Telehealth in optimising patient care in outpatient cardiology specialist clinic (TOPCare Cardiology).

Abstract

Background

Cardiologists at BHS expressed concern that treatment decisions on medications couldn’t be made during outpatient consultations due to incomplete patient medication histories. A new model of care was developed where patients undergo a telehealth consultation with a pharmacist in the week prior to their cardiologist outpatient clinic appointment. The telehealth cardiology pharmacist clinic (TCPC) consultation includes a medication history, cardiac health assessment and adherence assessment.

Objectives/Aims

To evaluate the impact and acceptability of the TCPC in improving patient safety and, supporting cardiology outpatient specialist consultations.

Method

The TCPC pharmacist reviewed patients one to two weeks prior to their cardiologist consultation. A time in motion study of cardiologist outpatient specialist clinic consultations before, and after, implementation of TCPC was conducted. Time spent by cardiologist in gathering medications information and number of consultations with medication uncertainties (missing cardiac-related drugs or -drug dosing details) were noted. Patient acceptance and attitudes towards medications were assessed via survey.

Results

Cardiologists spent 25% less time gathering medication information (p<0.001) during outpatient clinic consult. Observation of 87 patient-cardiologist consultations indicated that the mean consultation length reduced by 4.1 minutes if a patient attended the TCPC [13.5min vs. 9.4min, p<0.001]. Patients who attended the TCPC had a 5% (17/340) Did Not Attend (DNA) rate for their cardiologist outpatient specialist clinic appointment compared to those who didn’t attend the TCPC [5% (17/340) vs 24% (202/855), p<0.001]. Medication uncertainties reduced from 51% to 0% when patients attended the TCPC. All patients were satisfied with the consultation (n=100) and 84% (81/96) felt more confident to discuss their medications with their cardiologist. Telehealth was accepted by 99% (95/96) of patients. Compared to face-to-face consultations with a pharmacist. Telehealth avoided for the patients, 16,375km, $11,135 and 241 hours in travel.

Implications/Outcomes for Planned Research Project

Improved engagement and patient attendance at cardiology outpatient specialist appointments means that there are less wasted appointments and patient billing is maximised. Time saved could be used for adding additional patient appointment slots, improving access to the clinic. The model is replicable by other health services or, to other areas of outpatient specialist clinic.

Final Thoughts The TCPC demonstrated multiple benefits on the delivery of outpatient cardiology services. Impact on DNA rates and time savings assist in running a more effective and efficient service.