SATISFACTION AND ENGAGEMENT WITH VIRTUAL CLINICS FOR LONG TERM FOLLOW UP AFTER KNEE OR HIP ARTHROPLASTY

J. Yorke¹, P. Keane²

Background: Knee and Hip arthroplasty services are subject to significant inter-provider variation, with regards to how patients should be followed-up long term to monitor for complications/failure of the joint. Increasingly arthroplasty follow-up services are being delivered via virtual clinics, replacing traditional models of face-to-face review. This service change can be driven by financial and logistical gains, therefore evaluation is essential to ensure patients’ needs are adequately met.

Purpose: Current literature supports virtual arthroplasty clinics as a means of delivering service efficiency and meeting clinical requirements, however qualitative study of patient satisfaction with virtual clinics is poorly represented. Potential barriers to patient engagement with virtual clinic models are also poorly understood, limiting the extent that service providers can deliver patient centred care. The study objective was to evaluate patient satisfaction and explore barriers to engagement with a virtual arthroplasty clinic, replacing a face-to-face clinic at Liverpool Foundation NHS Trust. The data was subsequently used to generate recommendations for service improvement.

Methods: The study utilized qualitative methodology to explore patients’ experience of arthroplasty follow up. Following a questionnaire survey of 52 patients undergoing virtual clinic arthroplasty review over a 3-month period (response rate of n=15 / 29%), 9 patients were selected for semi-structured telephone interview based on a representative sample of follow-up preferences. The recorded interviews were transcribed and analysed by a single researcher (first author), using an Interpretative Phenomenological Approach. A combination of interview and questionnaire data was utilised to inform the discussion and conclusions.

Results: Two thirds of the survey participants preferred or were equally satisfied with virtual clinics, replacing face to face arthroplasty follow-up clinics. Analysis of interview and survey data suggests that this was based on perceived ease of the virtual process, attendance flexibility, time-saving factors, ease of paper-work completion in the home environment, patient confidence in the virtual assessment process, and supportive staff/patient interactions during x-ray attendance. Conversely, a third of the participants preferred face to face review. Several barriers to patient engagement with virtual clinics emerged including; unmet reassurance needs, inability to discuss co-morbidities, misunderstanding the virtual process, specific disabilities affecting access and patient mistrust regarding virtual assessment validity.

Conclusion(s): A virtual arthroplasty follow-up clinic met the needs and preferences of the majority of users of this service. Recommended improvements are outlined to enhance service accessibility and satisfaction. These include developing virtual patient/clinician communication options and delivering clearer information to service users. Achieving patient-centred arthroplasty follow-up service involves offering some patient choice for virtual or face-to-face clinics. Virtual clinics are not suitable or accessible for all patients. More research in this area would allow for cross provider comparison, strengthening the rationale for arthroplasty service planning and design.

Implications: Virtual clinics benefit some patients and meet the needs of the majority, however service capacity should remain reflexive to allow for virtual or face-to-face review. Meeting variable patients’ preferences enhances satisfaction by meeting expectations and achieving meaningful reassurance from clinician encounters. Flexibility within arthroplasty follow-up service design also supports accessibility for patients with pre-existing disabilities and co-morbidities.

Funding, acknowledgements: The CSP Charitable Trust

Keywords: Virtual Clinic, Satisfaction, Barriers

Topic: Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: University of Liverpool

Committee: Health and Life Sciences Research Ethics Committee

Ethics number: 4714