Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study

Abstract

Background: Asynchronous outpatient patient-to-provider communication is becoming widespread in UK healthcare. It has mostly been tested in primary care but is increasingly used in secondary care outpatient services. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation system from dermatology to gastroenterology and pain management. Objective:We conducted a multi-method study between April 2021 to July 2022 including staff, patient, and public perspectives and quantitative data from the NHS to obtain a rounded picture of innovation as it happened.Methods: Three online and one face-to-face focus groups (n=22) on public readiness for the new service and 14 semi-structured interviews with staff on service design and delivery were conducted. The new service's effects were examined using NHS data on service usage, a patient satisfaction survey (n=66), and six follow-up semi-structured interviews. Satisfaction survey responses were analyzed descriptively. Service users' demographics, acceptability across specialties, non-attendance rates, and appointment outcomes were compared. The Scottish Index of Multiple Deprivation was used to measure health inequality. Individual interviews and focus group transcripts were thematically analyzed.Results: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favourable setting and organizational assistance, it has been complicated. Key implementation difficulties comprised technical integration delays caused by the pandemic, misalignment with existing administrative processes, and a lack of continuity in project management. The pain management clinic started offering asynchronous consultations (known as 'digital appointments') in December 2021, and the gastrointestinal followed suit shortly thereafter in February 2022. Staff rapidly learned how to explain and utilize this new service. It was thought to function better for pain management since it fitted pre-existing practices. From February through July 2022, dermatology (adult and pediatric), gastrointestinal, and pain management offered 1709 appointments to a range of people (totaling n=1417). Asynchronous consultations reduced travel by an estimated 44,712 miles compared to face-to-face mode. The deprivation profile of people who opted into the digital appointment service was very similar to that in the Grampian region, people living in the least deprived areas were most likely to not attend (?2 = 19.3, p < 0.001), according to NHS data analysis. People from all deprivation quintiles were equally likely to receive any of the possible four outcomes including treatment and open return (?2 = 13.6, p > 0.05). In the survey, only 18% (12 out of 66) of respondents were unhappy or very unhappy to be offered a digital appointment invitation. The benefits mentioned included better access, convenience, decreased travel and waiting time, information gathering/sharing, and clinical flexibility. Overall, patients, the ...