What is the effect of communication technology on the work of being a patient in orthopaedics?

Purpose

The purpose of this research was to systematically review qualitative papers reporting communication technology consultations (phone and videoconference) in orthopaedics. Attention was focussed towards the effect of communication technology on patient workload and how this might influence patient preferences.

Approach

The protocol for the systematic review was registered and is available to view on the PROSPERO database (CRD42018100896). MEDLINE, AMED, CINAHL, PsychINFO, SCOPUS databases were independently searched, utilising the search strategy, by two researchers to identify qualitative papers reporting communication technology use in an orthopaedics setting. Data from Introduction, Results and Discussion sections were extracted and an attribution of statements formulated. All statements were thematically analysed into families of themes surrounding the work of being a patient when using communication technology.

Outcomes

The search identified 1542 papers that were included for review and 8 full texts met the inclusion criteria and were included for analysis. Two studies reported telephone consultations and 6 reported real time videoconferencing consultations. Six families of themes were identified from the meta-synthesis:

1) Skills - what were needed, how they were gained, how they were enacted in practice.

2) Clinical Interactions - the impact of technology consultations on clinical interactions.

3) Environment - the location and resources required to engage with clinical rehabilitation.

4) Processes - how technology consultations affect routine clinical practice.

5) Impact on Patient - how technology consultations influence the experience of living with illness and engagement with clinical care.

6) Preferences - the potential patients see for technology as an alternative to routine face to face care.

These themes were then reconceptualised to explore how patient work influences preferences surrounding the use of communication technology in orthopaedics.  

Literature on the use of communication technologies in healthcare, such as videoconferencing and telephone consultations, is growing in orthopaedics. Qualitative papers highlight the benefits and challenges of communication technology consultations. This review synthesises the change in workload patient´s face when using these technologies. These altered demands of communication technology consultations affect patient´s experience of accessing healthcare and ultimately their preferences for technology use. Consideration of these factors and tailored individualised support for patients may enhance patient experience and increase suitability of communication technology consultations for orthopaedic patients.

Implications

The use of communication technology changes the work of being a patient. The appraisal of individual patient circumstances and consideration of patient workload is recommended to determine suitability of communication technology based consultations in an orthopaedics setting.

Top three learning points

  1. The use of communication technology changes the work of being a patient
  2. Knowledge of this change in work allows healthcare professionals to tailor support for patients
  3. Making access to communication technology ‘easier’ for patients may enhance satisfaction, acceptability and uptake of virtual consultations.

Fund acknowledgements

This research was funded by the HEE/ NIHR ICA Programme Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-025) awarded to Anthony Gilbert.

Additional notes

This work was presented at Physiotherapy UK 2019, presented at Physiotherapy Research Society (London) and World Congress for Physical Therapy 2019, Geneva.

The manuscript has ben accepted in BMJ Open: Gilbert, A.W., Jones, J., Jaggi, A. and May, C.R., 2020. Use of virtual consultations in an orthopaedic rehabilitation setting: how do changes in the work of being a patient influence patient preferences? A systematic review and qualitative synthesis. BMJ open10(9), p.e036197. https://bmjopen.bmj.com/content/10/9/e036197.full

 

Please see the attached Innovations poster below.

For further information about this work please contact Anthony Gilbert