Telehealth has been deployed at an unprecedented scale during the Covid pandemic as social distancing measures resulted in face-to-face consultations being limited. Research from the University of Cambridge explores how patients and clinicians found the transition.
The study, which focused on rheumatology patients, found that while the convenience of video consultations was certainly welcomed, there were concerns about the clinical accuracy of them. Indeed, around 90% of clinicians and patients thought that telehealth assessments were less accurate.
“The pandemic has had a major impact on the ability of healthcare professionals to see their patients face-to-face, and this has led to a significant increase in the number of telemedicine consultations,” the researchers say. “While these are undeniably safer in terms of COVID risk, there had been little research previously on the impact on patient care, particularly for more complex conditions.”
Effective treatment
Between April 2021 and July 2021, the researchers surveyed over 1,300 patients and 100 clinicians, as well as conducted detailed interviews with 31 patients and 29 clinicians.
In addition to concerns around the clinical reliability of the approach, the research found that it made it harder for clinicians to develop a trusting relationship with their patients, although this was much easier if initial consultations were conducted face-to-face.
The general convenience provided by the platform was seen as a benefit by patients, however, even if some still reported difficulties accessing appointments. These fed into concerns that telehealth may help to widen health inequalities, with various groups being at a disadvantage with the technology, whether due to the complexity of their condition, cognitive or speech difficulties, language barriers, or socio-economic disadvantage.
“Of greatest concern was the great variability in accessibility to care,” the researchers say. “Approximately half of all patients felt they would not receive a prompt response when very unwell, often citing increased barriers due to some remote contact and administrative systems that are not yet efficient enough to cope with the sudden move towards telemedicine.”
No silver bullet
The findings illustrate the importance of taking a balanced approach to any roll-out of telemedicine, as while those in employment found the convenience, lack of travel required, and shorter waiting times clear benefits, it’s important that face-to-face consultations remain available for those who need them.
There were concerns expressed that a one-size-fits-all approach might be adopted, with telehealth seen as a cost-saving measure rather than something that can deliver meaningful improvements to patient care. This was often compounded by the lack of consultation with either clinicians or patients prior to the rollout of the technology.
“Our research exposes the inherent risks and benefits of telemedicine for patients with complex conditions, which may have important implications for patients who have other serious or unpredictable long-term conditions,” the researchers conclude.
“As the NHS develops a telemedicine strategy, we hope there will be a thorough assessment of the clinical and psychological risks and steps taken to mitigate those risks, as well as action to address the possibility of worsening existing health inequalities for those less likely to be able to benefit from remote consultations.”
