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Virtual Clinics

News and presentations from today’s conference looking at setting up and running virtual clinics in practice.

Dr Shanti Vijayaraghavan, Consultant Physician, Diabetes and Endocrinology at Newham University Hospital – Barts Health gave a case study presentation as part of a presentation with Joe Wherton, Research Fellow at the University of Oxford,  on the evidence for virtual clinics and consultants.

Pre-Event Abstract: Diabetes Appointments via Webcam in Newham

With rising demand on services, poor access to care and poor health outcomes, Newham exemplifies challenges faced throughout the NHS. Particularly high DNA (‘do not attend’) rates (approximately 30-50% for diabetes, depending on age) reflect the complex lives and access challenges of many local patients, largely from minority ethnic groups. 

We aimed to provide more accessible and cost-effective diabetes care by replacing routine follow-up outpatient appointments for patients not requiring physical examination with web-based consultations; evaluated using qualitative and quantitative methods. We anticipated improvements in efficiency of the outpatient process, improved patient experience, enhanced patient self- management skills and cost effective care. 

Uniquely the project utilised everyday technology available in people’s homes (rather than expensive pieces of kit), included all ages, patients from ethnically diverse communities and was conducted in an urban environment where face to face care remained a viable option.

Since 2011 we have reduced our DNA rate to 13% (62% uptake from patients) and improved blood glucose control in those who routinely use online care

Patients reported that, compared to face-to-face appointments, web consultations saved them time, were far more convenient, cheaper, that they preferred them and would be more likely to attend them. This has implication for DNA rates. Staff and patients reported that the quality of care over webcam was at least as good as that provided face to face. 

Initial savings are modest, through increased productivity, however results indicate that more substantial savings will follow through; further reduction in DNAs, better health outcomes and associated decrease in A&E admissions. In addition there are significant savings for patients (especially where this impacts on earnings) and wider societal benefits.

We are currently leading an NIHR-funded project called VOCAL who examines the clinician-patient relationship, organisational impact and NHS policy around remote consultations.
Full PowerPoint Presentation

Joe Wherton’s PowerPoint Presentation

Understanding service virtualization: where to start
Case study: Virtual clinics: From Urogynaecology to Pre Operative Assessment by Dr Stephen Radley, Consultant Obstetrician and Gynaecologist at Sheffield Teaching Hospitals NHS Foundation Trust

Pre-Event Abstract: From Urogynaecology to Pre-Operative Assessment

The initial development of an electronic Personal Assessment Questionnaire (ePAQ) was driven by issues of data entry as well as accessibility, value and burden of questionnaire use in clinical practice. Harnessing the power of detailed, reliable, objective and meaningful patient self-assessments is now proving valuable, not only for outcomes monitoring, but more importantly, for better understanding of patients’ conditions, particularly those of a sensitive or complex nature and when patient’s views of their condition and symptomatology are critically important. 

Well-designed web-based self-completed questionnaires can enhance communication and support Virtual Clinics, where elements of patient assessment are conducted remotely and can valuably inform consultations and subsequent management. This technology is now being applied more widely in other areas, such as vascular disorders and pre-operative assessment, enabling enhanced communication, efficiency and quality of healthcare.

In the context of Pre-Op Assessment, clear benefits in terms of cost, capacity, patient flow and patient experience have been realised utilising a one-stop clinic, with electronic patients interviewing using ePAQ. 
Full PowerPoint Presentation

Demonstrating savings and improvement
Case Study: Cardiology Virtual Clinic
Suzanne Jordan, Manger Cardiology Investigation Unit at Frimley Health NHS Foundation Trust

Pre-Event Abstract

The management of outpatient clinics is challenging across the majority of hospital Trusts in the UK.  One of the main concerns is prioritising urgent referrals and minimising referrals for patients who otherwise can be managed in primary care.

We introduced the Virtual Clinic in 2012 at Wexham Park in collaboration with our colleagues in primary care offering urgent advice and triaging with a turnaround time of 72 hours (Monday to Friday).

Since 2012 we have had more than 3,000 referrals providing advice from consultant to GP.  47% were for advice only and 22% were prioritised for an urgent OPD appointment. 

In conclusion our virtual clinic service has been a success, offering enhanced referral pathways and substantially reducing inappropriate referrals into clinic.

There have been significant benefits to the health economy as a result of this service.
Full PowerPoint Presentation

Also of interest:

In-depth legal masterclass: Informed Consent After Lanarkshire
Friday 12 May 2017 
De Vere West One Conference Centre, London

Effective Operating Theatres Summit
Friday 7 July 2017 
De Vere Conference Centre, London

Nurse Clinics 2017
Monday 20 November 
De Vere West One Conference Centre, London

National PROMs Summit 2017
Monday 11 December 2017 
De Vere West One, London

28 April 2017


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