A study into the benefits of GP video consultations has warned against rolling out the technology in Scotland until the technical problems can be fixed.
Based on a pilot scheme at six GP practices in the Edinburgh and Lothians region, the study found that web-based video communication had the potential to save both patients and doctors a significant amount of time.
The trial is the largest of its kind to date in Scotland, with a total of 45 patients aged 22 to 76 participating. Participants were chosen to represent a range of list sizes, varying rurality and patient demography.
Using the ‘Attend Anywhere’ digital platform, people were able to attend consultations without having to take time off work. One patient said the technology had helped him avoid a three-hour round trip from his work to the GP’s surgery. Instead, he was able to communicate with his GP via the platform while at his office.
An agoraphobic patient reported she felt a lot calmer about having a video consultation, which she said was much easier because “my stress levels weren’t sky high”. In the past, she had often cancelled her GP appointments because she could not face leaving the house.
Despite positive results, clinicians have warned against the roll out of the technology until technical issues have been resolved and it can be integrated with the existing NHS computer systems.
Technical problems included time lags and poor audibility. “Problems with the technology sometimes disrupted the consultation process,” wrote the study authors.
“A number of VCs had to be transferred to telephone because of these disruptions. Clinicians reported feeling awkward when issues such as the video freezing on their or the patient’s screen or poor audibility occurred.”
In addition to the technical hiccups, GPs said they felt that video consultations were not appropriate to deliver bad news or discuss more sensitive health issues.
One clinician quoted in the study anonymously said: “When holding of a hand [is needed], giving of tissues, sharing the cancer diagnosis.
“You are still quite removed at the end of a video line and heaven forbid if the technology were to let you down, that would be just ghastly.”
Although patients would save time by avoiding travel and house-calls, they would not necessarily see the doctor on time, with some finding themselves in a “virtual waiting room”. One patient said he was anxious in the virtual waiting room in case he had not configured his device correctly.
A doctor added: “The virtual waiting room was a good idea but the slightly awkward thing is I don’t know whether they [the patient] can see if you’re running behind.
“When you’re in a [surgery] waiting room, you can see other people coming and going.”
Compared to over-the-phone consultations, doctors said that video was more “formal and focused”. It enabled them, they said, to pick up visual clues from body language and facial expressions.
While face-to-face consultations were rated the most effective method, doctors said that video communication would be very useful for “psychiatric consultations where formal physical examination is not required” and in “chronic illness management, blood test results, and medication reviews”.
Funded by the Scottish Government’s Chief Scientist Office, the research was led by Edinburgh University in collaboration with the universities of Essex and Warwick.
Professor Brian McKinstry, of the University of Edinburgh’s Usher Institute, said: “Our study showed that there is real potential for video-consulting particularly for conditions where a visual examination can be helpful for example when assessing people who have problems with anxiety and depression and have difficulty getting to their general practice.”