NE PHROLOGY
took no more than five minutes. Because monitoring could take place more quickly and efficiently than traditional face-to-face appointments, the system was particularly valuable where frequent monitoring was required. Flexible “micro- consultations” which focus on the key issues (e.g. monitoring the response to new antihypertensive medication or checking decline in proteinuria after initiation of treatment for a relapse in nephrotic syndrome) saved repeated clinic attendances while keeping patients up-to-date with any medication changes on their clinical record. If problems were identified (either by the clinician or the patient), prompt action was initiated over the platform. An attempt to provide such a degree of oversight using traditional clinics would have been highly intrusive into a patient’s life and would burden clinic administration and capacity. The work-pattern which emerged from our experience was of timely ad hoc reviews determined by clinical need rather than our timetable of available clinics. If this way of working became widely adopted in future, the notion of allotting Programmed Activities in consultant job plans according to the number of clinics undertaken no longer seems appropriate. Organisations may need to consider how to address this issue during the reconfiguration of commissioning
Patient notified when review is complete
Clinician
sets next ‘routine’ virtual clinic
Clinician uploads feedback
Encourages patient engagement: BP Weight
Symptom reporting
Frequent home monitoring
Process takes five minutes
Little delay for patients
More efficient for clinician
Figure 2 A new way to deliver routine care – the web-app clinic
planned for the NHS in England (Integrating Care, 2020),6
one aim of which is to bring digitally-based care into routine practice.
Are patients ready for remote monitoring? Remote monitoring reduces the need for hospital clinics and thus save time and
People who recognise that they have a key role in managing their condition and have the skills and confidence to do so,
money. But in addition to the potential economic benefits of remote monitoring, there is a growing body of evidence that emphasises the importance of facilitating effective self-management of long-term conditions.7
Clinician
reviews app: BP, weight, symptoms
Lab test and convenient place and time
Patient notifies clinician once complete
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