Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice

Abstract

Background Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among patients with osteoporosis and rheumatoid arthritis. Methods Three UK qualitative studies, exploring patient experiences of accessing and receiving healthcare, undertaken during the pandemic, with people with osteoporosis and rheumatoid arthritis. Study team members agreed a consistent approach to conduct rapid deductive analysis using the Theoretical Framework of Acceptability (TFA) on transcripts from each data set relating to RC, facilitated by group meetings to discuss interpretations. Findings from the three studies were pooled. Results Findings from 1 focus group and 64 interviews with 35 people were included in the analysis. Participants’ attitudes to RC, views on fairness (ethicality) and sense-making (intervention coherence) varied according to their needs within the consultation and views of the pandemic. Some participants valued the reduced burden associated with RC, while others highly valued non-verbal communication and physical examination associated with face-to-face consults (opportunity costs). Some participants described low confidence (self-efficacy) in being able to communicate in RCs and others perceived RCs as ineffective, in part due to suboptimal communication. Conclusions Acceptability of, and preferences for RC appear to be influenced by societal, healthcare provider and personal factors and in this study, were not condition-dependant. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation.

Digital exclusion as a potential cause of inequalities in access to care: a survey in people with inflammatory rheumatic diseases

“…Second, one in five people reported wanting to have a choice of consultation modality at the time of the appointment. The notion that patient preferences for remote consultations vary depending on their context and situation at the time of appointments was highlighted in our previous qualitative studies [ 8 ] and has important ramifications for service design.…”

“…In a small US study, health literacy was not associated with willingness to undertake video consultations, although their population was younger than our cohort and all reported access to an internet-enabled device [ 21 ]. Nearly 2 million people in the UK alone report being unable to explain symptoms and feelings on the telephone, and our qualitative studies also identified that in addition to reduced confidence in being able to talk on the telephone, some participants described conversations as stressful and more hurried [ 8 , 22 ]. Given that people without access to the internet or with limited health literacy are more likely to be socioeconomically deprived and therefore at risk of poorer health outcomes [ 23 ], it is important to increase awareness and address these factors in health-care delivery to prevent worsening of existing health inequalities.…”

“…People were also asked about their preferences for accessing future care (telephone, video or face-to face) for a routine review appointment, for an urgent problem or for a new or first appointment about a problem. These questions were informed by our previous qualitative work, which indicated that some people had low confidence in communicating on the telephone and that preference for future consultation type was influenced by personal circumstances, such as work or family commitments [ 8 ]. Ethical approval was obtained (Surrey Borders REC Ref 21/PR/0867), and all participants provided informed consent.…”

The Impact of Telemedicine in the Diagnosis of Erythema Migrans during the COVID Pandemic: A Comparison with In-Person Diagnosis in the Pre-COVID Era

“…During the COVID pandemic, telemedicine has been accepted as an effective tool to provide virtual visits and remote care [ 37 , 38 , 39 ]. Our data clearly show that the use of tele-medicine for EM diagnosis is helpful as it allows shorter delays in antibiotic therapy and consequently fewer neurological and articular complications.…”

Patient–clinician dynamics in remote consultations: a qualitative study of cardiology and rheumatology outpatient clinics in the UK

“…In the UK, for example, National Health Service (NHS) planning guidance for 2022 sets out the ambition that ‘at least 25% (of outpatient appointments) should be delivered remotely by telephone or video consultation (equivalent to c.40% of outpatient appointments that do not involve a procedure)’ 3. Research conducted prior to the COVID-19 pandemic can inform us on user experience when planned remote services are implemented, but the rapid rise in the use of technology during the pandemic means that the background level of skill and acceptability has changed 4. Recent research has pointed to a need for the postpandemic remote delivery model to evolve in both primary5 and secondary care6 to reflect the variation in and changing levels of patients’ and clinicians’ confidence and skills, as well as changes in technology.…”