Building the evidence base on video consultations Three priorities for further research

The rapid implementation of video consultations across the NHS has been a striking feature of the COVID-19 pandemic. Health care professionals, leaders and policymakers are now reflecting on the learning from this period, and the role video consultations may play in patient care in the future. As they do so, it’s vital that they are able to call on timely, relevant, high-quality research. In this blog, we discuss the state of the evidence base on video consultations and set out some priorities for future research, based largely on the insights from Q’s collaborative learning and sharing project on implementing video consultations.

The state of the existing evidence base

There is a growing body of research from across the world on the use of video consultations (see the appendix at the end of this blog for a selection of recent articles). However, many of the studies have been short-term pilots involving a small number of people with very selective inclusion criteria. While these studies confirm the feasibility and acceptability of video consultations as an alternative or addition to face-to-face consultations – certainly for patients, and, to lesser extent, professionals – they show some major research questions remain only partially answered, if at all. The strengths and limitations of the evidence base are examined in Ignatowicz’s ‘review of reviews’, Mold’s review of e-consultation methods in primary care, and Greenhalgh’s editorial on how video consultations can be used during the COVID-19 pandemic.

Three priorities for further research

1. Can video consultations provide the same quality of communication as face-to-face consultations?

We need to understand more about how professionals and patients communicate during video consultations, and the extent to which it differs from face-to-face communication.There are some useful studies on this topic – examples include an Australian study on bodily communication during physiotherapy video consultations, and another on the interactional dynamics of video consultations by a team from Oxford – but there is undoubtedly room for more. This evidence will be particularly valuable in relation to the design of training and professional development focused on the delivery of video consultations.

2. Which patient groups will benefit most – and least – from video consultations?

We also need more evidence on the clinical circumstances in which video consultations are and are not appropriate. So far there has been a lack of data to show a change in patient outcomes. While some impact data is emerging, it has limitations. Although many studies point to high levels of patient satisfaction with video consultations, this may say more about the value that patients attach to their convenience and accessibility, than about the quality of the consultation itself. Another challenge is that almost all our evidence comes from patients considered suitable for video consultations who have the means and motivation to take part in them, rather than those who cannot or choose not to. This limits our ability to understand the impact of their rollout on health inequalities.

Furthermore, in the pre-COVID world, some hospital outpatients began with a face-to-face consultation, before shifting to video for any routine follow-up appointments. This illustrates  another crucial research question, namely: what is the right balance between virtual and face-to-face consultations? Answering this question will help patients and professionals decide when to go virtual and when to meet in person (once the latter is possible on a routine basis) and it will help managers and system leaders work out how to develop and resource flexible pathways that incorporate both formats.

3. What solutions are needed to support video consultations in the long-term?

A major risk is that, due to the speed at which video consultation services have been set up in response to COVID-19, they may have been put in place on ‘shaky foundations’ without integration with existing pathways, processes and working practices, or the necessary digital and physical infrastructure in place to support this mode of working at scale.

Furthermore, there were short-term fixes to matters relating to information governance, financial incentives and performance targets. We need to understand what solutions are needed to support this as a long-term change, and provide organisations and teams with support and guidance to inform their ongoing implementation and set it – and them – up for success.

Applying learning from the rapid scaling of video consultations to inform future work on innovation in health care

Our health services have dealt with unprecedented challenges over the last few months. The energy and commitment that staff at all levels of the system have given to the pandemic response – not least in the rapid work to implement and scale video consultations – has been a silver lining of this time. As we build on the evidence base around the use of video consultations and how to embed this as a sustainable change, we need to look at what can we learn from how this rapid response was enabled, and at any differences in the national and regional response.

We have commissioned research to develop the evidence base and explore some of these questions. For more information about this research visit the project webpage.

Bryan Jones is an Improvement Fellow at the Health Foundation.

Jo Scott is Insight Manager at the Health Foundation.

Appendix: A selection of peer reviewed articles on the use of video consultations

Video consultations enable patients and service users to have a consultation with a health professional using the video camera in a smartphone, tablet or computer.

Tools and systems used in video consultations include:

• Attend Anywhere
• Skype
• Whatsapp
• Facetime
• ACCURX
• SystmOne