'Perfect for some but disastrous for others': Patients and clinicians
express concerns over phone and video consultations

Date:
November 2, 2021
Source:
University of Cambridge
Summary:
A study of rheumatology patients and clinicians has found that while
the majority found phone or video consultations more convenient than
face-to- face consultations, they viewed so-called telemedicine as
less diagnostically accurate than in-person consultations and as
having the potential to increase health inequalities and barriers
to accessing appropriate care.



FULL STORY ==========================================================================
A study of rheumatology patients and clinicians has found that while
the majority found phone or video consultations more convenient than face-to-face consultations, they viewed so-called telemedicine as less diagnostically accurate than in-person consultations and as having the potential to increase health inequalities and barriers to accessing
appropriate care.


==========================================================================
A key finding was that the vast majority of respondents -- 86% of
patients and 93% of clinicians -- felt that telemedicine was worse
than face-to-face consultations for accuracy of assessment, with some
reporting misdiagnoses.

One rheumatology patient explained: "My rheumatologist cannot see or
hear how I move, look at my skin, eyes, hair, hands, bones, how I am...I
was diagnosed with something over the phone, which I know isn't right,
and it's getting worse." 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." In a
study published today in Rheumatology, researchers at the University
of Cambridge, working with a wider national team including expert
consultants, patients and psychologists, examined the pitfalls and
benefits of telemedicine for patients with chronic diseases.

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%).



==========================================================================
This is the first telemedicine study to have combined data from
rheumatology patients, GPs and hospital clinicians. In addition to less accurate assessments, the team found several other major disadvantages
and risks associated with telemedicine.

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 to continue trusting each other.

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.

"Waiting for a call back after 4 voicemails...feel sad and scared
knowing that when I really need medical help I have no-one," said one
young lupus patient.

There was concern, too, that telemedicine increased the potential for inequalities in treatment. Certain groups of patients were perceived to
be at a substantial disadvantage. These included those with undiagnosed
or more complex conditions, for whom English was not a first language
or who had hearing, cognitive or speech difficulties, and patients
experiencing socio-economic disadvantage or mental health difficulties.



========================================================================== "We've had some local Practices only allowing contact through econsult,
so that means that if you can't use it, you're elderly, English not your
first language, you've got learning difficulties... it's not fair. They're doing that whole barrier to protect their time," said one senior GP.

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 to get to appointments as discussed by this female
lupus patient: "I am very glad that telemedicine has become an option
as it not only makes me feel more relaxed and safer, but I often have
great difficulty getting to hospital," said a lupus patient.

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.

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.

"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." The research
team concluded that telemedicine's acceptability and safety can be
improved by training for clinicians, offering patients more choice,
careful selection of which patients to offer telemedicine to, and further consultation with clinicians and patients on its use.

Professor Caroline Gordon, from the Institute of Inflammation and Ageing
at the University of Birmingham and study co-author, said: "Some stable rheumatic disease patients can benefit from telemedicine but new patients, those with worsening symptoms or more complex conditions such as lupus
need quickly accessible, face-to face appointments to manage their conditions.'' Senior author, 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." ========================================================================== Story Source: Materials provided by University_of_Cambridge. The original
text of this story is licensed under a Creative_Commons_License. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Melanie Sloan, Elliott Lever, Rupert Harwood, Caroline Gordon, Chris
Wincup, Moira Blane, James Brimicombe, Peter Lanyon, Paul Howard,
Stephen Sutton, David D'Cruz, Felix Naughton. Telemedicine in
rheumatology: A mixed methods study exploring acceptability,
preferences and experiences among patients and
clinicians. Rheumatology, 2021; DOI: 10.1093/ rheumatology/keab796 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/11/211102093549.htm

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