The ViCo Study: Comparing the content and quality of video, telephone and face-to-face consultations: a non-randomised (quasi-experimental) exploratory study

Conference:

SAPC ASM 2019 - Exeter

Talk Code:

4E.3

Presenter:

Brian McKinstry

Twitter:

@brianmckinstry

Co-authors:

Victoria Hammersley, Eddie Donaghy, Richard Parker, Hannah McNeilly, Helen Atherton, Annemieke Bikker, John Campbell

Author institutions:

Usher Institute of Population Health Sciences and Informatics The University of Edinburgh, University of Warwick Medical School, University of Exeter Medical School; General Practice and Primary Care

Problem

People increasingly communicate online, at work, in college and socially, using visual communication mediums such as Skype and FaceTime. Demands on primary-care services mean that new ways of providing patient care are being considered. Video-consultation via internet is one such mode. However, it is not known how it differs in content from face-to-face or telephone consultations nor for which patients and problems it may work best. We aimed to explore the content and quality of, and satisfaction with, video-consultations (VC) compared with telephone (TC) and face-to-face consultations (FTFC) in general practice.

Approach

Primary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet or video-enabled computer. Clinicians invited eligible patients who required a follow-up consultation to choose from a telephone, face-to-face or video-consultation. Consultations were audio-recorded and analysed for numbers of problems raised, content using the Roter Interaction Analysis System (RIAS, a validated method of consultation analysis of voice recordings), and quality using an adapted and validated scoring system designed by the Royal College of General Practitioners (RCGP). In post-consultation questionnaires, patients rated interaction quality based on questions from the GP Patient Survey and all participants rated the technical aspects of TCs and VCs. Case-notes were reviewed for previous and subsequent NHS resource use.

Findings

VC participants were generally younger, and more experienced in communicating online than those choosing FTFC or TC. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% CI 2.1 to 5.2) and TCs (+4.1, 95% CI 2.6 to 5.5). Patients raised fewer problems in VCs (mean 1.5, SD 0.8) compared with FTFCs (2.1,SD 1.1), and there were fewer instances of information giving and data gathering between clinicians and patients. We found evidence of lower quality of consultations in two domains of the RCGP framework (seeking health understanding and placing problem in a psychosocial context) in TC and VC. In terms of consultation length, content and quality, VC appeared similar to TC. Both alternative approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, although patients really liked VC, infrastructure issues will need to be addressed before the technology can be mainstreamed in primary care.

Consequences

Although patients liked VC the advantages to clinicians are less clear as in terms of overall workload, VC has a similar duration, content and impact on follow-up consultations as TC. Considerable work may be required to integrate VC with current NHS systems. Before or during implementation, further research should be conducted to determine the best role for VC in terms of which patients and clinical conditions it is most suited. Ideally a randomised controlled trial should be conducted to explore the differences between VC and other modes of consultation and its impact on resource use, preferably in practices where VC is more established, and including use in first presentations.

Submitted by:

Brian McKinstry

Funding acknowledgement:

Scottish Chief Scientist Office