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Remote delivery of healthcare and online healthcare information

A short survey to understand attitudes and preferences

By Marie-Claire Wilson, Engagement Manager at Axian

The COVID-19 pandemic has accelerated the trend for many everyday activities, such as banking and shopping, to take place online, and has also led to rapid changes in how healthcare is delivered. Between March 2020 and June 2020; the proportion of GP appointments carried out face-to-face fell from 83% to 47%, with a concomitant rise in the proportion conducted via telephone or video link. [1]

Change of GP appointments carried out face-to-face
83% to 83%
March to June 2020

As with other activities, booking and carrying out a healthcare appointment online is potentially more convenient, for both healthcare professionals (HCPs) and patients. Healthcare professionals can in theory see more patients when appointments are remote, and technology can allow them to maintain contact with patients that do not live near to the clinic or hospital, or who have issues with mobility. Lab and radiology reports do not have to be sourced locally, and there are opportunities for easy collaboration with colleagues around the world. For patients, a 10-minute appointment might once have required taking time off work, because of the travel and waiting involved; when carried out remotely, appointments can be easily slotted in with other activities.

Alongside this new way of delivering and receiving healthcare, wherever we have access to the internet we also have access to a vast amount of information related to healthcare and wellbeing information at our fingertips. This means that we can be more aware of health issues, and better informed of treatment options than ever before. Only a few decades ago, researching a disease and its treatment in depth would only have been possible for the lay person through a visit to a well-equipped library. Today it can be done on a mobile phone over coffee. Furthermore, there is a huge range of healthcare apps, some of which are classified as medical devices, that allow patients to self-manage their conditions. Some examples of these are mentioned in our article on gamification. HCPs also benefit from the online information and the health-related app boom: they have faster and easier access to information, advice and data that can help them care for patients, develop their knowledge, and create professional networks.

Overall, it seems that remote delivery of healthcare combined with easy access to health-related information could be set to change the whole landscape of how healthcare is managed and delivered. But of course, there are downsides to these changes. Most of us have had a frightening experience when consulting “Dr Google”, and online anti-vax information has been a regular news topic, especially in recent months [4]. Consequently, this means that HCPs can end up spending valuable appointment time re-educating patients who have been misinformed. In addition, it can mean that online information is potentially a source of harm to individuals and populations.

When it comes to remote healthcare, we have anecdotal evidence of patients “attending” remote appointments whilst distracted by other activities such as driving. This prompted us to determine whether this was really the case – we surveyed Axian colleagues and their friends and families to understand a little more about their attitudes to online healthcare information and remote healthcare appointments.

Our survey: Demographics

40 people answered the survey – 65% of whom identified as female and 35% as male. The graph below shows the age group breakdown of the respondents, showing how 79% of the respondents were in the 45 years + age groups.

Age group breakdown (percentage) n=40

As significantly more respondents identified as female than male and most respondents were over 45, we need to bear this in mind when interpreting the results.

Findings – online healthcare information
  • 70% of respondents sometimes used the internet to find healthcare information, with 28% consulting the internet regularly for these topics and only 3% stating never
  • We asked a question on opinions of online healthcare information, where respondents could select more than one option. 62.5% of responses mentioned not taking online health information too seriously. 20% of responses referred to feeling that online healthcare information was not reliable
    • The older age group of the respondents should be remembered here – it is possible that people in younger age groups, who have grown up with internet access, may have a more positive opinion of online healthcare information

Opinions of online healthcare information n=40

I don’t take health information from the internet too seriously, or I only use it to get a general idea

0/40

It is more convenient to use the internet for health questions than asking a doctor or other healthcare professional

0/40

The health information I find on the internet isn’t always of a good quality/reliable

0/40

The health information I find on the internet can be confusing 

0/40
Findings – remote healthcare appointment

25 of the 40 respondents (62.5%) had attended a remote healthcare appointment in the past year. The majority of these (88%) stated that they had their appointment somewhere quiet where they could concentrate. When we asked for opinions on the remote appointments (selection of more than one option was possible in this question), 72% of respondents selected “having a remote appointment was more convenient”, but there were mentions of the interaction with HCPs not being as good as in person (20% of responses), and the appointment feeling less important (8% of responses).

Opinions of remote healthcare appointments n=25

Having a remote appointment was more convenient for me

0%

My interaction with the healthcare professional wasn’t as good in the remote appointment 

0%

My appointment felt less important because it was remote

0%

When asked what they would prefer in terms of healthcare delivery in the future, assuming at least partial removal of COVID-19 related restrictions, 76% of respondents preferred a mix of both in- person and remote delivery.

Preferences for delivery of healthcare (percentage) n=25

Discussion

Our short survey had several limitations, including small sample size, unequal gender and age distribution and the potential for the pandemic situation to influence opinions about remotely delivered healthcare. However, it has raised themes that merit further consideration.

The respondents felt that healthcare information from the internet may need to be interpreted with caution, was not always reliable and could be confusing (66% of responses to this question mentioned one of these options). This suggests a need for demonstrating which online information sources are “accredited” or “approved” by HCPs or governments. Providing good quality, balanced information could be an area where pharmaceutical companies could meet a genuine HCP and patient need.

We were interested to understand whether remote delivery of healthcare could “dilute” the importance of the interaction between HCP and patient through the loss of some of the elements of the traditional healthcare appointment that have a ritualised component. The physical examination of the patient is one example of this – not only is it a means of gathering information about the patient’s complaint, but it is also a key part of the relationship between the HCP and the patient [3]. We can also speculate that the interruption to the daily routine that can be associated with attending a clinic or hospital adds to its significance. Our survey results did not support the hypothesis that remote healthcare appointments were seen as less important by patients, with few selections of the “my appointment felt less important because it was remote” option, although they did show that some service users felt that the interaction with HCPs was not as good in remote appointments. Nevertheless, the convenience of remote appointments meant that most respondents would like to keep a remote element to their healthcare discussions going forward.

This survey did not cover the opinions of healthcare providers on online healthcare information or remote healthcare appointments, but there is evidence that GPs may prefer to see patients face-to-face [2].

Conclusion

Digital technologies offer HCPs and patients greater flexibility and convenience for healthcare, as they do in other areas. They also broaden opportunities, as they remove geographical and to some extent, hierarchical barriers to information and connection. However, there is more to the relationship between a healthcare professional and a patient than an exchange of information, and this is a point to bear in mind as we design online experiences in the healthcare space. Taking a design thinking approach reminds us to empathise with the end user, to ensure we reflect their needs when providing digital products and services.

References
  1. https://www.pulsetoday.co.uk/analysis/politics/data-lowdown-how-hancocks-call-for-all-gp-consultations-to-be-remote-is-unrealistic/ Accessed June 2021
  2. https://www.theguardian.com/society/2021/mar/28/gps-prefer-to-see-patients-face-to-face-says-uk-family-doctors-leader Accessed June 2021
  3. Verghese A, Brady E, Kapur CC, Horwitz RI. The bedside evaluation: ritual and reason. Ann Intern Med., 2011 Oct 18; 155(8):550-3. doi: 10.7326/0003-4819-155-8-201110180-00013. PMID: 22007047.
  4. Hotez P, Nature592, 661 (2021) doi: https://doi.org/10.1038/d41586-021-01084-x

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