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Benefits and costs of digital consulting in clinics serving young people with long-term conditions : mixed-methods approach
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Kim, Sung Wook, Madan, Jason, Dritsaki, Melina, Bryce, Carol, Forjaz, Vera, Fraser, Joe, Griffiths, Frances, Hamilton, Kathryn, Huxley, Caroline J. and Sturt, Jackie (2018) Benefits and costs of digital consulting in clinics serving young people with long-term conditions : mixed-methods approach. JMIR Medical Informatics, 6 (4). e48. doi:10.2196/medinform.9577 ISSN 2291-9694.
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Official URL: http://dx.doi.org/10.2196/medinform.9577
Abstract
Background
Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS.
Objective
This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions.
Methods
This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting.
Results
When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use.
Conclusions
Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > R Medicine (General) | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Medical consultation -- Cost effectiveness -- Great Britain, Teenagers -- Health and hygiene, Teenagers -- Medical care | ||||||
| Journal or Publication Title: | JMIR Medical Informatics | ||||||
| Publisher: | JMIR Publications | ||||||
| ISSN: | 2291-9694 | ||||||
| Official Date: | 30 October 2018 | ||||||
| Dates: |
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| Volume: | 6 | ||||||
| Number: | 4 | ||||||
| Article Number: | e48 | ||||||
| DOI: | 10.2196/medinform.9577 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||
| Date of first compliant deposit: | 29 January 2019 | ||||||
| Date of first compliant Open Access: | 30 January 2019 | ||||||
| RIOXX Funder/Project Grant: |
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