must stay, but appropriate patient selection is key, it is perfect for some but disastrous for others. It is critical to monitor the impact of telemedicine as we test the limits of digital health, in order to assess the benefits and risks.
Researchers at the University of Cambridge, working with a wider national team including expert consultants, patients and psychologists, have examined both the benefits and disadvantages of telemedicine for patients. Their study, published recently in Rheumatology, is the first telemedicine study to have combined data from rheumatology patients, GPs and hospital clinicians.
Between April 2021 and July 2021, a total of 1,340 patients and 111 clinicians completed online surveys. The team also conducted in-depth interviews with 31 patients and 29 clinicians. The majority of patients were from the UK (96%) and had inflammatory arthritis (32%) or lupus (32%).
little research previously on the impact on patient care
Melanie Sloan, lead author from the Primary Care Unit at the University of Cambridge, said: “The pandemic has had a major impact on the ability of healthcare professionals to see their patients face-to-face, and this has led to a significant increase in the number of telemedicine consultations. While these are undeniably safer in terms of COVID risk, there had been little research previously on the impact on patient care, particularly for more complex conditions.”
Convenience of remote consultations
Over 60% of clinicians and patients found telemedicine more convenient than face-to face consultations, pointing to benefits that included COVID-19 safety, no travelling and reduced waiting times as benefits. This was especially the case for those in employment, and for patients feeling well for quick check-ins, prescriptions or administrative queries or those who struggled physically to get to appointments.
Difficulty in building trust
Telemedicine made it more difficult for patients and clinicians to build a trusting medical relationship, according to 90% of clinicians and 69% of patients – although if both parties had previously established a trusting relationship, this made it easier.
Clinicians highlighted the importance of a quick response to ‘flaring’ patients with a rapidly worsening condition, but only about half of patients were confident that they would receive a quick response to an urgent request for medical advice within 24-48 hours from their GP or hospital team. Many patients were grateful for prompt responses despite the challenges facing clinicians, but others reported still struggling to get through administrative systems to receive any kind of response or appointment.
Can telemedicine be over-used?
However, some respondents, particularly clinicians, raised concerns that telemedicine may be over-used by the NHS and hospital management as a cost and time-saving measure, rather being than in patients’ best interests. Clinicians – only 3% of whom felt telemedicine overall was better than face-to-face – and patients had rarely been consulted as to their preferences. Clinicians felt the NHS and managers wanted a higher proportion of appointments to be telemedicine than their own preferences.
Dr Sloan added: “Our research exposes the inherent risks and benefits of telemedicine for patients with complex conditions, which may have important implications for patients who have other serious or unpredictable long-term conditions".
What can be done to mitigate risk?
Dr Sloan goes onto to say, “As the NHS develops a telemedicine strategy, we hope there will be a thorough assessment of the clinical and psychological risks and steps taken to mitigate those risks, as well as action to address the possibility of worsening existing health inequalities for those less likely to be able to benefit from remote consultations.”
Appropriate patient selection is key
The research team concluded that telemedicine’s acceptability and safety can be improved by training for clinicians, offering patients more choice, careful selection of those patients to offer telemedicine to, and further consultation with clinicians and patients on its use.
administrative systems that are not yet efficient enough
Senior author of the study, Dr Felix Naughton, from the University of East Anglia, added: ‘’Of greatest concern was the great variability in accessibility to care. Approximately half of all patients felt they would not receive a prompt response when very unwell, often citing increased barriers due to some remote contact and administrative systems that are not yet efficient enough to cope with the sudden move towards telemedicine.’’
One senior clinician study participant summed up the overall feelings of many:
"The rapid digitalisation and use of telemedicine must stay, but appropriate patient selection is key, it is perfect for some but disastrous for others."
NB This news item is included and expanded as part of a review of wider digitalisation across primary and secondary care in the Total Health article; Testing the limits of digital medicine