Moving to remote consultations to reduce the risk of COVID-19

Moving to remote consultations to reduce the risk of COVID-19
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A new study has examined how GPs in the UK coped with the rapid shift to remote consultations in a bid to help reduce the risk of COVID-19 infections in the community.

The National Institute for Health Research (NIHR) funded study, carried out by researchers from the Centre for Academic Primary Care at the University of Bristol and NIHR ARC West, found that overall, the rapid shift to remote GP consulting was successful and maintained a focus on vulnerable patients. However, it also highlighted that this shift was driven by necessity and may have risks.

The study has been published in the British Journal of General Practice.

Coping with change

The Rapid COVID-19 Intelligence to Improve Primary Care Response (RAPCI) study examined how 21 GP practices responded to the COVID-19 pandemic in Bristol, North Somerset, and South Gloucestershire. It explored how the practices coped with changes in demand, the implementation of alternatives to face-to-face consultation, and the impact that these changes had on the delivery of patient care from April to August 2020.

The findings demonstrated a universal consensus that remote consulting was necessary because of the risk of COVID-19 infection. In April 2020, the demands of the pandemic drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020, compared with 31% in April 2019.

By July 2020 GPs were doing 85% of consultations remotely and nurses 38%. GP-to-patient phone text messages increased three-fold, and nurse-to-patient almost five-fold in April to July 2020 compared to 2019.

Dr Mairead Murphy from the Centre for Academic Primary Care, who co-led the study, said: “The NHS long-term plan mandates a move to remote consulting and this change was accelerated by the COVID-19 pandemic. While pre-COVID-19 research established that telephone and video consultations were effective and safe, it was done in the context of remote consulting implemented for certain patients and conditions. Our study shows some limitations with remote consultations and suggests that remote GP consulting should be offered as one of a range of options, not by default. Post-pandemic we believe the model will need to be adjusted.”

Face-to-face contact

GPs and nurses maintained a focus on caring for the most vulnerable throughout the pandemic and, despite reductions in overall consultation rates in April 2020, consultation rates did not reduce for patients who were older, shielding, or had poor mental health.

The study also found that overall consultation rates returned to normal in July, however, complexity increased, causing some GPs to find high levels of remote consulting a strain. Many GPs also missed face-to-face contact, were concerned about clinical risk, and found remote consulting more time-consuming.

GPs stated that telephone consulting was deemed to be sufficient for many patient problems and that consulting was useful during the first lockdown, but video was used more rarely, and was less essential as lockdown eased.

Dr Jeremy Horwood, from the Centre for Academic Primary Care at the University of Bristol and NIHR ARC West, who co-led the study, said: “GP practices have had to rapidly adopt new ways of delivering care remotely and responding to the new norm of social distancing to reduce the risk of COVID-19 infection.

“This is a huge change, with GP practices and patients having to transform the way they interact overnight. While remote methods of consulting may have value for some patients, such as straightforward medical enquiries, they cannot replace face-to-face consultations in situations which are more complex.”

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