Our qualitative study had two main aims. First, to explore the experiences, feelings and expectations of patients who received care through either a virtual or traditional fracture clinic. Second, to understand clinician decision-making and willingness to refer patients with simple fractures to a virtual clinic.
This study was nested within a randomised trial (RECITAL) which evaluates a virtual clinic compared with a traditional clinic for people with simple fractures. Patients were purposively sampled to participate in a qualitative interview, based on their age, employment status, type of injury, and type of clinic attended. Clinicians were doctors, physiotherapists, or nurse practitioners with recent experience managing patients with simple fractures in the emergency department, fracture clinic, or primary care. The Theoretical Domains Framework guided development of the interview guides. Audio recordings of the interviews were transcribed verbatim. Data were analysed thematically based on Braun and Clarke’s six-phase framework.
We interviewed 30 patients (15 traditional, 15 virtual) and 30 referring clinicians (21 doctors, 8 physiotherapists, 1 nurse). Patients ranged from 18 to 82 years old, with fractures of the ankle and elbow being the most common injury. Clinicians worked in various departments (13 emergency department, 15 fracture clinic, 2 primary care). Patients using the physiotherapist-led virtual clinic reported the clinic was more convenient and accessible. However, some participants did not feel as engaged compared to seeing an orthopaedic doctor at the traditional clinic. Patients at the traditional clinic felt reassured that a doctor was able to physically assess them, however they stated the consults were too brief. Patients at both clinics reported that receiving information about their injury and recovery was important. When referring patients to a virtual clinic, clinicians reported considering the fracture type, prognosis and risk of complications, and patient access and ability to navigate technology. The type of clinician providing care (orthopaedic doctor vs physiotherapist) did not influence clinician decisions to refer.
A physiotherapist-led virtual fracture clinic was acceptable and convenient for patients who have sustained a simple fracture. Patients who valued a physical examination by a doctor, especially for more serious injuries, preferred a traditional in-person clinic. Referring clinicians were confident that simple fractures can be managed well by physiotherapists through a virtual clinic. Future studies could investigate clinician experiences providing follow-up fracture care through a virtual clinic.
Physiotherapy-led virtual fracture clinics can provide an alternative method to receive follow-up fracture care, but this cannot fully replace traditional fracture clinics.
Patient and clinician experience,
Qualitative interview
