Abstract
ObjectiveTo evaluate the impact of using a ‘virtual clinic’ on patient experience and cost in the care of women with urinary incontinence.Materials and methodsWomen, aged > 18 years referred to a urogynaecology unit were randomised to either (1) A Standard Clinic or (2) A Virtual Clinic. Both groups completed a validated, web-based interactive, patient-reported outome measure (ePAQ-Pelvic Floor), in advance of their appointment followed by either a telephone consultation (Virtual Clinic) or face-to-face consultation (Standard Care). The primary outcome was the mean ‘short-term outcome scale’ score on the Patient Experience Questionnaire (PEQ). Secondary Outcome Measures included the other domains of the PEQ (Communications, Emotions and Barriers), Client Satisfaction Questionnaire (CSQ), Short-Form 12 (SF-12), personal, societal and NHS costs.Results195 women were randomised: 98 received the intervention and 97 received standard care. The primary outcome showed a non-significant difference between the two study arms. No significant differences were also observed on the CSQ and SF-12. However, the intervention group showed significantly higher PEQ domain scores for Communications, Emotions and Barriers (including following adjustment for age and parity). Whilst standard care was overall more cost-effective, this was minimal (£38.04). The virtual clinic also significantly reduced consultation time (10.94 minutes, compared with a mean duration of 25.9 minutes respectively) and consultation costs compared to usual care (£31.75 versus £72.17 respectively), thus presenting potential cost-savings in out-patient management.ConclusionsThe virtual clinical had no impact on the short-term dimension of the PEQ and overall was not as cost-effective as standard care, due to greater clinic re-attendances in this group. In the virtual clinic group, consultation times were briefer, communication experience was enhanced and personal costs lower. For medical conditions of a sensitive or intimate nature, a virtual clinic has potential to support patients to communicate with health professionals about their condition.
Highlights
One initiative to improve the efficiency and accessibility of outpatient care has been the implementation of ‘virtual clinics’
No significant differences were observed on the Client Satisfaction Questionnaire (CSQ) and Short-Form 12 (SF-12)
The virtual clinical had no impact on the short-term dimension of the Patient Experience Questionnaire (PEQ) and overall was not as cost-effective as standard care, due to greater clinic re-attendances in this group
Summary
One initiative to improve the efficiency and accessibility of outpatient care has been the implementation of ‘virtual clinics’. Virtual clinics have been advocated for non-complex cases and have been implemented for the management of new [2] and follow-up patients [3,4] and for different specialties in both primary [5,6] and secondary care [7,8]. The format and delivery of a virtual clinic varies widely depending upon the technology deployed including telephone [9], online web sessions [6] and Skype [5]. Previous research in primary and secondary care has established the psychometric properties of the instrument [11,12,13] and the system architecture for which enables patients to securely and anonymously complete a detailed, interactive web-based assessment
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