Evaluating the impact of a ‘virtual clinic’ on patient experience, personal and provider costs of care in urinary incontinence: A randomised controlled trial
2018
Objective: To evaluate the impact of using a ‘virtual clinic’ on patient experience and cost in
the care of women with urinary incontinence.
Materials and Methods: Women, aged > 18 years referred to a urogynaecology unit were
randomised to either (1) A Standard Clinic or (2) A Virtual Clinic. Both groups completed a
validated, web-based interactive, patient-reported outome measure (ePAQ-Pelvic Floor), in
advance of their appointment followed by either a telephone consultation (Virtual Clinic) or
face-to-face consultation (Standard Care). The primary outcome was the mean ‘short-term
outcome scale’ score on the Patient Experience Questionnaire (PEQ). Secondary Outcome
Measures included the other domains of the PEQ (Communications, Emotions and Barriers),
Client Satisfaction Questionnaire (CSQ), Short-Form 12 (SF-12), personal, societal and NHS
costs.
Results: 195 women were randomised: 98 received the intervention and 97 received
standard care. The primary outcome showed a non-significant difference between the two
study arms. No significant differences were also observed on the CSQ and SF-12. However,
the intervention group showed significantly higher PEQ domain scores for Communications,
Emotions and Barriers (including following adjustment for age and parity). Whilst standard
care was overall more cost-effective, this was minimal (£38.04). The virtual clinic also
significantly reduced consultation time (10.94 minutes, compared with a mean duration of
25.9 minutes respectively) and consultation costs compared to usual care (£31.75 versus
£72.17 respectively), thus presenting potential cost-savings in out-patient management.
Conclusions: The virtual clinical had no impact on the short-term dimension of the PEQ and
overall was not as cost-effective as standard care, due to greater clinic re-attendances in this
group. In the virtual clinic group, consultation times were briefer, communication experience
was enhanced and personal costs lower. For medical conditions of a sensitive or intimate nature, a virtual clinic has potential to support patients to communicate with health
professionals about their condition.
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