A. Gilbert1,2, J. Jones2, M. Stokes2,3, C. May4,5
1Royal National Orthopaedic Hospital, Therapies Department, Stanmore, United Kingdom, 2University of Southampton, School of Health Sciences, Southampton, United Kingdom, 3NIHR Applied Research Collaboration, Wessex, United Kingdom, 4London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, United Kingdom, 5NIHR Applied Research Collaboration, North Thames, London, United Kingdom

Background: Videoconferencing (VC) technologies, such as Skype, Zoom, Attend Anywhere and MS Teams, have been received enthusiastically by healthcare policy makers as they provide a medium to improve access to care. Communication technologies such as videoconferencing is being used across many fields of healthcare and can offer advantages to patients. Previous research into Skype consultations in healthcare found that they were safe, effective and convenient for patients when healthcare professionals judged them clinically appropriate. Skype has been shown to be acceptable to half of patients in our previously published work. 
A preference is defined as an individualised ‘total subjective comparative evaluation’. Put simply, an individual weighs up the state of affairs of the alternatives. Preference theory suggests that a person will prefer the outcome that yields increased utility, and therefore that patients would prefer a VC if they believe its benefits outweigh its burdens. To date, patient preferences for telemedicine have only been investigated at a general population level. To our knowledge, the factors underpinning patient preferences have not yet been investigated for virtual physiotherapy rehabilitation consultations.

Purpose: To identify characterize and explain factors that influence patient preferences for video consultations in an orthopaedic rehabilitation setting.

Methods: This was a Qualitative study using semi-structured interviews and abductive analysis. Participants were: patients who were receiving orthopaedic rehabilitation for a musculoskeletal problem; Occupational therapists, physiotherapists or therapy technicians involved in the delivery of orthopaedic rehabilitation for patients with a musculoskeletal problem. All participants were recruited from a physiotherapy and occupational therapy department situated within a tertiary orthopaedic centre in the UK.

Results: Twenty-two patients and 22 healthcare professionals were interviewed. The average interview length was 48 minutes. Four major factors were found to influence preference: the situation (the ways that patients understand and explain their clinical status, their treatment requirements, and the care pathway); the expectations of care (influenced by a patient’s desire for contact, psychological status, previous care and perceived requirements); the demands (of care, of each patient’s respective social situation and the consequences of choice); and the capacity (the patient’s ability to allocate resources to care; these include financial, infrastructural, social and healthcare resources). These factors combined and competed with each other to influence preference.

Conclusion(s): This study has identified key factors that appear to influence patient preference for video-conferenced consultations in orthopaedic rehabilitation. Sensitising questions have been developed to support the formation of preference for patients. A conceptual model of these factors, derived from empirical data, has been developed highlighting how they combine and compete.  

Implications: A better understanding of influencing mechanisms on patient preferences is needed to support the design of patient centered communication technology pathways. An understanding of factors, such as those identified from this study, will enable clinicians to identify patients who prefer virtual consultations.

Funding, acknowledgements: Anthony Gilbert is funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship for this research (ICA-CDRF-2017-03-025).  

Keywords: Patient Preferences, Virtual Consultations, Orthopaedics

Topic: Service delivery/emerging roles

Did this work require ethics approval? Yes
Institution: Health Research Authority
Committee: South Central-Oxford C Research Ethics Committee
Ethics number: IRAS ID: 255172, REC Reference 18/SC/0663

All authors, affiliations and abstracts have been published as submitted.

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