Telemedicine: Every light has its shadow

Especially during the pandemic, digital health may enable a more focused assessment of heart failure (HF) patients. However, experience has shown that healthcare providers often feel difficulties in establishing a connection, especially with new patients.

Prior to the COVID-19 pandemic, there were very few telemedicine clinics for HF. “Social distancing measures and increased demands on health services resulted in a shift to ‘remote by default’ clinic appointments in many organisations across Europe,” explained Dr Arvind Singhal (Royal Brompton Hospital, UK) [1]. Digital health, focusing on teleconsultation, remote monitoring, and apps and wearables, can be used to support HF care and improve outcomes [2].

Dr Singhal presented clinician experiences of telemedicine from 16 March 2020 to 15 March 2021 at the Royal Brompton Hospital. During this time, there were 2,725 HF clinic appointments, and 99% of them were by telemedicine. The investigators interviewed 8 clinicians: 4 HF consultants, 3 HF specialist nurses, and 1 training-grade doctor. In these interviews, 4 key themes emerged:

1. 
   
   1. time management,
   2. information gathering,
   3. rapport and relationships, and
   4. choice and flexibility.

“Teleconsultations resulted in a more focused assessment and less time between appointments,” Dr Singhal explained. Clinicians also felt less guilty to keep consultations brief as patients had not travelled to their appointments. On the other hand, this advantage was offset by the longer preparation time.

The second theme that emerged was information gathering. Without physical examinations, clinicians relied more on history and objective data such as test results or imaging. Video consultations were perceived as superior to telephone consultations for assessing patients due to the ability to pick up visual clues. “Examination of oedema was possible with video but more difficult and less reliable than in-person assessment,” Dr Singhal said.

Telemedicine also changed the relationship between clinicians and patients. Clinicians experienced difficulty establishing rapport with new patients by telephone. Video was better than telephone, but clinicians still felt the lack of human connection that one experiences when meeting people face-to-face. Regarding choice and flexibility, clinicians expressed fear of a ‘one-size-fits-all’ approach for future delivery of care.

Finally, all clinicians felt that telemedicine consultation will continue to play a major role as they are more convenient for patients but patient´s choice is essential. Taken together, telemedicine HF consultations were acceptable for healthcare providers, but changed the workflow, consultation dynamics, and how clinicians establish a relationship with the patient.

1. 
   
   1. Singhal A, et al. Clinician experiences of telemedicine heart failure clinics: The VIDEO-HF study. P61068, Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.
   2. Singhal A, Cowie MR. Card Fail Rev 2021;7:e08.

 

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Posted on 19 August 202120 August 2021