Exploring the impact of digital remote care

The COVID-19 pandemic has been the greatest public health challenge of our time, and across many countries, primary care has been at the front line of responding to this crisis. Worldwide, digital-first approaches (telephone, video, online) became the preferred route of contact during the crisis. In England, practices have moved from having around 95% of their consultations face-to-face, to over 85% taking place ‘remotely’, via phone or video link.

Understanding doctors’ and patients’ perspectives may offer evidence as to the actual impact of virtual care models on quality, safety and equity of care - or about the lessons learned to deliver safe, high-quality virtual care in the post-pandemic future. This is what our international InSIGHT programme is seeking to do.

The inSIGHT study is an international project that aims to evaluate the impact of COVID-19 on the use of virtual primary care.

Find out more about the project’s areas of work below.

Digital tech in primary care

Working internationally and led by the Institute of Global Health Innovation at Imperial College London, the project aims to collect the perspectives of general practitioners on how COVID-19 has impacted the use of digital technologies in primary care. The project involves a team of more than 25 investigators across 20 countries. Read the study protocol here.

What are the aims of the project?

The project aims to understand the determinants and effects of the adoption of digital-first technologies (telephone, video, online), as an alternative to face-to-face appointments in primary care, during the COVID-19 pandemic. We listened to the voices of general practitioners and want their perspectives to reshape primary care for the better.

What have we found?

Early findings from the inSIGHT project suggested that virtual delivery can have a positive impact on quality and safety of care. We have surveyed more than 1,600 General Practitioners from 20 countries. The majority acknowledged a positive effect on the delivery of preventive care and acute care, identification of patients that need escalation of care, and on improving communication and patient satisfaction. Click here to read our pre-print report. 

Secondary care

The inSIGHT project has been expanded to include perspectives on digital tech in secondary care (urgent and planned care in the hospital or community). This work will include a thematic analysis of the main benefits and challenges of adopting digital-first technologies in secondary care.

What are the aims of the project?

This study examined patients’ perspectives on the main benefits and concerns with using digital health services in a large multi-site teaching hospital in North-West London during the COVID-19 crisis.

What have we found?

Patients report many benefits with digital health services beyond immediate COVID-19 support, including improved access, timeliness, and enhanced healthcare capacity. Yet, some concerns remain, including some less-addressed problems such as the more fundamental impacts on clinical effectiveness and the patient-doctor relationship. These large-scale and patient-driven insights can inform the major areas to be addressed in future research and practice.

Patient perspectives

Working in partnership with YouGov, we also evaluated the perspectives of members of the public on how COVID-19 has impacted the use of digital technologies in primary care.
Understanding patients’ perspectives of the use of these technologies may offer evidence as to the actual impact of digital-first models on quality, safety and equity of care - or about the lessons learned to deliver safe, high-quality digital-first care in the post-pandemic future.

What are the aims of the project?

This project aims to evaluate the impact of the adoption of digital-first technologies by patients for primary care access. As secondary aims, we evaluated the patient experience and the perceived impact on quality and safety of care.

What have we found?

We have surveyed 6,300 members of the public across four countries (UK, Germany, Italy and Sweden).

Our published findings indicate a stark increase in the use of remote care technologies in Primary Care during the COVID-19 pandemic in the UK and Italy. This sharp rise contrasts with usage in Germany and Sweden, which were found to remain more conservative in triaging patients to virtual care. These differences may reflect the respective health policy landscape in each country, underscoring the potential of lessons to be gained from inter-country comparisons. We also found that the COVID-19-driven shift towards virtual care has led to perceived improvements in timeliness and efficiency of healthcare. Click here to read our publication. 

Safety checklist development

With the growing adoption of digital remote care, it is critical to develop tools to identify, prevent and mitigate the safety risks associated. Over the last decades, health care professionals have often developed safety checklists to improve patient safety and reduce harm. Checklists can help to reduce errors caused by lack of information and inconsistent procedures and can have a significant positive impact on patient health. However, checklist development often lacks input from members of patients and carers.

Being at the centre of care, patients and carers have the potential to identify safety issues different to those identified by researchers and health professionals, and their perspective is critical to collectively define risks and ways of mitigating harm. To date, no safety checklist has been developed for remote care.

What are the aims of the project?

This project aims to develop a checklist to improve patient safety when using digital remote technologies in primary care. The study will first identify and map patient safety risks associated with remote care, based on the perspectives of patients, carers, healthcare providers, and researchers. We will then use this information to develop a checklist that can identify and mitigate these risks in practice. This checklist will be designed as a “shared guide” to be used both by patients, carers and providers.