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Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study.

Magdalena Rzewuska Díaz1, Louise Locock1, Andrew Keen2

  • 1Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.

Journal of Medical Internet Research
|June 4, 2024
PubMed
Summary

Asynchronous consultations in UK healthcare are viable and acceptable, expanding from dermatology to gastroenterology and pain management. Implementation requires addressing administrative challenges and ensuring digital inclusion for patients.

Keywords:
asynchronous communicationhospital dataimplementationmixed methods researchoutpatient carequalitative researchteleconsultation

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Area of Science:

  • Health Services Research
  • Digital Health
  • Patient Communication

Background:

  • The UK National Health Service (NHS) is expanding asynchronous outpatient communication to improve patient-provider interactions.
  • Aberdeen Royal Infirmary extended its asynchronous consultation service from dermatology to gastroenterology and pain management during the COVID-19 pandemic.

Purpose of the Study:

  • To evaluate the implementation and impact of asynchronous outpatient consultations using a mixed-methods approach.
  • To gather perspectives from healthcare staff, patients, and the public on the new service.
  • To analyze National Health Service (NHS) data to understand service utilization and outcomes.

Main Methods:

  • Mixed-methods study incorporating focus groups (n=22) and interviews (n=14) with the public and staff.
  • Analysis of NHS Grampian service use data, patient satisfaction surveys (n=66), and follow-up patient interviews (n=6).
  • Comparative analysis of user demographics, acceptability, and outcomes across different levels of socioeconomic deprivation and medical specialties.

Main Results:

  • Implementation faced challenges including technical integration delays and administrative misalignment, despite organizational support.
  • Asynchronous consultations were successfully launched in pain management (December 2021) and gastroenterology (February 2022).
  • The service reduced travel by an estimated 44,712 miles, with user demographics mirroring the general population and no negative impact from socioeconomic deprivation on treatment receipt. Patient satisfaction was high (82%), citing improved access and convenience.

Conclusions:

  • Asynchronous consultations in gastroenterology and pain management are feasible and well-accepted by patients.
  • Successful implementation is facilitated by minimal disruption to existing administrative processes and requires ongoing staff support.
  • Ensuring digital inclusion through clear patient explanations, technical support, and flexible consultation options is crucial for widespread adoption.