Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England

Duncan, Lois; Cheng, Kelly F.D.

doi:10.12688/f1000research.52161.2

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…During the first wave of the pandemic in 2020, most countries saw a rapid reduction in face-to-face consultations and an increase in remote ones in both primary and secondary care [12][13][14][15]. Guidance for conducting video consultations were initially produced based on early examples of implementation [16][17][18][19][20][21][22]. More definitive guidance was later developed, based on learning during the pandemic, with the view of informing best practices beyond COVID-19 [23][24][25][26].…”

Section: Video Consulting Before During and Beyond The Pandemicmentioning

confidence: 99%

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

Wherton¹,

Greenhalgh²,

Hughes³

et al. 2022

J Med Internet Res

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Background Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a “burning platform” for scaling up such services. As health care organizations look to expand and maintain the use of video in the “new normal,” it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. Objective This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. Methods A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al’s 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). Results Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an “organizing vision” for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. Conclusions For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.

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Section: Video Consulting Before During and Beyond The Pandemicmentioning

confidence: 99%

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

Wherton¹,

Greenhalgh²,

Hughes³

et al. 2022

J Med Internet Res

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“…The telemedicine model of IBD care was given new impetus during the COVID-19 pandemic. Travel restrictions meant face-to-face appointments were interrupted due to the potential risk posed by SARS-CoV-2 [16,17]. Telemedicine was used to minimise interruptions to care and maintain patient communication and monitoring.…”

Section: Telemedicinementioning

confidence: 99%

The future of telemedicine and wearable technology in IBD

Rowan

Hirten

2022

Current Opinion in Gastroenterology

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Purpose of reviewTelemedicine has quickly become an essential part of modern healthcare, particularly in the management of chronic conditions like inflammatory bowel disease. The purpose of this review is to describe the current use of telehealth, mobile applications and wearable devices in inflammatory bowel disease and potential future applications.Recent findingsTelemedicine was increasingly used during the Coronavirus Disease 2019 pandemic. Virtual consultations allowed clinical care to continue despite pandemic-related restrictions without compromising the quality of care for patients with inflammatory bowel disease (IBD). It also benefits patients who would not have access to care due to financial or geographical barriers. Mobile applications allow patients with IBD to record disease activity among other metrics, allowing for earlier healthcare provider intervention. Wearable devices are increasingly being explored to monitor physiological indicators of disease activity and flare.SummaryTelehealth and remote patient monitoring has been successfully integrated into the care of IBD patients. The advantages of these modalities include better access to specialist care and remote noninvasive disease monitoring. Careful consideration must be given to patient privacy, data protection and equitable access. These modalities have enormous potential to improve patient care through accurate consistent data collection and even the prediction of disease activity.

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Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England

Cited by 2 publications

References 11 publications

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

The future of telemedicine and wearable technology in IBD

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