The impact of remote care on burden of treatmentBMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1579 (Published 27 June 2022) Cite this as: BMJ 2022;377:o1579
- Natalie Richards, research assistant
Burden of treatment is the work that patients, and their carers and families, need to do to manage their healthcare, and how this affects their functioning and wellbeing.1 This burden can include managing long term conditions, monitoring health, and implementing lifestyle changes. Some of this work can be difficult, time consuming, and costly.
The covid-19 pandemic and associated infection control measures have led to an increase in the use of remote care (via telephone or digital methods), and may result in a change to the way patients access healthcare in the long term.23 Research has focused on patients’ experiences of accessing care remotely, but it is also important to consider how remote care might increase or decrease the burden of treatment for patients. The BMJ and The Healthcare Improvement Studies Institute (THIS Institute) at the University of Cambridge co-hosted a #BurdenOfTreatment Tweetchat. Patients, carers, healthcare professionals, and researchers discussed four questions, sharing their insights and experiences of burden of treatment and remote care. This piece summarises some of the key themes that emerged during that discussion.
What are the benefits of receiving care remotely?
Remote care means patients don’t need to travel to and from healthcare settings, which can reduce the time and cost of accessing healthcare. This is particularly the case for people living with disabilities and those needing access to specialist services that are a long way from their homes. The reduction in travel is also beneficial for immunocompromised patients, as it lessens their exposure to potential infections.
Remote care is particularly convenient for routine appointments and those that do not require physical examination. Remote care offers more flexibility of appointments, and self-monitoring may give patients an increased sense of control over their condition.4
Accessing care remotely can also reduce patients’ feeling of being a burden to services, family, or carers, as they can attend appointments independently and from their own home. However, this does raise important questions about patients’ sense of deservedness for in-person care, and the role of healthcare services in facilitating access.
Does remote care make treatment or management more burdensome?
The barriers to accessing remote care include cognitive and hearing difficulties, language barriers, and challenges for people who are not able to, do not have access to, or prefer not to use digital devices. Patients and carers have continually stressed the importance of tackling these inequalities and taking into account individual circumstances and preferences.
Remote care may contribute to the burden of treatment, for example if users experience technology failures or delays. It could also exacerbate the burden for those patients who find it challenging to find the mental and physical space to engage in clinical interaction. Concerns have been raised that remote methods may make it harder for patients to build a rapport with their health professionals, and can be isolating.
The burden of treatment for clinicians is also an issue. Some clinicians don’t feel comfortable providing remote care and feel pressured to ensure patients feel empowered.
How could remote care help reduce the burden of treatment or management?
Automated electronic devices could be beneficial if patients are sufficiently empowered and if technology is an enabler of relationships rather than an obstacle. Remote care could improve care coordination and make patients feel more involved in decisions about their care, for example if they have full access to their electronic records or if they can arrange to attend appointments with more than one specialist. Remote methods may be effective for enabling early intervention and support. Assessing the appropriateness of remote care on a case-by-case basis is important.
What research topics would be useful to help us understand and reduce the burden of treatment in remote care?
Research is needed on patient and carer experiences of remote care, as well as the barriers and facilitators of remote care uptake. The importance of seeking the views of those who may be particularly disadvantaged by remote care, and investigating the potential impact on their health outcomes, is key. It is vital that remote care pathways nurture inclusion and tackle inequalities.
More research is also needed into the effectiveness of remote appointments generally, given privacy constraints and potential diagnostic challenges. It may be useful to consider whether remote care provides opportunities for more joined up working and better patient access to medical records. Importantly, there was also a call for accessibility in disseminating research findings.
Natalie Richards is based in The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK.
Competing interests: none to declare.
Thank you to Emma Doble, patient editor at The BMJ, Maddie Read, events and communications coordinator at The Healthcare Improvement Studies Institute (THIS Institute), Helen Gardner, research engagement manager, THIS Institute, and Samantha Benedetto, communications administrator, THIS Institute, who coordinated the twitter chat.