By: Rebecca Baines, Heather Eardley, Nigel May & Oli Sleeman
We recently held a webinar to explore people’s experiences, perceptions, and aspirations for video consultations in primary care. During the webinar we explored four key areas:
- The potential benefits of video consultations
- What a ‘good’ consultation might look like
- The potential barriers to video consultation use and acceptance; digital exclusion
- The sustainability of video consultations beyond Covid-19.
The discussion sessions generated some really interesting insights that we’d like to share with you today.
Beginning with potential benefits, people who attended the webinar suggested that video consultations could:
- Save time
- Provide patient choice and convenience
- Prevent unnecessary, expensive, and inconvenient travel, (an issue considered particularly relevant in a rural area)
- Enable quicker access to relevant services and healthcare professionals
- Reduce lengthy waiting times
- Allow people to stay in the comfort of their own home
- Prevent people having to take time off work and/or arrange childcare
- Encourage some people to share more information with a healthcare professional as they may feel more comfortable at home
- Reduce the potential risk of picking up an infection when visiting a surgery/waiting room
- Help patients feel like they have more time
- Facilitate multidisciplinary team meetings reducing patient burden, time and travel
What does a good consultation look like?
When exploring what a ‘good’ video consultation looks like, attendees discussed the need for: technology to be simple and easy to use; clear advice to be given on factors that could affect user experience such as using a bigger screen where possible and ensuring a good connection; health care professionals being on time and remaining calm and understanding if technological difficulties are encountered; sharing the content of video consultations and relevant information with patients and carers such as scans, test results and letters; and providing continuity of care with previous healthcare professionals wherever possible to maintain existing relationships and avoid the risk of having to repeat potentially traumatic histories online.
However, while viewed as beneficial by a number of participants, it was also acknowledged that not everyone has access to technology, leading us to our second theme of potential barriers to using video consultations as outlined below.
Potential barriers to video consultation use and implementation
A lack of connectivity, bandwidth, and technology availability were all identified as barriers to video consultation use. These issues were considered particularly relevant in areas of deprivation and rural locations. Concerns of privacy and security for both healthcare professionals and patients were also discussed, with attendees stressing the importance of being aware of what could be seen in the background of a video consultation, and the importance of trying to find a quiet space where interruptions could be minimised if possible. The use of kiosks in local community centres, libraries, pharmacies or other community spaces were suggested as an alternative solution if a safe and quiet space was not available at home.
Other barriers that were identified included the skills, confidence, and capability of both healthcare professionals and patients, with requests for effective training, enablers or support that could help demonstrate the technology, and provision of user-friendly information.
The need for patient choice and voice
Importantly, participants repeatedly commented that digital technology should not be forced upon patients. Patient choice and voice must remain central to any digital health technology design, implementation and evaluation. As one attendee described “digital technology should be something that is available for patients, not something that is done too.” The same arguments could also be made for healthcare professionals. Despite this, the importance of patient choice and voice, and seeing digital technology as supplementary to existing services, as opposed to instead of, was repeatedly reiterated.
Digital inclusion and exclusivity
Moving on to digital inclusion, people who attended the event repeatedly discussed the importance of actively considering how to accommodate individuals with limited access to digital technology and related services such as WiFi, and the risk of assumptions that may intentionally, or unintentionally exclude certain patient groups.
For example, participants discussed the risk of older people being excluded due to assumed issues of capability or confidence, particularly if people do not have support or ‘influencers’ in their lives such as family, people in their community, or loved ones who could help get them online comfortably and safely.
Participants also highlighted the risk of assuming that people who frequently use technology for non-healthcare reasons would automatically be comfortable with using the same technology for healthcare purposes. A quote shared in the webinar group of “why would I want to speak with a random I’d never met face to face” highlights the importance of relationships and continuity of care as previously referred to, and issues of confidence or lack of familiarity that may span across multiple patient groups. Many attendees acknowledged that such assumptions can often be patronising and dismissive of individual skills, insights and experiences.
Sustainability and the patient voice
Finally, we explored the potential sustainability of video consultations and the role of the patient voice in such technologies. In order to encourage sustainability participants suggested a number of solutions including:
- Raising awareness about the benefits of video consultations from a patient perspective using a variety of methods including local radio, community based newsletters/newspapers, magazines, existing online communities etc. Importantly, going to where people already are or using services they already engage with.
- Providing co-produced information that is engaging and visual about how video consultations work, and things that can be done to enhance user experience
- Involving local Patient Participation Groups (PPGs), community groups, and digital health champions to hold drop-in information sessions or training sessions (when possible) to help empower people and get them online
- Sharing personal accounts/experiences of patients and carers who have used video consultations
- Emphasising the interactional nature of video consultations
- Demonstrating the ability of video consultations to provide person centred care
- Identifying people who can help connect individuals
- Providing opportunities for people to ‘try’ online health services such as a demo provided by the practice so people can become familiar and confident with the technology
- Developing hardware/handsets that make it easy for people to use video consultations and other digital health technologies
- Asking patients if they are in a space where information can be shared confidentially and adapting consultation content as appropriate
- Continually collect, reflect and act on patient feedback helping to adapt services/technology accordingly
- Proactively consider ways to address digital exclusion and promote inclusivity wherever possible
- Don’t assume individual confidence, competence or skill in digital technology use
When reflecting on our webinar it was clear that people felt there were a number of potential benefits for using video consultations, many of which could enhance the patient experience.
However, further work is required to empower health and social care professionals and patients, address the barriers identified in using video consultation particularly in relation to digital exclusion and accessibility, and ensure patient choice and voice remains at the centre of all current, and future digital health technologies. Exploration of who, when, and in what contexts video consultations may work best would also be beneficial.
Following a significant amount of interest, we have set up a community of individuals with an interest in patient experience and digital health technologies. If you would like to join this network or find out more about the EPIC project, please email Rebecca.email@example.com or firstname.lastname@example.org
Thank you to everyone who took part in the webinar, and to all our guest speakers.