Videoconsult wrongly still used minimally

For patients, video calling with a hospital is often a solution

Video-calling has become an indispensable part of social traffic. However, whilst it is a patient-friendly way of making healthcare more efficient, it is still used only sparingly in the healthcare sector.

With a video consultation it is possible for patients to have contact with their healthcare provider at all times, even when at home. Given the increasing concentration of specialist care, video consultation has become increasingly relevant for more and more patients. In this way, if the content of the consultation allows it, they no longer have to travel to the hospital – or at least less often so. This has the potential be an efficient form of contact with the caregiver, which also allows for more tailor-made care. The literature shows that the gains in travel time and costs, avoiding the waiting room, not being dependent on others to come to the hospital and the comfort of a consultation in one’s own environment are the main advantages of online care for the patient. However, what do Dutch patients actually think about this?

Patient federation the Netherlands and the Amsterdam UMC, location AMC, conducted a survey among their patients about video consultations in healthcare. The results were then tested at the Outpatient Clinic for Surgery of Amsterdam UMC. Out of the 968 patients who participated in the survey, the male/female distribution was equal, the average age was 65 years and 93.4 percent had one or more chronic condition. Of those individuals surveyed, only 1.7 percent had ever had a video consultation with their care provider in the hospital, whilst more than half of them use video calls in their private life.

Technology

To be able to conduct a video consultation while maintaining good quality of care and privacy, a stable and secure internet connection is required, as well as a computer, tablet or smartphone with a camera function. More than 75 percent of those surveyed have sufficient experience with the use of mobile technology, with one in four private individuals even using video calls on a monthly basis. Technically, more than 60 percent of patients are convinced that they will be able to start a video connection themselves, and only 10 percent think they cannot.

More than 70 percent trust that privacy is guaranteed during a video consultation

The survey shows that almost 60 percent would opt for access through a secure patient-portal and that 70.8 percent trust – without actually knowing it – that privacy is guaranteed during such a video consultation. Nearly 80 percent of those questioned think it should be possible to record a video consultation so that they can look back at a later date via the secure patient portal.

Small part

Since 1 January 2018, remote consultations in the hospital, including from the first patient contact, are reimbursed by insurances. It is therefore possible to start a care process remotely, provided that somewhere in the initial dbc-care product there is a physical face-to-face contact with the professional performing the gate function.

What is generally meant by ‘care at a distance’ was changed in January 2018. Such a change in definition makes it difficult to paint a picture of the number of registrations for this healthcare activity prior to January 2018. We have requested registration details for the period 2016 up to and including September 2018 from a Dutch health insurer, and this data show that thirty hospitals in the Netherlands have registered a screen-to-screen contact in the period 2016-2018. A total of 135 consultations were registered in 2016, 166 in 2017 and 83 in 2018. By way of comparison: up to September 2018, 113,917 call consultations to replace a repeat outpatient clinic visit were registered.

There is clearly no need for a video consultation during a first appointment with the care provider.

Out of the 968 respondents, 34 patients indicated that it was possible to have a video consultation with their healthcare provider, spread over 23 different hospitals. From this we can conclude that only a small part of all hospitals in the Netherlands currently offer the possibility of a video consultation.

Personal contact

When asked whether patients would want to use a video consultation in the future, almost half indicate that they would, a third do not know yet and just over 20 percent states that they do not. When asked whether they would have preferred to replace their last physical appointment with the care provider in the hospital with a video consultation afterwards, about a quarter of patients indicated that this would have been desirable and more efficient. The most important arguments for this are saving energy, avoiding the waiting room, being less dependent on others and saving travel time and costs. Patients who prefer a physical appointment indicate that they would miss out on the personal contact that such an oppiontment would provide.

For a first appointment with the care provider, respondents clearly stated that they did not feel the need to substitute the physical oppointment for a video consultation: only 6.7 percent would opt for a video consultation in that case. Our respondents also expressed a preferrence to discuss a treatment or bad news, such as a pathology result, face-to-face.

Patients prefer a video consultation when it comes to a monitoring appointment to discuss general progress or to discuss a result from which the patient expects good news. According to patients, a video consultation is of added value, especially in the follow-up after admission.

Satisfaction

We then tested the results of the survey in practice. We asked fifty patients whether they wanted to replace their physical outpatient appointment at the surgery of the Amsterdam UMC with a video consultation. This was a follow-up check-up appointment after admission to hospital. Out of the 50 patients, 21 (42%) opted for a video consultation. The video connection was done through the patient portal. The measured level of satisfaction of both the patient and caregiver was very high (3); both rated the video consultation with a score of 9 out of 10. The user-friendliness was rated as excellent. As many as 96 percent of the patients stated that they would use a video consultation again in the future. In the group that opted for the physical appointment, 38 percent said they still wanted to use a video consultation in the future. An additional advantage of the video consultation is that the patients have to travel less, which to some extend can have benneficial effect for the environment (1).

Deciding together

It seems that patients prefer the possibility of video consultation in hospitals. Not every appointment between caregiver and patient lends itself to being replaced by a video consultation, but it is also not necessary to travel to the hospital for every appointment. Provided it is medically sound, the patient should be able to decide more often what type of consultation (face-to-face, video or telephone) is to be arranged. This fits in with the current climate in which ‘deciding together’ is of paramount importance in the consultation room. However, this should be done so properly and safely via the secure networtk of the patient portal.

Recommendations

  • As a hospital, provide the possibilities for patients to have video contact with their primary caretaker.
  • For this purpose, arrange the embedding of the process and arrange responsibilities (management, agenda building, instructions).
  • Inform patients actively about this possibility.
  • Patient and caregiver decide together whether and when video consultation is a good alternative.
  • When the patient requests a video consulatation but this is not possible in that specific scenario, explain to the patient why.
  • Offer video consultations via a secure connection (e.g. a patient portal or a personal health environment).
  • Ideally, a consultation can be viewed via the patient’s own secure portal.
  • The healthcare provider discusses with the patient that general rules of conduct also apply to the video consultation (e.g. do not disseminate via social media).
  • Support patients and caregivers who would like to use a video consultation but need help with setting it up.

Authors

Esther Barsom, physician-researcher, Department of Surgery, Amsterdam Gastroenterology & Metabolism (AG&M), Amsterdam UMC

Anneloek Rauwerdink, medical researcher, Department of Surgery, AG&M, Amsterdam UMC

Dr. Marcel Heldoorn, manager digital care, Patient Federation Netherlands

Prof. Dr. Marlies Schijven, professor of surgery, programme leader Citrienfonds programme e-health NFU, AG&M, Amsterdam UMC