Would technology enabled remote consulting save time and add value in primary care – the bmj

Most face to face general practice appointments in the UK last at least eight to nine minutes almost regardless of the reason for the consultation. [1] [2] Doctors and patients, respecting the effort involved in attending an appointment, expect a “reasonable” consultation time. [3] If someone has taken half a day off work to come and see the doctor for their results—all of which are normal—the doctor does not quickly say, “good news, it’s all clear, goodbye.” A consultation comes with an expectation of time to be spent on it, and this perception may lead the doctor or patient to raise another issue they may not otherwise have mentioned.

This is not the case for a remote consultation, where the same effort has not been expended and it is perfectly acceptable for it to last less than a minute.

Telephone consultations are generally shorter and often focused on a single problem. [2] Although telephone triage of acute problems does not save time, [4] research suggests that follow-up appointments for established diagnoses, particularly long term conditions, are more efficiently carried out remotely and that patients like them. [5] However, there are two main barriers to telephone consulting: the loss of non-verbal cues and the inability to physically examine a patient. [3] Technology may provide solutions for these.

Video consulting is little used in the UK, but may overcome the loss of non-verbal cues. [6] [7] It could prove useful for following up patients who don’t require a physical examination, particularly those with psychological problems where the assessment of affect is important. However, research is required to determine how easily it could be securely integrated into ageing NHS IT infrastructures, and whether it saves time or improves outcomes. [8]

Remote physical examination is a challenge. Although trials of remote monitoring of some long term conditions have been equivocal, there is strong evidence of clinical effectiveness for high blood pressure and type 2 diabetes. [9][ [10] Blood pressure management may provide an exemplar for clinical pathway changes that can save clinician and patient time. Based on Scottish figures, an estimated 12 million UK GP and practice nurse appointments annually are for blood pressure checks, even though patients’ measurements of their blood pressure at home is more predictive of cardiovascular outcomes than clinic measures. [11] [12]

Self-monitoring alone can leave patients feeling somewhat abandoned, however, clinician-supported telemonitoring enhances clinician-patient collaboration and improves blood pressure control. [9] [13] [14] Systems now exist that allow for telemonitored data to be integrated into monthly, three monthly, or six monthly reports within normal data management routines in practice. Clinicians can phone, text, or email advice, and patients appreciate avoiding surgery attendance. [15] Recent price drops in sphygmomanometers and telemetry provide an opportunity to scale up this technology.

Remote consulting could free up time for patients with complex multimorbidity to have longer consultations. [16] We should implement those technologies that have an evidence base, albeit in an evaluative framework, and explore the potential of others, such as video consulting. The rapid growth in the prevalence of long term conditions makes the evaluation and adoption of potentially time saving technologies ever more necessary.

[16] Mercer SW, Fitzpatrick B, Guthrie B, Fenwick E, Grieve E, Lawson K, Boyer N, McConnachie A, Lloyd SM, O’Brien R, Watt GCM, Wyke S. The Care Plus study- a whole system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: cluster randomised controlled trial. BMC Medicine 2016;14:88. doi: 10.1186/s12916-016-0634-2 NHS