Hi, I’ve brought you a pot of my wee: how does digitalisation improve clinical practice efficacy?

Problem

Digitalisation of health is a key current UK government focus, with the introduction of The Plan for Digital Health and Social Care in 2022. Rapid digitalisation has occurred across General Practice, with significant learning from the Covid-19 pandemic, where digital consultation was used to minimise infection risk. Accurx, a digital software start up created by Innovate UK, has been increasing used for teleconsultation and facilitates video and text consultation. Accurx enable pre-made questionnaires (Floreys) and the ability to create individual templates. These allow collection of structured information by text to patients and direct transfer into electronic health records with appropriate coding.Urinary Tract Infections (UTI) are a common presentation to GP, where virtual consultation has been shown to be feasible for average risk patients, saving clinician time and costs.

Approach

We aimed to examine healthcare professions’ perception of the processing of urine samples dropped into a small inner-city General Practice in Stockport prior to and following introduction of a Digital Health Intervention (DHI). We anonymously surveyed a range of clinical and non-clinical staff including Administration staff, Nurses, Healthcare Assistants, General Practitioners (GPs) and GP Registrars. We then piloted a DHI using a pre-made Florey assessing urinary symptoms. This was sent to patients by reception staff where patients had dropped in urine sample which were random or pre-requested by a clinician. This occurred prior to clinical triage and assessment. We performed a further anonymous survey to assess impact of the DHI.

Findings

Prior to development of the DHI, of the General Practice staff surveyed (Admin/Nurses/GPs/HCA) 70% felt the system could be improved. The majority felt a DHI could be feasible to improve time efficiency for staff and improve clinical decision making. After introduction of the DHI, 90% of respondents found an improvement in clinical practice and 10% felt there may have been improvement. Feedback included increased patient autonomy, relevant information capture, increased speed of information gathering and improved triage. Staff felt teleconsultation was still required following. Suggested improvements included adding patient leaflets. Overall, the feedback was positive for expanding the use of floreys across other areas.

Consequences

DHI using text questionnaire can be useful in clinical triage and information gathering. We have capitalised on the success of this initial pilot and will be looking to incorporate further clinical text questionnaires within triage. This may prove increasing useful with the recent announcement of changes in the GP contract, which require all patients to have assessment of need and signposting to services at initial contact. Verbal patient feedback has been positive but further work will access patient views.