The hybrid model of medical consultation

Are we entering a brave new world for healthcare access?

Agrowing concern amongst all health professionals is how the Covid-19 pandemic continues to erode the rest of healthcare. Hospital waiting times, never in the best of health, have skyrocketed with the recurrent curtailment of operating theatre time as ‘regular’ ICU beds are occupied with the latest wave of Covid patients.

A number of hospitals are having to cancel more routine investigations and treatments each week, according
to the HSE. And of course, preventive medicine activities take an inevitable back seat as the acute needs of the system take over.

The issue has begun to appear on conference agendas also. I see the National Institute for Prevention and Cardiovascular Health (NIPC), in its recent annual meeting, had a keynote session titled ‘The era of pandemic consequences in cardiovascular health: Are we facing a crisis in prevention?’ When you add in the recent derailment of Sláintecare to the Covid equation, there are definite storm clouds brewing for proactive medicine.

All of which makes the recently published results of the annual Pfizer Health & Science Index even more interesting. It found that one-in-five people are worried that they could have missed out on a diagnosis and treatment due to the pandemic, with around 50 per cent of respondents either cancelling medical appointments or missing scheduled appointments.

Hospital-initiated cancellations were higher among older age groups with 28 per cent of over-65s having a hospital
appointment cancelled compared to 16 per cent of 25-to-34- year-olds. Meanwhile, just over one-in-10 adults did not seek treatment despite feeling unwell during this period.

Even though people were, in general, less worried about visiting a hospital compared with 2019, almost one-fifth of
respondents were still very or quite worried about being in a hospital environment. Tellingly, some 43 per cent of people believe they have experienced a negative health implication of the pandemic, with mental health, diet and weight, and a lack of exercise, the main areas of concern.

The research, carried out on a nationally representative sample of 1,052 adults, also shows that people are anxious
about their long-term health and the prospect of developing a variety of serious illnesses in the future, with cancer the
most significant concern.

But the health service’s capacity to see these people remains a huge constraint. Is there anything we have learned from Covid-19 that could be used to change how we process patients? After all, there is general agreement that society cannot return to the old normal; can we construct a new normal for how we access healthcare?

Just as no-one expects to return full-time to their place of work in the future, with hybrid working arrangements the likely new reality for workers, let’s change our modus operandi in health. Outpatient clinics in particular need a major revamp. They are surely ripe for a telemedicine takeover.

An indication of the possibility of productive change emerged from some summer research carried out in the UK by the health booking app, MyGP. It concerns male patients and found that 82 per cent of those surveyed said they are now more inclined to seek a medical opinion, because they can do so remotely.

According to the study, before Covid-19, the main reasons men put off seeking medical advice were mainly associated with having to physically attend a clinic or surgery and present symptoms to a clinician (65 per cent). The main barriers were awkward conversations with reception staff (29 per cent), undressing or an awkward silence in the waiting room/seeing other patients (both 15 per cent).

Additionally, another major reason why men put off seeking medical advice was lack of flexible appointment times around their office working hours (55 percent of respondents). The findings suggest an open goal awaits those who reorganise their service and create a hybrid model of consultation. To begin with, all repeat visits to an outpatient clinic should be by some form of telemedicine.

Next, why not make initial assessments of new patients online, using a form of triage to allocate subsequent in-person visits? It strikes me the possibilities are endless. What do Mindo readers think?