Near Me at Home: codesigning the use of video consultations for outpatient appointments in patients’ homes

Abstract

Reforming the delivery of outpatient appointments (OPA) was high on the healthcare policy agenda prior to COVID-19. The current pandemic exacerbates the financial and associated resource limitations of OPA. Videoconsulting provides a safe method of real-time contact for some remotely residing patients with hospital-based clinicians. One factor in failing to move from introduction of service change to its general adoption may be lack of patient and public involvement. This project, based in the largest Island in the Inner Hebrides of Scotland, aimed to codesign the use of the NHS Near Me video consulting platform for OPA to take place in the patient’s home. A codesign model was used as a framework. This included: step 1—presenting a process flow map of the current system of using Near Me to public participants and establishing their ideas on various steps in the process, step 2—conducting numerous Plan, Do, Study, Act (PDSA) tests and creating a current process flow diagram based on learning and step 3—conducting telephone interviews and thematic analysis of transcripts (n=7) to explore participants’ perceptions of being involved in the codesign process. Twenty-five adaptations were made to the Near Me at Home video appointment process from participants’ PDSA testing. Four themes were identified from thematic analysis of participants’ feedback of the codesign process, namely: altruistic motivation, valuing community voices, the usefulness of the PDSA cycles and the power of ‘word of mouth’. By codesigning the use of Near Me with people living in a remote area of Scotland, multiple adaptations were made to the processes to suit the context in which Near Me at Home will be used. Learning from testing and adapting with the public will likely be useful for others embarking on codesign approaches to improve spread and sustainability of quality improvement projects.

Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review

“…Contrary, a lack of both resources [22,25,42] and provider and staff knowledge surrounding updated patient flow protocols [15,22,25] serve as barriers to an enhanced throughput initiative. The review findings also suggest the implementation of additional telehealth initiatives [21,23,33], while also attributing this same identified construct as a barrier to the throughput initiative [19,22,42].…”

“…An ongoing initiative to maintain a high level of quality ambulatory/outpatient care continues to challenge the U.S. healthcare system as the COVID-19 pandemic continues. Evidence from this review suggests that enhanced safety and patient distancing protocols [20,27,41], in conjunction with appropriate provider training centered around such public health initiatives [19,23,31]. enhance outpatient providers' ability to increase patient throughput.…”

The impact of the COVID-19 pandemic on pharmacy personnel in primary care

“…Previous research has also identified challenges building rapport during remote consultations (Verity et al, 2020) and identified that healthcare professionals are less likely to elicit additional concerns using this mode of communication (Hewitt et al, 2010). The sparse use of video consults may be considered surprising, as pre-pandemic there were extensive efforts to develop and subsequently adopt 'Attend Anywhere' (Wherton and Greenhalgh, 2020;Beattie et al, 2020), a video consultations platform which has national licence throughout Scotland. It is unclear why this technology was not adopted by pharmacy personnel in primary care despite its availability, and future work should explore patient and pharmacy personnel perceptions and preferences of remote consults in a post-COVID era (Murphy et al, 2021), which should inform evidenced-based guidelines on when, and how, to conduct remote consultations.…”

Lessons post-COVID from national and international approaches to safety and quality in healthcare

“…41 In the UK, a range of co-production policy and guidance, including the co-production model, have been developed (Case study 6). [42][43][44][45] Lesson 7: Ensure integration of care…”

“…The project led to 25 adaptations being made to the appointment process, as patients had the opportunity to design the healthcare delivery tool that best suited their needs. 43 Developing policy, guidance and tools towards co-production and patient, carer and community inclusion must be met with a commitment to the principles of co-production across the healthcare sector, and crucially by senior leadership. 44,45 Critically, patient, carer and community participation must be representative of the communities served.…”