key: cord-0724668-8q0o3hvq authors: Lavery, Michael Joseph; Phillips, Derrick; Yip, Vincent; Azurdia, Richard; Thompson, Ben title: Survey to evaluate the patient experience of virtual telephone consultations during the COVID-19 pandemic date: 2020-11-25 journal: Clin Dermatol DOI: 10.1016/j.clindermatol.2020.11.004 sha: c1db330ff2cb90280cbf4dd597ec28a8d6658a3f doc_id: 724668 cord_uid: 8q0o3hvq nan Keywords: COVID-19, virtual consultation, patient satisfaction To the Editor: The COVID-19 pandemic has resulted in significant morbidity and mortality and devastated healthcare systems around the world. 1 Public health guidance advocating social distancing means alternative models of delivering healthcare are required to reduce footfall and face-to-face consultations to minimize the spread of contagion. 2 Our dermatology department is based within the United Kingdom National Health Service and serves a population of 630,000 people. Following lockdown ,we had to rapidly convert face-to-face consultations to telephone appointments, while concurrently developing a teledermatology service. We sought to capture the patient experience and outcomes of telephone consultations through performing a patient survey. Patients were eligible for the survey if they received a telephone consultation between June 1 st and June 5 th 2020. A resident, who was not part of the direct care team, phoned the patient at least 48 hours after their telephone appointment to participate in the survey. If patients agreed, a survey proforma was completed. All patients had a confirmed dermatologic diagnosis from a previous clinic visit and were called to assess the status of their condition. An example included a patient with plaque psoriasis, stable on oral methotrexate, who had no side effects or disease flare along with a recent satisfactory blood test result. In total, 60 patients completed the survey, with a response rate of 92%. Demographics and clinical characteristics are outlined in table 1. The mean age of participants was 54.4 years and 62% of participants were female. The majority of patients were recruited from general clinics (73%) with the remaining from specialist clinics. The most common dermatologic diagnoses were psoriasis (32%), atopic dermatitis (18%) and non-melanoma skin cancer (10%). Virtual telephone consultations were conducted by a range of healthcare professionals including attending physicians (50%), residents/interns (38%) and nurse practitioners (12%). Table 2 outlines the outcomes for patients who received a telephone consultation. Overall, 93% of patients were very satisfied or satisfied. One subject was dissatisfied and reported feeling confused after the phone consultation. All patients were happy to discuss medical problems over the telephone. A small proportion of patients were requested to attend the hospital for further investigations (15%) or were issued a prescription (17%) following the telephone consultation. One patient was asked to forward an image of the eruption, electronically. There were no urgent face-to-face consultations as a result of the telephone appointment. The majority of patients (78%) supported future telephone consultations. The global COVID-19 pandemic has brought challenges to the way dermatology services are delivered, while offering opportunities to deliver novel approaches to patient care. Our survey has demonstrated that patients are comfortable with the remote telephone consultation format, and in the majority of cases, would welcome its use beyond the pandemic. Only a small number of patients were required to attend the hospital after telephone consultation, and the clinician workload was not significantly increased. In addition, the dermatology team were content with this new patient consultation service. There are limitations to telephone consultations, as dermatology is both a visual and tactile specialty. There are potential concerns around privacy and confidentiality with photography and electronic communications. 3 In our department, telephone consultations have been especially useful for the management of patients with chronic conditions and who are stable on treatment. Lack of visualization meant it was ill-suited to skin cancer clinics. Our findings complement those of a recent study from Yale, whereby a teledermatology service was amenable to common dermatoses e.g. atopic dermatitis and acne vulgaris, with full skin examinations being less suitable for this consultation modality. 4 Another recent study from as China has shed light on some of the pitfalls with telephone consultations for patients with dermatomyositis. 5 In the Chinese study, adjustments to treatment regimens caused undesired side effects including liver function test derangement and leg edema. An unwanted degree of psychologic distress was noted in patients concerned about disease progression, particularly in those with associated malignancy or interstitial lung disease. A faceto-face consultation was required in 65% of patients; however, no patient desired a further telemedicine consultation. The differences observed between the telephone consultation model and the video teledermatology service in the Yale study may reflect the different dermatoses surveyed. It could also reflect a cultural difference in acceptance of a telemedicine consultation model. A limitation in our study may be that the review of the telephone consultation spanned a short time frame of five days, with a resultant relatively small sample size of 60 patients. It is possible that a larger sample size may have highlighted more dissatisfaction. Conversely, it may have further confirmed high satisfaction with telephone clinics. As the pandemic progresses ,telephone consultations have become a useful adjunct in the management of dermatology patients whilst infrastructure is developed for more advanced teledermatology. Were you happy to discuss medical problems over the telephone? 60 0 Did the telephone consultation address your concerns? 54 6 Did the telephone consultation lead to photography and further electronic communication? 1 59 Did the telephone consultation result in a face-to-face consultation? 0 60 Did the telephone consultation lead to a prescription? 10 50 After the telephone consultation did you have to visit the hospital for further investigations? Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study Virtual health care in the era of COVID-19. The Lancet Telemedicine in dermatology: findings and experiences worldwide -a systematic literature review Teledermatology in the era of COVID-19: Experience of an academic department of dermatology Management Strategies of dermatomyositis during the Outbreak of Novel Coronavirus Disease (COVID-19)