JMIR Publications

ABSTRACT

Background:

Asynchronous outpatient patient-to-provider communication is becoming widespread in UK healthcare. It has mostly been tested in primary care but is increasingly used in secondary care outpatient services. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation system from dermatology to gastroenterology and pain management.

Objective:

We conducted a multi-method study between April 2021 to July 2022 including staff, patient, and public perspectives and quantitative data from the NHS to obtain a rounded picture of innovation as it happened.

Methods:

Three online and one face-to-face focus groups (n=22) on public readiness for the new service and 14 semi-structured interviews with staff on service design and delivery were conducted. The new service's effects were examined using NHS data on service usage, a patient satisfaction survey (n=66), and six follow-up semi-structured interviews. Satisfaction survey responses were analyzed descriptively. Service users’ demographics, acceptability across specialties, non-attendance rates, and appointment outcomes were compared. The Scottish Index of Multiple Deprivation was used to measure health inequality. Individual interviews and focus group transcripts were thematically analyzed.

Results:

Staff anticipated a simple technical system transfer from dermatology to other receptive specialties, but despite a favourable setting and organizational assistance, it has been complicated. It was thought to function better for pain self-management since it fitted pre-existing practices. Staff rapidly learned how to explain and utilize the system, and the gastrointestinal and pain management departments started offering digital appointments in December 2021. From February through July 2022, dermatology, gastrointestinal, and pain management offered 1709 appointments to a range of people (totalling n=1417). Asynchronous appointments reduced travel by an estimated 44,712 miles compared to face-to-face mode. People living in more and less deprived areas were equally likely to accept asynchronous consultations, treatment, or open returns, according to NHS data analysis. In the survey, only 18% of respondents were unhappy or very unhappy to be offered a digital appointment invitation. The benefits mentioned included better access, convenience, decreased travel and waiting time, information gathering/sharing, and clinical flexibility. Overall, patients, the public, and staff saw its potential as an NHS service but highlighted informed choice and flexibility, noting that it may not work for others, especially individuals with limited digital or writing abilities. Better communication—including ‘appointment’ definitions—may increase patient acceptance.

Conclusions:

Asynchronous pain management and gastroenterology consultations are viable and acceptable. Transfer of this technology into new services is easiest when there is a limited disruption to existing administrative processes but regardless always needs significant and continuous support. This study can inform practical strategies for supporting staff in implementing asynchronous consultations (e.g., preparing for the process's non-linearity, working around task issues). For potential patients, careful technical support and explanation are needed, as well as a choice of consultation routes, to ensure digital inclusion.