Virtual phone clinics in orthopaedics: evaluation of clinical application and sustainability

BMJ Open Quality

article

Raj Pradhan¹  Wouter Peeters¹  Sara Boutong¹  Chris Mitchell¹  Rahul Patel¹  Rad Faroug¹  Mark Roussot¹ 

[1] Department of Trauma and Orthopaedics , University College London Hospitals NHS Foundation Trust;Department of Orthopaedics , University Hospital Antwerp

关键词: telemedicine;    quality improvement;    cost-effectiveness;    COVID-19;   

DOI  :  10.1136/bmjoq-2021-001349

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Aims Adoption of virtual clinics has been accelerated by the COVID-19 pandemic and they will continue to form an integral part of healthcare delivery. Our objective was to evaluate virtual clinics in orthopaedic practice and determine how to use them effectively and sustainably.Methods We surveyed 100 consecutive patients participating in orthopaedic virtual phone clinic (VPC) at an academic hospital to evaluate patient satisfaction against face-to-face (F2F) consultations and obtain suggestions for improving patient experience, and we surveyed 23 clinicians who conducted orthopaedic VPCs in 2020. Data were correlated with clinic outcomes, reason for consultation, diagnosis, patient age and clinician grade. Consultation duration, clinician-associated costs and reimbursement were analysed. Significance was tested using two-tailed Student’s t-test and Fisher’s exact test.Results Patient satisfaction (out of 5) for VPC was significantly lower than F2F (4.1 vs 4.5, p=0.0003), and a larger proportion of VPC scored <3 compared with F2F (11% vs 2%). Higher VPC scores were associated with appointments for delivering results and where patients felt clinical examination was not needed. Patients suggested introducing video capability, adhering to appointment time and offering the choice of VPC or F2F. Mean clinician satisfaction scores for VPC were 4.3/5 and suggested indications for VPC included: routine surveillance, communication of results, discussing/consenting for surgery and vulnerable patients. Integrating video, providing private rooms and offering patients time intervals for VPC were recommended. Current National Health Service VPC structures uses greater clinician resources and generates lower reimbursement than F2F consultations, resulting in 11.5% reduction in reimbursement.Conclusion VPC plays a valuable role when clinical evaluation has been performed or considered not necessary. Offering the choice of VPC or F2F, adding video capability and providing a time interval for VPC may reduce resource use and increase satisfaction. We recommend renegotiating VPC tariffs and cost-neutral modifications of clinic structure.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND