When to use video consultations versus other methods

Top tips

  • Use your clinical judgement to decide which is likely to be the most appropriate and safe method to use – is it feasible and safe to complete the assessment or consultation remotely?
  • Trust your instincts if you have any concerns – but follow the Health & Care Professions Council (HCPC) Code of Conduct.
  • Weigh up the benefits and risks associated with different methods, including the risk of doing nothing. To aid your decision-making, you could fill in a table, or just keep the benefits, risks and likelihood of risks in mind. The more patients you see, you will find this decision comes more naturally.

  • Ask your patient what their preference is, and discuss their needs and circumstances to jointly decide on the consultation method. Find out how familiar they are with technology and if they have a family member, friend or carer who could help with technical issues or assist with carrying out physical assessments remotely.
  • Complement video-based consultations with other methods where necessary – for example, you could start by seeing the patient face-to-face and follow up with a phone or video call (or vice versa).
  • Think about what you have to do face-to-face, rather than what cannot be done remotely.

Advantages and challenges

Video-based (online) consultations

Advantages:

  • Reduced travel burden and costs.
  • Patient may be less fatigued.
  • Reduced risk of infection.
  • Flexibility – appointments can be arranged around work or childcare.
  • Easier to reschedule or transfer than face-to-face.
  • Easier for family to join consultations.
  • Enables other practitioners to be involved more easily.
  • Gives more power to the patient / encourages self-management.
  • Practitioner can view patient’s home environment.
  • Patient is likely to be more comfortable at home.

Challenges:

  • Possible reduction of communication quality compared with face-to-face (e.g. body language more difficult to read).
  • May be more difficult for people with cognitive or communication issues, and for people with anxiety.
  • Information governance, data protection and ‘red tape’.
  • Ensuring accuracy and quality of physical assessments.
  • Cannot perform ‘hands-on’ assessments.
  • Safety of the assessment - need to rely on support from family members or carers.
  • Technical issues and interruptions.
  • Need to learn new technology.
  • Safeguarding and privacy concerns - need to consider who is at home with the patient and if the patient consents to them listening in.

Telephone consultations

Advantages:

  • All of the advantages listed for video-based except viewing patient’s home.
  • Provides anonymity - useful for discussing sensitive information.

Challenges:

  • All of the challenges listed for video-based except needing to learn new technology.
  • Communication and rapport building may be more difficult as you are not able to see the patient.
  • No visual cues available for identifying emotional (e.g. distress, anxiety) or physical issues (e.g. injuries following a fall; inflammation or swelling; muscle contractures)
  • Patients may block/not pick up unknown numbers.

When to use different consultation modes

Experiences will vary, but the practitioners we spoke to gave some examples of when they have successfully used video-based, telephone and face-to-face consultations. This is for guidance only and will depend on the needs and preferences of individual patients.

Video-based (e.g. Attend Anywhere or MS Teams)

  • Updating / providing information and advice to patient or carer.
  • Simple follow-ups - e.g. answer questions about a treatment plan.
  • Non-urgent conditions – e.g. chronic joint pain, osteoarthritis, nonspecific subacute low back pain.
  • Reviews by multiple practitioners.
  • Initial assessment when all required information can be captured without touch (e.g. self-report).
  • Rehabilitation following total hip replacement, total knee arthroplasty or shoulder hemiarthroplasty.
  • Review of minor aids and adaptations (e.g. bath boards, rails, raisers)
  • Re-assessment (e.g. seating or riser-recliners).
  • Review or demonstration of home program (e.g. paediatric occupational therapy).
  • Dietetic assessments where access to kitchen cupboards and own foods is beneficial.
  • Providing real-time dietary education during food preparation and mealtimes.
  • Assessing infant feeding or meal time behaviours.
  • Follow-up care for diabetic leg and foot ulcers.
  • Speech and language therapy for aphasia.
  • Prescription of exercises including demonstration.
  • Group exercise therapy.

Telephone

  • People who are unable to access or use technology.
  • Triage – assessing the patient’s background, medical and medication history and deciding on the best method for follow-up treatment/management.
  • Updating / providing information and advice to patient or carer.
  • Simple follow-ups - e.g. answer questions about a treatment plan.
  • Review of exercises, aids or equipment without demonstration.
  • Discussing sensitive information (in some cases, the patient may feel more comfortable disclosing information over the telephone).

Face-to-face

  • People who are unable to access or use technology.
  • Patients with significant cognitive impairment, communication difficulties, anxiety or depression.
  • Conditions requiring urgent care (e.g. falls or sudden, unexplained symptoms).
  • Where there are safeguarding concerns.
  • Communicating sensitive information or bad news.
  • Some special tests – although it is sometimes feasible to do these remotely (e.g. shoulders, hands).
  • Assessment of reflexes.
  • Specific strength testing (e.g. assessing myotomes).
  • Sensory testing (e.g. assessing dermatomes).
  • Initial hands-on assessment (e.g. occupational therapy seating assessment).
  • Complex physical assessments.
  • Where anthropometric measurements cannot be taken in the home or primary care.
  • Community or school-based assessments or interventions.
  • Managing spasticity and spasticity medication.
  • Adjustment of prostheses and orthoses.
  • Manual therapy / soft tissue techniques.