Principal Investigator: Professor Chris Kipps, Consultant Neurologist at University Hospital Southampton NHS Foundation Trust

Team: Dr Sarah Fearn, Senior Research Fellow, University of Southampton

Starts: 1/2/2022

Ends: 31/07/24

Background

The number of people living with a neurological condition is increasing, placing ever greater demand on existing services. The NHS Long Term Plan outlines a need for new service models to optimise care. Remote and digital technologies, aimed at improving efficiency and service delivery, can promote a more personalised approach to outpatient care, with a key outcome being a reduction of unnecessary appointments.

‘Remote care’ provides synchronous communication between the patient and the healthcare professional (HCP) across different locations. The COVID-19 pandemic accelerated the uptake of remote care with a rapid shift in appointments performed via phone or video-call.

‘Digital care’ provides technology-enabled asynchronous communication between the patient and their care team (e.g. messaging) where contact with an HCP is not required in real time. UHS has been a leader in developing digital care through the My Medical Record care platform that provides a unique digital tool connecting patients to their care team.

Both remote and digital care provide cost effective, implementable opportunities to transform outpatient services in neurology and for other long-term conditions. Yet little is known about the most effective ways to combine the standard face-to-face appointment with remote and digital technologies to provide effective, efficient, high quality outpatient care. There has been some research into the advantages, disadvantages, barriers and enablers of remote care during the pandemic for people with neurological conditions (Nakornchai et al. 2021), with a growing body of work into digital healthcare and the moderating factors of its use and success within this population (Moccia et al. 2018). However, in a post-pandemic environment, we need to shift the focus from separate analyses of remote and digital care onto how best to combine face-to-face, remote and digital care to better serve patient needs and realise the ambitions of the Long Term Plan.

Why this research matters

During the COVID-19 pandemic, many outpatient neurology appointments were moved online or over the phone to keep people safe. Five years on, remote care is still widely used—but are we doing it well? We wanted to find out what works, what doesn’t, and how we can make remote neurology care better for both patients and healthcare professionals.

What we did

We analysed large national surveys about remote appointments from over 2,400 neurology patients and carers (via The Neurological Alliance’s national survey) and nearly 600 neurologists (via two surveys collected by the Association of British Neurologists). We also ran local focus groups and co-production workshops with patients, carers and healthcare professionals to understand what really matters in a neurology appointment. Together, we co-designed a set of practical, evidence-based recommendations to help services deliver better, more person-centred, and efficient remote neurology care.

What people told us

Remote care can be hugely beneficial when done well. Patients appreciated the convenience – avoiding travel, hospital parking and long waits - especially if they had mobility issues or lived far from the hospital. It also made it easier for carers or family members to join the appointment.  But there were challenges. Patients worried they might not get the same quality of care without being seen in person. They were concerned about symptoms being missed, not being taken seriously, or struggling to explain themselves over the phone. Some felt remote appointments could feel rushed or impersonal.  Patients were also concerned about maintaining their own privacy during the consultation and wanted to feel certain that their healthcare professional was also in a private space.  Not all patients felt confident with video technology and weren’t sure what to do if things went wrong. Healthcare professionals also found remote working challenging at times — IT systems and technology weren’t always reliable and were clunky to use, finding a private room could be difficult, and it wasn’t always easy to ensure timely in-person follow up if a concern had been identified remotely. 

What we recommend

Together with patients, carers, and professionals, we developed key recommendations to improve remote care:

•Let patients choose the type of appointment that suits them—face-to-face, phone, or video—where it’s safe to do so.

•Co-design clear, accessible tools and information with patients to improve trust in remote care and help all patients get the most out of their remote appointments.

•Protect clinical staff time to keep digital platforms and patient resources up-to-date.

•Implement fair and robust triage systems to reduce variation in care.

•Provide regular training and support so staff can deliver the quality of patient care they aspire to.

•Ensure there are enough private spaces for healthcare professionals to deliver confidential remote consultations.

•Maintain enough rapid-access face-to-face slots to allow timely and safe in-person follow up when needed. 

•Improve digital systems and streamline admin to reduce stress, avoid unnecessary delays and boost satisfaction for both staff and patients.  

•Regularly review how remote services are working to make sure they’re fair and effective for all, especially those with less digital access or confidence.

What’s next

Remote care is here to stay. But for it to work well, it needs to be flexible, inclusive and built around patient and staff needs.  We have shown that with the right systems, tools and support, remote neurology can deliver safe, high-quality and accessible services.  These recommendations will not only optimise remote care in neurology but would also be adaptable to other clinical specialities across the NHS.  

What did we do with this new Knowledge?

•Shared findings with patients and carers and healthcare professionals.

•Informed content of the UHS outpatient webpages. 

•Provided national and local feedback to the UHS outpatient transformation team to inform strategy for remote care in neurology and more generally.

•Used the positive feedback from our workshop participants to inform future approaches to Increase engagement and inclusion in research.

•Drafted an article about optimising remote appointments in neurology for publication.

What's next

We will discuss the recommendations with the Association of British Neurology Quality Committee with regards to endorsement of the recommendations for a neurology clinical practice guideline.

Once endorsed and put into practice, the next step would be to audit practice and measure change.