Written by Dr Katie Stephens, GP
Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP).
A change to the healthcare provision landscape
We are all finding a ‘new normal’ with COVID-19 showing no real signs of abating just yet. For some people, this may involve working from home more, while for others it’s remembering the face mask alongside the keys, phone and wallet when they leave the house.
For many people, this means interactions with healthcare professionals look different than they did pre-pandemic. Given the risks of spreading COVID-19 with in-person appointments, doctors and allied healthcare professionals are consulting a majority of consultations now ‘remotely’, using video technology or phone calls to connect with patients rather than seeing them in their clinic or surgery.
What are remote consultations?
Remote consultations are any consultations that take place with the doctor and the patient in different locations. This can be through the NHS or privately, and could be a video or phone call. They are a very useful way of assessing and treating conditions that don’t necessarily need an in-person examination, such as cases of tonsilitis, waterworks infections, mental health reviews, and certain aches and pains to give just a few examples.
From an NHS GP perspective, in-person appointments now take up much more time than the typical pre-pandemic 10min slot. Prior to one of these appointments, NHS GPs now have to put on new PPE (Personal Protective Equipment – gloves, new mask, gown etc) and spend time screening the patient for a temperature and COVID-19 symptoms. They also have to clean any equipment used, the chair that was sat on, any parts of the desk that were touched etc afterwards, in order to reduce the risk of COVID-19 spread to the next patient or to themselves. Depending on the extent of any examination, this might take 5-10 min altogether per patient, which essentially results in a whole extra appointment slot per person getting eaten up. Conducting a greater proportion of consultations remotely, therefore, enables them to keep more appointments free for patient contact and cuts down on the time needed for the preparation and cleaning.
With the demand for GP appointments only going up (according to the RCGP, ‘in the nine weeks to the end of 2020 general practice delivered approximately 2.5m more appointments than in the same period in 2019’1), and the outbreak of new strains of COVID-19 such as the Omicron variant, the need for remote consultations will likely be around for some time.
Multiple private healthcare providers have been primarily working this way on a large scale even pre-pandemic. Patients often like the ease of being able to speak to a doctor from home without having to spend time and money travelling. Or they like being able to avoid the risk of catching an illness waiting in a crowded waiting room with other ill people.
Of course, there are important limitations and certain situations where an in-person examination is called for. For instance, if someone is acutely unwell, or particularly short of breath, or needs a hands-on examination. In these cases, there is vital information that can only be gathered in person, such as through listening to the chest with a stethoscope, clinically examining an abdomen for signs of serious inflammation, or looking in the ear with an otoscope. A good remote service will recognise these cases and appropriately direct people to seeking face-to-face attention, rather than try to treat outside of safe boundaries.
What is remote monitoring?
This is also being done more now than ever before, in part due to the increased use of remote consulting. The phrase ‘remote monitoring’ in a healthcare context generally refers to data gathering that is done somewhere other than the usual clinical setting. The data might include blood pressure, blood sugar, temperature, pulse (heart rate), height, weight or oxygen saturation.
Why do remote monitoring?
There are lots of reasons why someone may want to monitor part of their health from home. I will go into more detail around these in a future article, so I will just briefly outline a few here:
· Access difficulties
As outlined above, with the pandemic making in-person access to healthcare professionals more limited, more people are choosing to monitor their own conditions or data themselves. Whereas they may have previously had a nurse follow up appointment for a borderline blood pressure reading for example, they are instead getting their hands on their own machine and checking this at home and then passing on the data to the practice.
· Improving remote interactions
It can be very useful to know the oxygen saturation (what proportion of the blood has oxygen in it) of someone who has a cough and has felt a little out of puff, or the pulse rate of someone who feels as though their heart is racing, or the temperature of someone who wonders if they may be a little warm but isn’t sure if they have a fever or not. Getting more accurate data when consulting with a doctor remotely can help the doctor give better advice and may help save an unnecessary visit to A&E (or conversely might help prompt a necessary visit when needed!).
· Improving diagnosis of asymptomatic conditions
Did you know there are some 5.5 million adults in England alone who have high blood pressure (hypertension) without knowing it2? With hypertension being the third biggest risk factor in the nation for premature death and disability2, this means a huge number of people may be getting strokes, heart attacks or even dying from something that is treatable. Picking up an inexpensive machine and testing your blood pressure at home means you can hopefully pick up potential issues before they lead to any serious damage. Use our blood pressure tool3 to check if your reading is okay.
How can we do remote monitoring?
Depending on what you are wanting to monitor, there are a variety of options to choose from. Some GP surgeries have their own devices that they are able to lend out to patients. If this isn’t an option for you, or you’d rather not have to be on a waiting list, or you just want your own machine that you can hold on to, you can always purchase one yourself. The key thing to check when choosing a device is that the readings you get from it are reliable. Generally, this means ensuring that it has been approved by a regulatory body for accuracy.
Kinetik’s blood pressure devices have all been approved by the British Hypertension Society and also the European Society of Hypertension so you can trust that the readings will be accurate. The British Hypertension Society is the main organisation that provides recommendations for devices used in the UK. You can look up your device to see if it is on their approved list here4.
Wherever you purchase your device, the other factor to consider is how long it stays accurate. Over time, any machine can be liable to losing some of its accuracies. If your machine is quite old and you’ve not had it checked or recalibrated recently, chances are it may need replacing. Usually this is done every 12 – 24 months for best accuracy, depending on the manufacturer’s advice and your own needs.
How do we interpret results from remote monitoring?
I will cover this in more detail in linked articles to come over this month and next, but of course this depends on what it is you are monitoring.
For blood pressure, you can use our blood pressure tool3 to see where you stand. If you are using our blood glucose monitor, I expect you already know what your target should be and when to be concerned about particularly low or high readings, but you can check your knowledge against a handy summary table of nationally recommended levels here5.
Normal oxygen saturation levels depend on whether or not you have conditions that can affect your usual baseline, such as lung disease, as well as what altitude you are at, if abroad! As a rule of thumb though, levels at about 96% and above are considered ‘normal’ for most people. Of course, it shouldn’t be taken as a blanket reassurance, as depending on symptoms or activity level, further medical attention may still be appropriate. If you’d like further information about interpreting oxygen levels, the NHS has made a handy leaflet you can find here6.
And of course, there is always your NHS GP or 111 available if you have concerns and think you might need further medical advice.
It looks like remote consulting and remote monitoring are here to stay. Fortunately, their advantages of giving individuals more power to take control of their own health, and to manage their health from home, can only improve the way we view health monitoring going forwards, even when (and if!) that day comes when we can finally call ourselves ‘post-pandemic’.