Remote consultations versus standard face-to-face appointments for liver transplant patients in routine hospital care: feasibility randomized controlled trial of myVideoClinic

Sarah Damery, Janet Jones, Elaine O'Connell Francischetto, Kate Jolly, Richard Lilford, James Ferguson

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Abstract

BACKGROUND: Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights.

OBJECTIVE: This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients.

METHODS: Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences.

RESULTS: Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that-according to patients-remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial.

CONCLUSIONS: Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS.

TRIAL REGISTRATION: ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2953-4.

Original languageEnglish
Article numbere19232
Number of pages14
JournalJournal of Medical Internet Research
Volume23
Issue number9
DOIs
Publication statusPublished - 17 Sept 2021

Bibliographical note

Funding Information:
This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West Midlands (NIHR CLAHRC WM), now recommissioned as the NIHR Applied Research Collaboration West Midlands (NIHR ARC WM). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The authors would like to thank the members of the myVirtualClinic RCT Steering Group, as follows: Gill Combes, Sarah Damery, Eric Deeson, James Ferguson (chair), Foyzal Miah, Pamela Nayyar, Elaine O’Connell Francischetto, Aziz Sheikh, and Katie Squire. The data monitoring committee consisted of Eleanor Walsh (University of Bristol), Theo Arvanitis (University of Warwick), and Richard Aspinall (Portsmouth Hospitals NHS Trust). The study sponsor was the University of Birmingham. The study sponsor had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication. The corresponding author had full access to all of the study data and had the final responsibility for the decision to submit for publication.

This study received a favorable ethical opinion from the West Midlands Solihull Research Ethics Committee on October 24, 2017 (reference: 17/WM/0338). Research governance approval was obtained from the University Hospitals Birmingham NHS Foundation Trust in February 2018 (reference: RRK6080). The study was sponsored by the University of Birmingham.

Copyright:
© Sarah Damery, Janet Jones, Elaine O'Connell Francischetto, Kate Jolly, Richard Lilford, James Ferguson.

Keywords

  • digital health
  • remote consultation
  • patient satisfaction
  • feasibility
  • VSQ-9
  • secondary care
  • liver transplant patients
  • mobile phone

ASJC Scopus subject areas

  • Health Informatics

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