Virtual clinics can enable remote monitoring of rheumatology patients

Once patients have been prescribed advanced therapies for rheumatoid arthritis, the next challenge is regular follow-up to ensure they remain well and that any problems are picked up and dealt with.

Even before the pandemic, North Devon Healthcare Trust was pioneering virtual clinics to improve access for patients stable on advanced therapies. The initiative, which won a 2020 best practice award from the British Society of Rheumatology, is bringing benefits both to patients and to the NHS.

These include reduced patient travel time, and improved patient convenience and satisfaction, while potentially freeing up clinical space, and reducing pressure on hospital transport and parking.

According to consultant rheumatologist and deputy medical director Stuart Kyle, the trust’s decision to set up the clinics was aligned to the NHS long-term plan and to the Royal College of Physicians’ future outpatients report. “Many patients with long-term conditions are stable and well; we were already remotely monitoring a cohort of stable biologic patients and knew they were digitally enabled, so targeted them for a pilot.”

The pilot ended in September 2019 and evaluated very positively – and, although this obviously wasn’t the initial intention, provided a good basis for running virtual services throughout the pandemic. As well as measuring patient satisfaction, the trust has started looking at clinical outcomes, and has set up a harm risk on the DATIX incident reporting system. “In order to assure clinical outcomes, we need to understand PROs (patient reported outcomes) that have good correlation and to have good systems for remote monitoring,” he says.

As well as measuring patient satisfaction, the trust has started looking at clinical outcomes, and has set up a harm risk on the DATIX incident reporting system

He advises others considering setting up similar services to get project support in place to make sure that appointment booking is linked to the electronic patient record, engaging with patients and staff throughout, and not making assumptions.

“Respond to what they’re telling you,” he says. “For instance, we have created patient information leaflets to help people prepare for their appointment, including a prompt to let us know if they don’t want a video/telephone/face-to-face appointment and would like to discuss a different option. We have also set up video volunteers to support patients to feel more confident to use video.”

Talking to commissioners at an early stage to ensure it doesn’t have an impact on payment is also important – as is recognising that it cannot be a one-size-fits-all system.

“Each patient cohort and specialty will be different, so it really is important that clinicians feel empowered to explore this within their area and look at how video appointments are best used,” he says. “You need a holistic approach, not just one model to fix the problem.”