Exploring Patient and Staff Experiences With Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data

  1. Hannah Bradwell
  2. Rebecca Baines
  3. Katie J Edwards
  4. Sebastian Stevens
  5. Kate Atkinson
  6. Ellen Wilkinson
  7. Arunangsu Chatterjee
  8. Ray B Jones

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Abstract

Video consultations (VCs) were rapidly implemented in response to COVID-19 despite modest progress before.

Objective

We aim to explore staff and patient experiences with VCs implemented during COVID-19 and use feedback insights to support quality improvement and service development.

Methods

Secondary data analysis was conducted on 955 patient and 521 staff responses (from 4234 consultations; 955/4234, 22.6% and 521/4234, 12.3%, respectively) routinely collected following a VC between June and July 2020 in a rural, older adult, and outpatient care setting at a National Health Service Trust. Responses were summarized using descriptive statistics and inductive thematic analysis and presented to Trust stakeholders.

Results

Most patients (890/955, 93.2%) reported having good (210/955, 22%) or very good (680/955, 71.2%) experience with VCs and felt listened to and understood (904/955, 94.7%). Most patients accessed their VC alone (806/955, 84.4%) except for those aged ≥71 years (23/58, 40%), with ease of joining VCs negatively associated with age (P<.001). Despite more difficulties joining, older adults were most likely to be satisfied with the technology (46/58, 79%). Patients and staff generally felt that patients’ needs had been met (860/955, 90.1% and 453/521, 86.9%, respectively), although staff appeared to overestimate patient dissatisfaction with VC outcomes (P=.02). Patients (848/955, 88.8%) and staff (419/521, 80.5%) felt able to communicate everything they wanted, although patients were significantly more positive than staff (P<.001). Patient satisfaction with communication was positively associated with technical performance satisfaction (P<.001). Most staff members (466/521, 89.4%) reported positive (185/521, 35.5%) or very positive (281/521, 53.9%) experiences with joining and managing VCs. Staff reported reductions in carbon footprint (380/521, 72.9%) and time (373/521, 71.6%). Most patients (880/955, 92.1%) would choose VCs again. We identified three themes in responses: barriers, including technological difficulties, patient information, and suitability concerns; potential benefits, including reduced stress, enhanced accessibility, cost, and time savings; and suggested improvements, including trial calls, turning music off, photo uploads, expanding written character limit, supporting other internet browsers, and shared online screens. This routine feedback, including evidence to suggest that patients were more satisfied than clinicians had anticipated, was presented to relevant Trust stakeholders, allowing for improved processes and supporting the development of a business case to inform the Trust decision on continuing VCs beyond COVID-19 restrictions.

Conclusions

The findings highlight the importance of regularly reviewing and responding to routine feedback following digital service implementation. The feedback helped the Trust improve the VC service, challenge clinician-held assumptions about patient experience, and inform future use of VCs. It has focused improvement efforts on patient information; technological improvements such as blurred backgrounds and interactive whiteboards; and responding to the needs of patients with dementia, communication or cognitive impairment, or lack of appropriate technology. These findings have implications for other health care providers.

Article activity feed

  1. Version published to 10.2196/30486
  2. Version published to 10.2196/preprints.30486
  3. ScreenIT

    SciScore for 10.1101/2020.12.15.20248235: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Survey respondents gave consent for their data to be used but some chose to not have comments quoted verbatim.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Qualitative analysis was supported through the use of NVIVO software.
    NVIVO
    suggested: (NVivo, RRID:SCR_014802)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This also echoes results of Isautier et al. (9), with technology limitations being a reason for poor experience. Our results indicating age differences in independent use and family involvement are also congruent with other research (27). However, given the difficulties that many older people have in travelling to outpatient clinics (28) and the high acceptability of VC in our study for older people no quick assumptions should be made about the unsuitability of VC for older people. Our participants reported higher levels of satisfaction and willingness to use VCs in the future than those in previous work (4). The previous feedback was collected within an entirely orthopaedic service, which could suggest greater satisfaction and use intentions are seen here due to the variety of services included, which may better translate to VC than orthopaedics, as perhaps a more ‘hands-on’ service. However, this would need further exploration, as survey limitations impair our understanding of exactly which service our participants accessed. Other contributions of this research include the identification of additional benefits including enhanced comfort and subsequent ability to ‘open up more’, increased sense of affordability and accessibility and difficulties faced as a result of perceived inadequacy with existing patient information. Furthermore, the research by Gilbert et al. (4) had a smaller sample size, collected from an orthopaedic service in an urban area, differing from the rural ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.12.15.20248235 on medRxiv