How I built my confidence with Remote Reviews
Following the results of the National Review of Asthma deaths and the National COPD report, I was tasked by the cluster I work within to begin conducting respiratory reviews within Primary Care, with the aim of improving both management and care of respiratory patients. Initially these reviews were face to but due to the rapid spread of the Covid pandemic across the UK these had to be curtailed.
It soon became apparent that COVID-19 was 'here to stay' and new ways of working would need to be considered, established and implemented with adaptations to our delivery style. When I realised, I was going to have to deliver 'remote reviews’, I was extremely nervous as I was really unsure about how it was going to work. Like many of you, all my previous experience had been face to face, using established practices such as visual cues, the ability to physically examine patients, and the opportunity to observe their inhaler technique. Understandably, the prospect of doing all of this 'remotely' was an extremely daunting one.
Fortunately, there were many additional resources available to help with this new anticipated way of working. The PCRS webinars were a particularly valuable resource and I found the contributions of Bev Bostock, Katherine Hickman and Mark Levy significantly helped increase my knowledge base. During these webinars they shared techniques that we could use to conduct these reviews successfully as well as highlighting pitfalls to avoid.
From my limited experiences I do not profess to be an expert in this delivery style but can reflect that these routine 'remote reviews' appear to be as successful as face to face reviews yielding really great results.
With most of my patient group I now feel as confident delivering remote reviews as I do face to face. There are of course some patients that I would prefer to review face to face such as children and those who are acutely unwell as they do not fall into the remote review cohort well.
Interestingly with these reviews I have experienced a greater 'patient centred' arena, with the bance of power lying with the patient. As the patient is no longer sat in our consulting rooms where we hold ‘all the information’ the patient can sit comfortably at home and the conversation appears more 'natural' on the telephone.
I have also experienced an apparent increased accessibility to patients for these remote reviews particularly within the COPD patient group due to their subsequent reduced mobility as well as those who it was necessary to shield due to the Covid response strategy of lockdown.
Aim of Reviews
Ultimately the aim of these reviews is to ensure the patients are optimised to the best possible care. For asthma this is good asthma control and for COPD this is reduced symptoms, reduced exacerbations and reduced hospital admissions. See my other article for more information on how I structure these reviews, including how I go about changing inhalers remotely.
My overall aim at the end of the review is that the patient will leave with a clearer understanding of their condition, how to self manage it pharmacologically and non-pharmacologically, as well as a clearer understanding of the aims of their individual treatment plan including details on why they have been prescribed each particular medication. In doing so I hope that this increased level of understanding and education will empower them to self-manage their condition thereby reducing unscheduled appointments with GPs, A&E attendance and hospital admissions.
From my experiences to date I have observed that there appears to be a knowledge gap for patients when self-managing their long-term health conditions and feel that increased public health education provision is the key to reducing this gap. Whether this is done in a ground consultation, a virtual consultation or face to face there are benefits and financial elements for the NHS if this is achieved effectively.
Patient Feedback from Remote Reviews
Patient feedback is an important and necessary part of my work with the cluster. Patient feedback is achieved by completion of a 'questionnaire'. The results seen to date have been positive with benefits seen to patients, practices and the cluster.
The necessary changes to practice delivery due to Covid resulted in a fast change to long term condition reviews. These 'virtual reviews' have been positively received by patients and appear to be offering similar outcomes to historic face to face reviews. This offers the viewpoint that it is potentially unlikely that a return to the 'standard' face to face review 'one size fits all' approach will occur. I expect a blended approach of a 'virtual review' followed by face to face if any serious problems are identified will be the norm of the future.
Three Top Tips
- Listen to the patient- Ask open questions - this empowers them to share their personal history and story of their symptoms
- Involve the patient in the decision making - Explain the physiological effects vs their symptoms and treatment, empowering them to effectively self-manage their own condition
- Don’t forget non-pharmacological treatments- Address these first – once these are sorted move on to optimising medications