Patient experience of changes from face-to-face to remote appointments throughout Covid-19

Patient experience 2020 to 2022

 

Poster references

NHS. ‘The NHS Long Term Plan’. NHS, 2019. www.longtermplan.nhs.uk. NHS Commissioning Board. ‘2013/14 NHS STANDARD CONTRACT FOR COMPLEX NEUROFIBROMATOSIS TYPE 1 SERVICE (ALL AGES)’. NHS Commissioning Board, 2013

 

 

 

Abstract

Patient experience of changes from face-to-face to remote appointments throughout Covid-19

Written 2023. Rona Inniss, Natalie Smith, Susie M.D. Henley.

Introduction

We sought to gain an understanding of how patients experienced changes to outpatient appointments throughout Covid-19 by administering questionnaires to a selection of patients in 2020, 2021 and 2022.

The Neurofibromatosis Service at Guy's and St Thomas' NHS Foundation Trust provides multidisciplinary care to patients with nerve tumour predisposition syndromes that include Neurofibromatosis Type 1 (NF1), NF2-related Schwannomatosis (NF2), SMARCB1-related Schwannomatosis, and LZTR1-related Schwannomatosis (NHS Commissioning Board, 2013). Patients are invited to attend regular outpatient appointments led by a team of consultant neurologists and supported by healthcare professionals including clinical nurse specialists (CNS), physiotherapists (PT), psychologists, and a social worker (SW).

Covid-19 impacted healthcare provision across the NHS (Thorlby et al., 2020). During the first wave in 2020, face-to-face outpatient activity was almost completely stopped in the NF service and remote consultations offered instead(Vas et al., 2022). Remote consultations took the form of telephone calls or video appointments via the Attend Anywhere platform. The unpredictable influence of the pandemic continues to impact on outpatient care even as our service returns to pre-pandemic levels and modalities of activity. Across the service, face-to-face activity has increased, and remote activity decreased since 2020 but a percentage of consultations continue to be held remotely.

 

Conclusions

The NHS long term plan seeks a reduction in face-to-face appointments (NHS, 2019). Covid-19 necessitated that frequency of face-to-face appointments be severely and rapidly reduced. The responses to these questionaries demonstrate that patients attending the NF service find advantages and disadvantages to remote consultations and want flexibility over their appointments. To accommodate our patients’ needs we should offer flexibility which may result in a natural reduction in face-to-face outpatient attendance.

Technology that enables remote appointments might reduce language barriers via translation and closed captioning capabilities. Patients with NF2 are likely to have impaired hearing (Widemann et al., 2014) and may find communication improved by easy access to closed captions.

A small but significant number of patients either do not have access to technology or do not have the confidence to use appropriate technology. As a result, they are unable to easily access remote appointments. We must ensure that all our patients continue to be able to access appointments as required to support their health, either by empowering patients to gain confidence with technology or to provide alternative means of contact which may include continuing face-to-face contact.

 

NHS. (2019). The NHS long term plan. NHS. www.longtermplan.nhs.uk

NHS Commissioning Board. (2013). 2013/14 NHS STANDARD CONTRACT FOR COMPLEX NEUROFIBROMATOSIS TYPE 1 SERVICE (ALL AGES) (B13/S(HSS)/a). NHS Commissioning Board.

Thorlby, R., Fraser, C., & Gardner, T. (2020). Non-COVID-19 NHS care during the pandemic: Activity trends for key NHS services in England. The Health Foundation. www.health.org.uk/news-and-comment/charts-and-infographics/non-covid-19-nhs-care-during-the-pandemic

Vas, V., North, S., Rua, T., Chilton, D., Cashman, M., Malhotra, B., & Garrood, T. (2022). Delivering outpatient virtual clinics during the COVID-19 pandemic: Early evaluation of clinicians’ experiences. BMJ Open Quality, 11(1), e001313. doi.org/10.1136/bmjoq-2020-001313

Widemann, B. C., Acosta, M. T., Ammoun, S., Belzberg, A. J., Bernards, A., Blakeley, J., Bretscher, A., Cichowski, K., Clapp, D. W., Dombi, E., Evans, G. D., Ferner, R., Fernandez-Valle, C., Fisher, M. J., Giovannini, M., Gutmann, D. H., Hanemann, C. O., Hennigan, R., Huson, S., … Morrison, H. (2014). CTF meeting 2012: Translation of the basic understanding of the biology and genetics of NF1, NF2, and schwannomatosis toward the development of effective therapies. American Journal of Medical Genetics Part A, 164(3), 563–578. doi.org/10.1002/ajmg.a.36312