Asynchronous Consultation Research for the NHS
Research type
Research Study
Full title
Asynchronous Consultation Research for the NHS (ACORN)
IRAS ID
293558
Contact name
Craig Ramsay
Contact email
Sponsor organisation
University of Aberdeen and NHS Grampian
Duration of Study in the UK
0 years, 9 months, 30 days
Research summary
Covid19 changed many aspects of healthcare, including how consultations are managed. Remote consultation methods (e.g. phone or video) were gradually being introduced before COVID19, but in March 2020 most face-to-face contacts were replaced by remote consultations. Most research has focused on ‘synchronous’ forms, where patient and clinician talk online or by phone in real time. There is less research on ‘asynchronous’ consultation, where patients and professionals are not available at the same time. Examples include email and text messages.
More sophisticated systems have been developed which are more like the flow of information in face-to-face consultation. NHS Grampian in Scotland is piloting asynchronous consultation, using a platform developed by Storm-ID. Patients have a 5-day ‘appointment’ to complete questions online and upload photos. The doctor then looks at these and may request further information; make a diagnosis or treatment plan; invite the person for a phone or face-to-face appointment; or discharge them.
As part of its Covid recovery plan, NHS Grampian will roll out the Storm-ID platform across many specialties, making asynchronous consultation available to thousands of patients deemed suitable. This represents a unique opportunity to research what happens during system implementation. Through a four-stage project ( 1- service evaluation/audit, 2 - online public focus groups, 3 - telephone/online staff interviews, 4- telephone/online patient interviews) we will explore whether it is acceptable to public, patients and staff; how it changes the nature of the consultation; who is advantaged/disadvantaged by the system and; what can be learnt for future roll-out in the NHS.
LAY SUMMARY OF RESULTS:
People from less wealthy areas attended ‘digital appointments’ and got treatments just as much as those living in more wealthy areas, which is reassuring. Over 1,417 people had nearly 1,709 appointments using asynchronous consultation for skin problems, stomach and intestine care, and pain management. Most users liked this new service, with 80% feeling neutral, happy, or very happy about it. Patients who used it told us that its ease of use helps to share information and offers doctors and nurses flexible schedules. Doctors and nurses agreed and highlighted that the service helps ensure the right patient connects with the appropriate clinical expert at the right time. The public believed it served as a valuable complementary service in Grampian, given its vast geographical area. Overall, the public felt positive about the potential role of this service, staff thought it was needed, and service users had mostly good experiences with it.The study participants thoughtfully considered who this service might or might not be suitable for. The primary concerns of the public, staff and patients were the possibility of excluding some individuals and the loss of personal interaction. Clinics attempted to address these issues by carefully choosing their patient groups. Concerns were also raised about technical difficulties, a lack of devices, and digital literacy, which some service users indeed reported. We noted that some patients simply prefer face-to-face consultations, as they thought they could better express their needs in person. Overall, while efforts can be made to make the service more inclusive, it might not be suitable for everyone, especially those who aren't tech-savvy or struggle with written communication. Therefore, it is important to continue offering patients a choice while working to reduce barriers to access. The service could be enhanced by providing a simpler explanation of its functioning and renaming 'digital appointment' to 'assessment' for clearer understanding.
When it came to staff opinions about integrating this service into everyday practice, there was hope at the beginning that rolling out a similar service between departments of the same hospital would be straightforward. Even with good support, the process was more challenging than expected. However, over time, staff improved their ability to use the new service and explain it to patients. Even though numbers showed this service was effective across all departments, the pain management team found it easier to use, primarily because it resonated with their existing administrative process. To make it workable long-term, the service needs to be adaptable enough for various clinics, and there needs to be sufficient funding for its operation and to pay all the people who run the service, including clinical, technical, operational staff and clinical coordinator.
REC name
London - Bloomsbury Research Ethics Committee
REC reference
21/PR/0051
Date of REC Opinion
28 Feb 2021
REC opinion
Further Information Favourable Opinion