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Dr Gemma Hughes, Health Services Researcher in the IRIHS Team, writes on current research led by Dr Sara Shaw and funded by the Health Foundation.

A sign for the car park at Manchester Royal Infirmary. © Shutterstock

Before Covid-19 hit, we already knew that patients (on the whole) enjoyed the convenience of having a video consultation in the comfort and privacy of their own home. In previous research they talked about how easy it was, and far better than having to travel to a practice or hospital with all the difficulties that can entail especially with mobility problems. Taking time off work, or having to find someone else to look after children or elderly relatives all added to the practical and financial burdens of attending regular health care appointments. Video consultations offered an alternative which not only eased these pressures for patients, but also had broader societal impacts such as reduced travel, traffic and carbon emissions and potential productivity gains for employers.

But what about during the pandemic, and beyond – what have been the experiences of patients trying to access services via video? Do patients still feel as positive about the video medium? And what do different kinds of patients think?

Our research into video consulting during the Covid-19 pandemic has included interviews and discussion groups with patients and the public about their experiences of video consultations and implications for health care. We have heard diverse views, and learned how personal preferences and circumstances interrelate with broader issues of access to resources that might shape use of video consulting in the future.

Greater accessibility for some

The convenience of video consulting that patients talked about pre-pandemic continues. Those we spoke to also talked about increased accessibility offered by video consultation during the pandemic. Take, for example, a patient with chronic pain who explained how she had found a video consultation with a physiotherapist to be just as good as an in-person consultation. The consultation involved physical assessment and demonstration of different movements. An in-person consultation would have involved not just the risk of transmission of Covid-19 but a lengthy journey by public transport, all whilst experiencing chronic pain. A video consultation was both more convenient, and more suitable as it accounted for the very restrictions related to her health that had led her to seek treatment. The greater accessibility afforded by video consultations is likely to benefit others and make it easier to keep appointments.

It is not only patient-clinician interactions that can be achieved by video – requirements for social distancing and infection control during the pandemic have also prompted online groups. One patient told us how she and her husband had been able to participate in support groups for parents established during the pandemic via video. With one of her children diagnosed with a serious illness, the demands of looking after her other children, including a small baby, would have made participation in face-to-face groups extremely difficult. Joining video groups with other parents was relatively easy. Such groups may not be for everyone (something we plan to cover in a future blog), but for this patient, the personal and social support she was able to access online helped her to cope at a time of great stress.

Problems of access for others

Access to video consultations relies on having the equipment, the skills and the means to create (and sustain) a reliable internet connection. The patients we spoke to were concerned about people who could be ‘digitally excluded’: people who might not have the devices or data required to hold a video consultation, and those who are not regular users of smartphones or do not feel comfortable with video technology. Patients told us that being sent a link to their phone can help with access and, for some, is far better than a lengthy log-in process. Some thought a standardised NHS video consultation platform would work well, others prefer the flexibility of being able to use familiar platforms (such as Zoom, WhatsApp, or FaceTime). Clearly there is no ‘one size fits all’ solution.

Even those who were well equipped talked about video consultations being disrupted due to, for example, poor wi-fi, mobile phone coverage or slow broadband. Others were concerned about cyber-security or about how their personal data is handled – both could stop them using video.

Unfortunately not everyone is able to find comfort and privacy at home. Living under conditions of lockdown make finding a private space to have a video consultation very difficult for lots of people. Parents did not want their children to overhear discussions of worrying conditions, or found it impossible to find a quiet time away from babies and toddlers. Young people often needed privacy from family members when talking to their clinician. Others might be living in temporary accommodation, sharing communal spaces, or in unsafe homes at risk of coercion or abuse. 

Advantages of visual connections but a loss of physical presence

Patients valued being able to see their clinicians, and felt that video offered them the chance to communicate well, even about serious matters. However others pointed out that physical examinations could only go so far on video. We heard of an example where the finer details of how a child was swallowing and breathing were difficult to show by video. In some cases hands-on physical examinations are required. 

Experiences and preferences varied. We heard from some patients about how hard it can be to only consult by video. One patient, reflecting on her experience of several video consultations for a complex condition, struggled to put her finger on exactly what was missing in a video consultation that made it a less satisfactory experience than being in a room with her clinician. She had felt it was ‘more difficult’ to have a video consultation and that this made her feel less supported.  

More generally, patients were concerned about what might be missed during a video consultation in relation to diagnosis. We heard concerns from patients that they might not accurately describe their condition during video consultations, perhaps downplaying a worrying symptom; also about the potential for missing a problem that might be spotted by a clinician but which the patient hadn’t spoken about.

Next steps

Reflecting the broader challenges of digital exclusion in remote services, notwithstanding significant effort, we have yet to hear directly from those who have been unable to access video consultations. Despite positive experiences from some patients, before and during the pandemic, caution is needed in assuming that people will benefit equally from sustained provision of video consultations. There are clearly opportunities for video consultations to play an important role in increasing accessibility to healthcare beyond the pandemic for those who have access to technology and are adept and confident at using it with their clinicians. However, there is a significant risk that the patients who are missing from our data are also missing from video consultation services. Unless we take action now it is likely that they will remain out of the picture entirely.

Opinions expressed are those of the author/s and not of the University of Oxford. Readers' comments will be moderated - see our guidelines for further information.

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