REMOTE-Neuro: co-produced recommendations to optimise remote neurology

Area of Science:

• Neurology
• Health Services Research
• Digital Health

Background:

• Remote neurology outpatient care offers accessibility and convenience.
• Integration challenges persist between remote and in-person care models.
• Stakeholder perspectives are crucial for optimizing remote healthcare delivery.

Purpose of the Study:

• To examine stakeholder experiences with remote neurology outpatient care.
• To co-produce an evidence-based framework for safe, equitable, and sustainable remote neurology services.
• To address challenges in remote care quality, privacy, and equity.

Main Methods:

• Inductive thematic analysis of national survey free-text responses from patients, carers, and neurologists (N=3056).
• Validation through co-production workshops and interviews with patients, carers, and healthcare professionals (N=43).
• Triangulation and refinement of themes to generate stakeholder-endorsed recommendations.

Main Results:

• Participants appreciated flexibility but noted concerns regarding clinical quality, privacy, and equity.
• Remote care requires distinct training and improved digital infrastructure.
• A novel challenge identified is the perception of remote appointments as less legitimate, impacting engagement and equity.
• Five key domains were identified: patient-centered care, specialist considerations, clinical safety, capacity/sustainability, and operational efficiency.
• These findings informed the REMOTE-Neuro framework.

Conclusions:

• Remote care offers significant benefits but faces unresolved integration issues.
• The REMOTE-Neuro framework provides actionable recommendations for optimizing remote neurology practice.
• The framework is grounded in extensive stakeholder input and aligned with NHS transformation priorities, offering a transferable model for other specialties.