2 results
Telemedicine for Memory Service Assessments, a Literature Review
- Dominic Treloar
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S73
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Aims
Memory clinic waiting times are at a record high, increasing from 13 weeks in 2019 to 17.7 weeks in 2022. This backlog is partially due to COVID-19 disruption. Staff are concerned that waiting times are resulting in missed diagnoses, particularly with early-onset memory loss, and that relatives of patients with challenging behaviours are not receiving adequate support. At the start of the pandemic, many Memory Service Assessments (MSAs) were done via teleconsultation to ensure patients could access services despite lockdowns. Telemedicine has continued to be used for MSAs and is a strategy proposed to tackle waiting times. This literature review explores whether using telemedicine for MSAs is evidence-based.
MethodsA search using the MEDLINE database was conducted, using the terms ‘dementia’, plus ‘telemedicine’, ‘video calls’, and ‘telephone calls’. This identified one relevant systematic review and one clinical trial. The identified evidence was insufficient for a systematic review. A google search carried out with the same terms, identified a variety of non-academic papers: NHS Audits, Quality Improvement Projects, Clinical Network publications, and one governmental publication.
ResultsTelemedicine was reported to reduce waiting lists. Appointments could be organised quickly, without infection risk, and without requiring transportation. At-home telemedicine consultations were relaxing for some patients and reduced demand for home visits. However, clinicians reported that some environments were cluttered and noisy, impacting the MSA.
Patients struggled with the complex telemedicine technology; carers were required to facilitate the calls, which increased the risk of an inaccurate assessment. Patients with sensory impairments disliked telemedicine, and clinicians struggled to distinguish between cognitive impairment and poor hearing. Financial inequalities at times prevented telemedicine. Some relatives felt that patients would mask their memory symptoms in teleconsultations, and not speak openly about their concerns. Clinicians felt adequate safeguarding assessments were not possible over teleconsultation. There was no inclusion of the long-term impact of these assessments. No distinction was made between dementia subtypes.
ConclusionThe National Audit of Dementia, RCPsych 2021, encourages the future use of telemedicine for MSAs. However, there is limited evidence to support its use. Telemedicine was essential during COVID-19 and may help reduce waiting times, but may also produce worse outcomes than face-to-face consultations. Only pilot studies without randomisation exist on the topic and none of these are UK based. Further research is required to produce NHS-specific data on the impact telemedicine has on: the quality of MSAs, the patients’, carers’, and clinicians’ experiences, and memory service waiting times.
Telemedicine in addictions feasibility RCT – staff and patient qualitative satisfaction
- Dominic Treloar, Soraya Mayet
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S297
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Aims
Opioid dependence has high risks. Opioid substitution treatment (OST) improves outcomes. Addiction specialist prescribers prescribe OST and monitor safety, but nonattendance may lead to worse outcomes. Telemedicine can reduce travel and improve attendance at appointments. Before COVID-19, we started a telemedicine in addictions trial to see if this helped in addictions. We present the qualitative patient and staff experience results.
MethodHealth Research Authority approval for randomized controlled feasibility trial of Telemedicine versus Face-to-Face (control) consultations at community addictions semirural service (2500km2) using a modified Hub-and-Spoke (outreach) model. Adult opioid dependent patients prescribed OST and attending outreach were recruited. Participants received two appointments in randomized group. Telemedicine was delivered using Skype-for-business videoconferencing. Patients attended outreach, saw keyworker for drug testing first, and telemedicine conducted via keyworker's laptop. Addiction prescribers located remotely at Hub. Post-trial research interview conducted assessing patient and staff experience of Telemedicine versus Face-to-Face consultations. Data transcribed, inputted to RedCap Cloud and free-text analysed using qualitative thematic analysis.
ResultOf fifty-nine patient participants, 58 completed a research interview. Patient participants reported similar levels of satisfaction between the Telemedicine and Face to Face groups. The themes generated in relation to Face-to-Face were no difference, easy, kind staff and liking being part of research. For Telemedicine, themes were less travel, good experience, easier to access, good communication, saves time and saves money. For instance, one patient stated ‘Clear, easy to access less travel’ and another patient stated ‘I struggle with travel. I found it easier’. Of 19 staff participant research interviews completed, Staff reported Good or Very Good experience with telemedicine which was equivalent for Face-to-Face consultations. Eleven staff had experience of telemedicine consultations during the trial. They reported similar themes to patients with telemedicine leading to less travel, beneficial to patient care, improves attendance and was innovative technology. One staff member reported satisfaction with telemedicine due to ‘Time, travel and money reduction’. When questioned on the downsides to telemedicine, technological issues were mainly related to connection issues and sound issues.
ConclusionIn the first known RCT of Telemedicine versus Face-to-Face consultations for patients with opioid dependence attending prescriber review, we found that both patients and staff were satisfied with telemedicine as compared to face-to-face consultations. Overall themes were reduced travel, saving time and more convenience. This will be very important given the impact of COVID-19 on access to addictions services.
Financial Sponsorship
East Riding CCG
Academic Health Science Network