Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study

In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development of this type of service has been controversial, particularly in the United Kingdom, but there has been little formal published evaluation of these services in any country. This paper outlines the main controversies about the use of privately provided video consultation services for primary care and shows how they are informed by the limited evaluations that have been conducted, particularly the evaluation of BGPaH. This paper describes the advantages of these services in terms of convenience, speed of access, the ability to consult without traveling or face-to-face patient-doctor contact, and the possibility of recruiting doctors who cannot work in conventional settings or do not live near the patients. It also highlights the concerns and uncertainties about quality and safety, demand, fragmentation of care, impact on other health services, efficiency, and equity. There are questions about whether private primary care services based on video consultations have a sustainable business model and whether they will undermine other health care providers. During the recent COVID-19 pandemic, the use of video consulting has become more widespread within conventional primary care services, and this is likely to have lasting consequences for the future delivery of primary care. It is important to understand the extent to which lessons from the evaluation of BGPaH and other private services based on a video-first model are relevant to the use of video consulting within conventional general practices, and to consider the advantages and disadvantages of these developments, before video consultation–based services in primary care become more widely established.

Section: Discussionmentioning

confidence: 99%

Private Video Consultation Services and the Future of Primary Care

Salisbury¹,

Quigley²,

Hex³

et al. 2020

“…Video visits provide a new way of conducting clinical meetings, potentially reducing costs and providing services for patients living in remote or rural areas [ 1 , 3 ]. There is no doubt that video visits can be beneficial for different stakeholders from different perspectives [ 1 , 3 ], but the implementation of telemedicine also causes changes in the organization of work; tasks and processes; and identities, roles, and authority, potentially affecting the power relationships among the participants; and participants’ expectations of the meeting (cf [ 4 - 7 ]). Recent research has shown that video visits in outpatient care settings appear to be safe, effective, and convenient; however, there are complex challenges related to their adoption by clinicians [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Satisfaction with video technology has been explored in surveys [ 9 ], but problems with technology are seldom explored in-depth [ 1 ]. Experiences regarding the implementation of video visits have not been examined very well [ 3 ], but recent research addresses the question of implementation and has generated five key recommendations concerning how technology should be introduced: iterative introduction with the involvement of staff, time for reflection with staff and patients, relations with the information and communication technology (ICT) department to establish roles and processes, understanding patients’ conditions, and flexibility of use to fit patients’ needs [ 8 ]. If video visits are going to be beneficial at the macro level, they need to attract users (ie, clinicians and patients) at the micro level by considering professional dimensions and meeting the users’ needs.…”

Section: Introductionmentioning

confidence: 99%

Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care

Sturesson

Groth

2018

BackgroundVideo mediated meetings with patients were introduced in outpatient care at a hospital in Sweden. New behaviours and tasks emerged due to changes of roles, work processes and responsibilities. The study investigates effects of digital transformation, in this case how video visits in outpatient care change work processes and introduces new tasks, in order to further improve the concept of video visits.ObjectiveThrough real-time, social interactional features of preparing for and conducting video visits, the study examines clinicians’ perceived limitations and disturbances, and how the conditions between patients and clinicians may change when using video visits instead of face-to-face meetings in outpatient care.MethodsQualitative methods have been used including 14 observations of video visits at two different clinics and 14 followup interviews with clinicians. Transcriptions of interviews and field notes were thematically analysed, discussed and synthesised into themes.ResultsDisturbances and limitations related to the technology were related to time; a flexibility to schedule the meeting unbound of place, frustrations when the other part was late for the scheduled meeting, and that more experienced users of video visits usually waited longer before logging in. They were also related to sound; problems getting the sound to work satisfactory during the video visits, and problems with the image. Disturbances and limitations related to the surroundings were related to both the patient’s and the clinician’s environment; the principle of video technology in itself may affect the experience and the content of the consultation, and the surrounding chosen changes the conditions for and reduces the participants’ field of view.ConclusionsWe could see 1) a transformation of roles and responsibilities when turning from face-to-face meetings to video visits, 2) that video visits add new circumstances, with a risk of introducing disturbances and limitations, that in turn affects the content of the meeting, 3) that avoiding negative disturbances during a video visit, requires a sensibility from the clinician’s side as well as a trust in the patient’s judgement, 4) that both expected and unexpected disturbances and limitations during a video visit affect the clinician’s behaviour, feelings, the content of the meeting and how the clinician’s relate to the different components of the concept, and 5) that there is a change of roles introduced when conducting video visits, eg, the clinician taking the first line support if both (s)he and the patient encounter problems with the technology.

“…It is recommended that patients living a long distance from the health care premises are offered telemedicine solutions, and physicians are recommended to begin with less complex cases [ 13 ]. The selection of patients for video visits may hence be determined by various criteria such as the complexity of the meeting, the patient’s preferences and distance from the clinic, the clinician’s experience with the technology, and so forth [ 2 ]. It is known that the physical clinical environment affects patient satisfaction, attitudes, and work performances [ 14 ], which implies that selecting patients for video visits needs careful consideration.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ Selection Criteria for Video Visits in Outpatient Care: Qualitative Study

Sturesson¹,

Groth²

2018

BackgroundVideo visits with patients were introduced into outpatient care at a hospital in Sweden. New behaviors and tasks emerged due to changes in roles, work processes, and responsibilities. This study investigates the effects of the digital transformation—in this case, how video visits in outpatient care change work processes and introduce new tasks—to further improve the concept of video visits. The overarching goal was to increase the value of these visits, with a focus on the value of conducting the treatment for the patient.ObjectiveThrough the real-time, social interactional features of preparing for and conducting video visits with patients with obesity, this study examines which patients the clinicians considered suitable for video visits and why. The aim was to identify the criteria used by clinicians when selecting patients for video visits to understand what criteria the clinicians used as the grounds for their selection.MethodsQualitative methods were used, including 13 observations of video visits at 2 different clinics and 14 follow-up interviews with clinicians. Transcripts of interviews and field notes were thematically analyzed, discussed, and synthesized into themes.ResultsFrom the interviews, 20 different arguments for selecting a specific patient for video visits were identified. Analyzing interviews and field notes also revealed unexpressed arguments that played a part in the selection process. The unexpressed arguments, as well as the implicit reasons, for why a patient was given the option of video visits can be understood as the selection criteria for helping clinicians in their decision about whether to offer video visits or not. The criteria identified in the collected data were divided into 3 themes: practicalities, patient ability, and meeting content.ConclusionsNot all patients with obesity undergoing treatment programs should be offered video visits. Patients’ new responsibilities could influence the content of the meeting and the progress of the treatment program. The selection criteria developed and used by the clinicians could be a tool for finding a balance between what the patient wants and what the clinician thinks the patient can manage and achieving good results in the treatment program. The criteria could also reduce the number and severity of disturbances and limitations during the meeting and could be used to communicate the requirements they represent to the patient. Some of the criteria are based on facts, whereas others are subjective. A method for how and when to involve the patient in the selection process is recommended as it may strengthen the patient’s sense of responsibility and the relationship with the clinician.