Akpan, Asangaedem

Al-Refaie, A

Chauhan, Umesh

Cooper-Moss, Nicola

Hussain, Aqsa

Leung, WY

CLoK

What is the role of virtual community medicine for older people?Scoping Review and Clinic Data AnalysisSchool of MedicineLeung WY., Hussain A., Al-Refaie A., Cooper-Moss N., Akpan A., and Chauhan U.Background Increase in virtual consultations due to COVID-19.Minimise virus transmission in clinically vulnerableolder adults.This research has two components:1) Scoping review (ongoing)2) Analysis of data from a sample of virtual community medicine consultations for older patientsPreliminary findings:Virtual clinics associated with fewer appointmentcancellations and shorter waiting times (Murphyet al., 2020).Virtual consultations may not benefit everyone.This review therefore aims to identify the keyfactors to consider for virtual consultations andmap a broader range of clinical outcomes.Scoping review PRISMA-P and PICO frameworkFour databases: Medline, Embase, CINAHL and PsycinfoSearch terms combined: 1) Virtual care (31 terms)2) Older people (7 terms)• Patients ≥ 65 years old at any geographical locationP• Virtual community consultationsI• Face-to-face consultationsC• Clinical outcomes, factors affecting virtual consultation, satisfaction OExclusion Criteria:• Published >10 years ago• Non-English• Non-human• No data on virtual consultation method • Inpatient services only• Intervention NOT for patients (i.e. carers only)PRISMA FlowchartIdentificationScreening6231 papers identified from four databases2776 papers for title screening1220 papers for abstract screeningExcluded by automation tools (n=1302)Duplicates (n=2153)1556 papers excludedOngoing Review• Broad research question• Rapidly evolving and emerging research area• Recent increase in the use of virtual technology due tothe COVID-19 pandemic• Mapping of wide range of intervention approaches and outcomes • Identification of a focus for subsequent systematic reviewWHY a scoping review?Virtual clinic data resultsTable I: Demographic and medical characteristics (n=100)Gender distributionFemale: 43Male: 57Mean age 81.04Mean waiting time 8.9 days Mean time for clinic letter to get to the GP 1.6 days Mean IMD score 25.10 (quintile group 4)Mean no. of medications 8.16Mean no. of past medical conditions3.19Most common referral reason Neurology problemsMin: 0 daysMax: 34 daysMin: 0 daysMax: 12 daysClinic’s efficiency• The average waiting time meets the self-imposed standard(14 days) but not the letter sending time (24 hours).• Most patients live in L30 and the clinic is based in L21.Virtual approach may have saved travelling time and costfor both patients and clinicians.Deprivation• Average IMD score is within the quintile group 4.• Comparing to the report by Liverpool Council (2019), theIMD score of the patients in this clinic is similar to theNorthwest area and lower than the Liverpool City Region.• Patients are living in more deprived areas when comparednationally.• Higher proportion of patients from more deprived areaswaited over 2 weeks to be seen than that of the those inless deprived areas.Analysis:Polypharmacy issues• 80% of patients had polypharmacy (≥ 5 medications)• More than half of the patients that are over 65 take morethan 8 medications- a fivefold increase of what NHS Digital– Health Survey for England (2016) suggested.0%10%20%30%40%50%60%70%80%90%100%Mild Moderate SeverePercentage of unplanned hospitalisation in different levels of frailty Without hospitalsation With hospitalsationHospital admissions post virtual consultation• Frailty: 50% of patients with severe frailty compared to only29% of patients with mild frailty experienced unplannedhospitalization.• Age: Increase from 20% to 41% in patients aged >80 years• Polypharmacy: Increase from 18% to 66% in patients withpolypharmacy.• Deprivation: Patients with unplanned hospitalisation livedin areas with a higher IMD score than those who were nothospitalised.Graph I: Unplanned hospital admissions according to frailtyDiscussionLimitationsSample size: 314 new patients were seen in total during the timestated. 100 patients were included in this sample.No comparison data: Absence of data when clinic runs face-to-face. Remaining uncertainty on whether patient outcomeshave improved or worsened due to the new approach.Limited breadth of data: Unable to determine how the clinic benefits from avirtual approach.Recommendations for further service evaluationData from the clinic:I. Clinician’s experience of virtual approachII. Evolution of diagnosis certainty levelIII. Any appointment duration differenceData from patients:I. Patients’ satisfaction on virtual consultationII. Patients’ education level and technology literacyIII. Virtual modality preference (video/telephone)IV. Role of family/carer supportConclusions• Data and papers from the review suggested that factors such as age, frailty level, social economic status and technology literacy should be considered when deciding if a virtual approach will benefit patients.• Additional data and comparison data is required in order to fully evaluate the impact of virtual consultations in older patients. References:Fang, M., Siden, E., Korol, A., Demestihas, M., Sixsmith, J. and Sixsmith, A., 2018. A scoping review exploration of the intended and unintended consequences of eHealth on older people: A health equity impact assessment. Human Technology, pp.297-323.NHS Digital. 2016. Health Survey for England, 2016 - NHS Digital. [online] Available at: <https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/health-survey-for-england-2016> [Accessed 5 August 2021].Liu, L., Goodarzi, Z., Jones, A., Posno, R., Straus, S. and Watt, J., 2021. Factors associated with virtual care access in older adults: a cross-sectional study. Age and Ageing,.Murphy, R., Dennehy, K., Costello, M., Murphy, E., Judge, C., O’Donnell, M. and Canavan, M., 2020. Virtual geriatric clinics and the COVID-19 catalyst: a rapid review. Age and Ageing, 49(6), pp.907-914.Liverpool.gov.uk. 2019. The Index of Multiple Deprivation 2019 - A Liverpool analysis. [online] Available at: <https://liverpool.gov.uk/media/1359213/imd-2019-liverpool-analysis-main-report.pdf> [Accessed 12 August 2021].Deprivation: • Costs of accessing the internet and purchasing a digitaldevice can be a burden for patients (Fang et al., 2018).• A possible cause of extended clinic waiting time.• Devices may need to be provided to the patientsEducation Level:• Technology literacy may hinder patients to use digitaldevices.• Educational support may be needed.Virtual consultation modalities:• Presence of carers’ support may affect patients’preference on using a video-based or telephone-basedassessment (Liu et al., 2021).Risk versus benefit:• Those with higher degrees of frailty and complexitytend to be at much higher risk of hospital attendancedespite virtual interventions.• Living in a more deprived area may also be associatedwith higher hospital admission rates.• Social determinants of health and wellbeing cannot beomitted.• Health and social care could provide additional means ofmonitoring these higher risk individuals continuously(e.g., self/remote monitoring).Sample of 100 new virtual community medicine consultations from April 2020 to March 2021 in Litherland, Liverpool.Convenience sampling of 8-10 patients per month (EMIS records).Analysis on IBM SPSS software (version 27).Categorisation of dataVirtual clinic data analysis

What is the role of virtual community medicine for older people?

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What is the role of virtual community medicine for older people?

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