Virtual online consultations: advantages and limitations (VOCAL) study

Abstract

IntroductionRemote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations.MethodsTo explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel—audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel—interviews, ethnographic observations and analysis of documents within the trust; macrolevel—key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory.Ethics approvalCity Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883.Planned outputsWe plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: ‘what to expect in your virtual consultation’.DiscussionThe research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We anticipate that this study will contribute to a balanced assessment of when, how and in what circumstances this model might be introduced.

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

“…As set out in our protocol published previously, 13 the VOCAL (Virtual Online Consultations -Advantages and Limitations) study aimed to define good practice and inform its implementation in relation to clinician-patient consultations via Skype and similar media, addressing three key objectives: 1. at the macro level, to build relationships with key stakeholders nationally and identify from their perspective how to overcome policy and legal barriers to the introduction of remote consultations as a regular service option 2. at the meso level, to illuminate and explore the sociotechnical microsystem that supports the remote consultation, thereby identifying how organisations can best support the introduction and sustainability of this service model in areas where it proves to be acceptable and effective 3. at the micro level, to study the clinician-patient interaction in a maximum variety sample of 30-45 remote outpatient consultations in two clinical areas; in particular, to highlight examples of good communicative practice, to identify and characterise examples of suboptimal communicative practice and to propose approaches for minimising the latter.…”

Ethnomethodological studies of nurse-patient and nurse-relative interactions: A scoping review

“…phone consultations; face-to-face interactions in clinical facilities and patients' homes; and computer-assisted consultations either faceto-face or over the phone) may help create more solid theoretical, methodological and practical grounds to assess the costs and benefits of new hybrid modes of consultations (e.g. virtual consultations over Skype and/or other video-supported electronic media) and contribute to a more effective regulation of such novel practices (Greenhalgh et al, 2016). Such an understanding can be better accomplished by examining in depth the web of mutual dependencies between behavioral modalities in communication.…”

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

“…[4]). Still, they needed time to become familiar with the concept and the changes that are introduced, e.g., new tasks and division of labour (cf.…”

“…Telemedicine solutions, such as video visits in outpatient care, can be beneficial for different stakeholders at different levels and from different perspectives [4]. Through telemedicine, healthcare can be provided to patients having difficulties to physically visit the healthcare premises, e.g., living far away or not being strong enough for traveling.…”

“…Development of telemedicine solutions has increased during the last decades as an efficient way to meet the shifting challenges of a growing number of patients and demographic changes in the population (cf. [4]). Telemedicine, being "the use of telecommunications to diagnose and treat disease and ill-health", has evolved "from a technology-driven novelty to an essential component of health care delivery in a number of specialties and fields" [6].…”