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'Virtual' clinics for chronic diseases

The UK Department of Health's patient website has teamed up with an online healthcare information provider to run week-long interactive web-based consultations
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The UK Department of Health's patient website has teamed up with an online healthcare information provider to run week-long interactive web-based consultations.

Challenge
All institutes or organisations offering specialist care of chronic conditions are faced with a wide range of issues; however, some have a wider impact than others. There is the basic issue of how to increase direct patient contact without changing the level of resources. Then there is the question of how to maintain and manage patients at a chronic level so that the potential progression to an acute state is either negated or slowed down, thus avoiding prolonging any form of hospitalisation and the subsequent cost implications to the subsidising body.

Solution
The solution is widely accepted as being to educate the patients to manage themselves. The necessity, as pointed out by Sir John Oldham (UK Department of Health), is that "we need to shift from a biomedical model to a social model…". It is clear that no single person or organisation is able to achieve this alone and such a model needs to take into consideration a whole raft of influencers. Collaboration is key to success and all parties involved in offering some part of this shift in healthcare need to offer a unified presence. One such example of collaboration is a series of forums presented by NHS Choices and talkhealth.

Talkhealth is an online, community-based healthcare information provider partnered with NHS Choices to provide a series of 'Online Clinics on...'. These are a series of monthly forums hosted on the talkhealth platform covering a wide range of ailments – with an emphasis on chronic conditions. Topics covered so far range from eczema and allergies to menopause and skin cancer; with psoriasis, prostate disease, thyroid and circulation scheduled for next year. 

The clinics are open for a seven-day period with the opportunity for questions to be posted on to the forum by visitors to the talkhealth sites. A panel of leading medical experts chosen for their specialisation in the clinic's topic are available on a rota basis throughout the week of the clinic to answer all questions posed and offer additional advice. Once the clinic is closed, it is left on both the NHS Choices site and talkhealth as a reference source.

The panel generally consists of a consultant and/or professor, a GP with a specialist interest in the topic and a nursing professional also with a specialist interest. Having such a wide spread of expertise and knowledge available, the patient is given a rounded view of his or her condition and potential treatment plans.

The clinics are also sponsored by the charities or patient support groups that are most closely connected to the clinic's topic/condition. The clinics are also promoted in all libraries in the UK, GP surgeries and children's SureStart Centres via a poster campaign to heighten awareness levels. NHS Choices promote the clinics heavily on its site, also displaying the forum when it is running live.

Results
Audience participation – The forums attract a wide spread of interest. The numbers actively taking part are typical of this type of social media interaction – which is normally cited at 5 per cent active involvement and 95 per cent passive participants. A short questionnaire completed by patients after the clinic has ended reveals consistently that many people find either their question has already been asked or they are happy to wait until someone asks it. Alternatively, although the forum is anonymous, a small percentage cites concern about asking an incorrect question for fear of appearing ignorant.

Questions asked – The questions range from general enquiries to ones about specific medication. The depth of knowledge available from the panel allows a question to be answered in a number of ways; thus, the participant receives different perspectives from the medical profession which would not be the case in a normal consultation.

Abuse/adverse reactions – A concern that is often mentioned about using open forums is the threat of abuse and reports of adverse reactions. The forums are heavily moderated, with no abuse or adverse reactions to medication having been reported or discussed. Within the talkhealth forums in general when adverse reactions are commented on, the 'community' counteracts quickly with a positive – proving the old adage 'what works for some doesn't always work for others'. 

Resourcing – The clinics have satisfied the criteria of increasing direct patient contact without changing resource levels. 

Administration/adherence – The clinics allow the opportunity for education on administration of drugs, thus potentially increasing adherence levels due to correct use of the medication.

Positive management – Many feel encouraged to visit their GP with a more informed sense of what treatment is now available, resulting in early and correct management of the condition.

Ongoing reference – The clinics' information is permanently available on both NHS Choices and talkhealth for all to view and is viewed every day, providing a lasting resource.

Communication – The experts consider it an excellent way to communicate quickly with a large number of people quickly, allowing a friendly and informal approach that they feel is most effective in conveying information.


Catriona WilliamsThe Author
Catriona Williams
is director at talkhealth

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20th October 2011

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