Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID‐19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting

Abstract

Aim To investigate the experiences of patients, clinicians and managers during the accelerated implementation of virtual consultations (VCs) due to COVID‐19. To understand how patient preferences are constructed and organized. Methods Semi‐structured interviews with patients, clinicians and managerial staff at a single specialist orthopaedic centre in the United Kingdom. The interview schedule and coding frame were based on Normalisation Process Theory. Interviews were conducted over the telephone or by video call. Abductive analysis of interview transcripts extended knowledge from previous research to identify, characterize and explain how patient preferences for VC were formed and arranged. Results Fifty‐five participants were included (20 patients, 20 clinicians, 15 managers). Key mechanisms that contribute to the formation of patient preferences were identified. These were: (a) context for the consultation (normative expectations, relational expectations, congruence and potential); (b) the available alternatives and the implementation process (coherence, cognitive participation, collective action and reflexive monitoring). Patient preferences are mediated by the clinician and organisational preferences through the influence of the consultation context, available alternatives and the implementation process. Conclusions This study reports the cumulative analysis of five empirical studies investigating patient preferences for VC before and during the COVID‐19 pandemic as VC transitioned from an experimental clinic to a compulsory form of service delivery. This study has identified mechanisms that explain how preferences for VC come about and how these relate to organisational and clinician preferences. Since clinical pathways are shaped by interactions between patient, clinicians and organisational preferences, future service design must strike a balance between patient preferences and the preferences of clinicians and organisations. Patient and Public Contribution The CONNECT Project Patient and Public Involvement (PPI) group provided guidance on the conduct and design of the research. This took place with remote meetings between the lead researcher and the chair of the PPI group during March and April 2020. Patient information documentation and the interview schedule were developed with the PPI group to ensure that these were accessible.

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“…This may help to explain, in part, the results of a mixed methods study conducted in a UK outpatient department following the rapid implementation of a remote video consultation platform which indicated that, while all patients reported that the consultations met their needs, they were less satisfied than clinicians that they had communicated everything they wanted to (86% vs 95%) 19. A quarter of clinicians showed some recognition of this, reporting a belief that patient experience of a remote video consultation was worse than that in a face-to-face clinic 18 19. This echoes findings from primary care, where general dissatisfaction with video consultations among both patients and practitioners has been reported, emphasising a belief that the best therapeutic care is delivered in person 7.…”

“…Indeed a survey study of patient and staff perceptions of video consultations conducted from an older adult outpatient unit in the UK found high levels of satisfaction with this format, particularly among patients 6. In contrast, however, an interview study with patients and clinicians at an orthopaedic centre in the UK found some clinicians perceived video call assessments to be less accurate and more likely to result in worsening of a patients’ condition; this corresponded to some patients’ experiencing slower rehabilitation and perceiving remote appointments to be less effective than face to face 18. This may help to explain, in part, the results of a mixed methods study conducted in a UK outpatient department following the rapid implementation of a remote video consultation platform which indicated that, while all patients reported that the consultations met their needs, they were less satisfied than clinicians that they had communicated everything they wanted to (86% vs 95%) 19.…”

“…Given that some degree of remote care is certain to continue,21 further work is needed to find effective ways of supporting patients to give, and clinicians to gather, all necessary information during remote consultations. This could help to set the expectations for and, in turn, satisfaction with remote consultations of both patients and clinicians 18. This may involve, for example, additional training for clinicians in communication techniques for remote consultations, different appointment structures to allow space for reflection, and exploring other approaches that could help to improve both patient and professional confidence and satisfaction.…”

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“…Furthermore, the assessment of the patient experience postoperatively in one American study allowed clinicians to identify factors that could be optimised to improve patient care [ 10 ]. The accelerated use of Penthrox at our hospital was brought about by the COVID-19 pandemic, as were remote consultations, which have been assessed in a British tertiary orthopaedic rehabilitation centre [ 11 ]. This study identified means of aligning patient and clinician preferences with the use of remote consultations and relied upon evidence gathered from the patient experience [ 11 ].…”