Follow-up management and the need to go from binary to a spectrum

Binary decision to follow-up

One of the problems with the current model of follow-up management involves doctors and limits their decision making. If you are a doctor and you have treated a patient or prescribed them something, deciding what happens next results in one of two options; either you discharge the patient or decide you need to check in on them again later because there’s a risk their condition may deteriorate.

Currently the only model within follow-up scenarios is that you bring the patient in for a further face-to-face appointment. There’s nothing in between not seeing the patient again or bringing them in for a physical appointment. This makes the doctor’s choice binary. If you discharge the patient due to the level of risk not warranting a face-to-face follow-up and the patient ends up needing further treatment, the patient will be forced to fight their way back into the system via a possibly lengthy route of referrals or A&E admissions.

When we design our products, such as Follow-up Management, we start the process by thinking about the implications of a digital approach. What does it mean for both sides of the coin; the patient and the doctor? What additional tools are required in the first place to offer choice for both parties in order to help create a spectrum of options for connecting. And to create new channels for communication.

Spectrum of options

By allowing a way to reach patients while they are at home, you are providing solutions that live in the middle of the spectrum i.e. in the middle of the traditional, binary approach. In this way risk can be managed much more actively and stratifying groups of patients into different risk categories is easier. Ultimately doctors benefit from different options for how they want to care for their patients.

DrDoctor’s Follow-up Management enables patients to respond and provide information remotely, i.e. whilst at home or work or the gym or wherever life takes them. Doctors can review patients quickly and keep a close eye on how they are getting on by utilising shorter digital review clinics. If this review was done in-clinic, more added pressure would pile onto the health system.

The reality is that a lot of patients need to be seen again throughout their health journey but, due to time and cost restraints, the process is demanding for the NHS and laborious for patients and health professionals alike. Currently the doctor must make a decision every time they are with a patient; do I or do I not see this patient again. This seems simple enough, yes or no. But the decision is everything but simple when you are assessing someone’s wellbeing, risk, or quality of life. Introducing a third option adds an additional control on managing that risk.

Assessing patients remotely does not mean that the patients that require a face-to-face appointment will be unable to get one. It simply adds a level of security so that patients that can benefit from remote follow-ups have the option to do so. In addition to this, patients that traditionally wouldn’t require a further face-to-face appointment can be offered another layer of follow-up. To increase confidence without increasing demand.

Real-life example

Last summer, I was in a small car accident that resulted in a small rib fracture. I was taken to a hospital near the accident-site for treatment, so naturally follow-up activity was to take place in the same hospital. The hospital is on the other side of London, far from my home. My injuries were minor and by the time I received a letter inviting me for a follow-up appointment at said hospital I felt much better and felt I did not need further appointments. I called the hospital explaining my situation and tried to cancel my impending appointment.

Later on, I received another two letters at home; one indicating that I had not attended my scheduled appointment (which I thought I had cancelled) having therefore wasted NHS time and resources. And a second letter for a further follow-up appointment. I called the hospital again explaining I do not need any more of the valuable NHS time as I had healed fine.

The risk indicators associated with my case obviously determined I need to be followed up with. The only resource the hospital had was to invite me in for a face-to-face appointment to see I was ok. If the hospital could have offered me the option to be followed up with remotely, I feel the benefits would have clearly been mutual. If communication is easier, everyone benefits.

Having the option to continue someone’s health journey remotely enables doctors to offer the best possible care to patients. When digital follow-up exists for the patients that can benefit from it, everyone has the potential to benefit, even the patients that won’t go digital. This is because ultimately reducing the number of face-to-face appointments frees up invaluable time and resource that the NHS so desperately requires.