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A review of the virtual healthcare landscape and recommendations for effective care.
Content developed by Emily Sidlow, Scientific Strategist at Page & Page and Partners on behalf of Pfizer UK, following attendance at the British Society for Rheumatology congress 2022.
Estimated 2.5 minute read
The post-COVID-19 world has required numerous adaptations to ensure effective patient care can still be delivered. While they were in existence before the pandemic, remote or digital clinical pathways have been further developed and refined to work in harmony with standard face-to-face pathways. They have been key to tackling the backlog of patients who are waiting for appointments due to the mismatch between reduced capacity and the increased clinical need and number of patients with chronic conditions who need long-term management and care.1
Turning to remote, whether video, telephone or virtual, allows the assessment of patients in a different way and the capturing of patient information outside of the context of usual review appointments. Digital is here to stay, but how we use it and get the best out of it is still very much open for discussion. Successfully redesigning a service to incorporate remote monitoring or virtual consultations provides the potential to optimise referrals and bring in the right patients at the right time, reducing unnecessary appointments and resource use.
The move towards digital has been a long time coming and fits with the push to empower patients to self-care. The overarching principles of the 2021 EULAR recommendations for the implementation of strategies in patients with inflammatory arthritis focus on self-management and self-efficacy, with one of the recommendations stating that digital healthcare can help patients to self-manage and should be considered for inclusion in a self-management pathway, where possible.2 Managing
outpatient capacity is a challenge for already-stretched services, so empowering patients to be engaged in the progress of their condition supports the appropriate use of resources, and continuation of the best possible treatment journey.
For more information on the EULAR recommendations for self-management as discussed at BSR 2022 you can visit this link. Please note, this link directs you to a third-party website, owned and operated by an independent party over which Pfizer UK has no control.
The benefits of patient-initiated follow-up (PIFU) are numerous, allowing patients to manage their own condition and encouraging shared decision making and supported self-management, in line with the NHS self-care agenda.3 Within a remote consultation setting, patients may also have more time with their consultant, which is of additional importance to those suffering from multiple chronic conditions.
All successful services are thoughtfully designed, and continuous review and redesign of such services and their pathways is necessary for ensuring up-to-date and effective provision of care.
Steps to setting up and ensuring the success of a digital pathway focused on self-management include:
|Steps to implement service redesign||Questions to ask to ensure optimum uptake|
|Put together the correct team||What is the appropriate skill mix?|
|Understand the problem in the context of the service||What solutions are needed?|
|Consult widely across stakeholders, including the patient||What are the key points for each stakeholder group to ensure progression of the pathway?|
|Remember to keep the patient at the heart of the service||What needs to be discussed with the patient to ensure they feel comfortable, educated and informed?|
|Try, test, change, repeat||What continuous improvements can we make?|
While service redesign is a necessary step for many institutions to ensure the transition to a digital landscape is as smooth and effective as possible, barriers are nevertheless still present and must be addressed:
|Potential barrier||Questions to ask to address barrier|
|Patient||Do they have access and availability to attend virtual consultations and follow-ups, and the ability to understand the requirements?|
|System||Is it possible to integrate different systems and measurements?|
|Clinical||Is the condition appropriate for remote monitoring?|
|Technical||Does the institution have the capabilities to employ a digital pathway?|
While the barriers and caveats to use must be remembered, PIFU and the move towards digital pathways can be effective in ensuring continued patient care and the appropriate use of resources and sits in-line with the NHS long-term plan. It offers potential cost savings and more streamlined resource use, 4 and its application across other chronic diseases outside autoimmune rheumatology and musculoskeletal conditions also has significant potential.
Reviewing and redesigning clinical pathways to encourage the move towards supported self-care should involve the whole team. We must find our allies and fire starters to initiate the movement, but everyone must be brought on the shared journey of trying, testing, changing and repeating to continuously improve the services provided for both patients and clinical teams, and to effect the gradual change required to make a difference.
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