Evaluating the impact of a 'virtual clinic' on patient experience, personal and provider costs of care in urinary incontinence: A randomised controlled trial

• Published in: PloS one 2018-01, Vol.13 (1), p.e0189174-e0189174
• Main Authors: Jones, Georgina, Brennan, Victoria, Jacques, Richard, Wood, Hilary, Dixon, Simon, Radley, Stephen
• Format: Article
• Language: English
• Subjects: Archives & records; Biology and Life Sciences; Care and treatment; Clinics; Consultation; Costs; Diagnosis; Economic aspects; Emotions; Engineering and Technology; Health care costs; Health economics; Interactive computer systems; Intervention; Medical personnel; Medicine and Health Sciences; Methods; Patients; People and Places; Qualitative research; Quality of life; Randomization; Research and Analysis Methods; Social Sciences; Studies; Teaching hospitals; Urinary incontinence; Virtualization (Computing)
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0189174

To evaluate the impact of using a 'virtual clinic' on patient experience and cost in the care of women with urinary incontinence. 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. 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. 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.