A qualitative assessment of patient satisfaction with remote dermatology consultations utilized during the UK's first wave of the COVID-19 pandemic in a single secondary care dermatology department.

During the first wave of the SARS-CoV-2 coronavirus (COVID-19) pandemic, many dermatology departments in the UK delivered remote consultations in order to minimize viral transmission. To assess patient perception of remote consultations delivered in a single dermatology department during this time, we retrospectively contacted patients via an electronic questionnaire and the responses are summarized. We anticipate that increased use of remote consultations will be a legacy of the pandemic, although healthcare professionals will have a responsibility for ensuring appropriate patient suitability.

Dear Editor,

During the first wave of the SARS‐CoV‐2 coronavirus (COVID‐19) pandemic, conventional face‐to‐face (F2F) appointments in many UK dermatology departments were largely replaced by remote consultations to minimize viral transmission. In our department, most new and follow‐up patients were triaged to receive either telephone or video consultation, as published previously. Patients were asked to submit photographs of their skin problem via email.

To evaluate these patients' perspectives of remote consultations, we retrospectively surveyed a random sample of patients who had appointments during the period May–June 2020 via an email invitation asking for feedback via an online questionnaire (SmartSurvey, 2020). Multiple choice answers were sought, with detailed free‐text responses encouraged (Fig. 1). The primary outcomes evaluated were patient‐reported satisfaction with remote consultation, and future preference of appointment type. Secondary outcomes included which areas of the process were thought to be inadequate, with suggestions for improvement invited. The questionnaire was approved locally, and data were collected in an anonymized format.

Figure 1

Multiple choice survey questions and selected free‐text responses.

In total, 486 patients were contacted and completed responses were received from 177 (36.4%). Of these, 37 participants (21%) had attended an F2F appointment and were excluded from the analysis. Participant characteristics are summarized in Table 1.

Table 1

Patient survey sample characteristics.

Characteristic	Result
Age group, years; n (%) (N = 140)
16–29	10 (7.1)
30–49	20 (14.3)
50–69	54 (38.6)
70–89	54 (38.6)
> 90	2 (1.4)
Sex, n (%) (N = 140)
Male	63 (45.0)
Female	77 (55.0)
Consultation type, n (%) (N = 177)
Telephone	139 (78.5)
Video	1 (0.6)
Face‐to‐face	37 (20.9)
Patient type, n (%) (N = 140)
New	69 (49)
Follow‐up	71 (51)

Of the 177 participants, 76 (51%) had previously attended an F2F appointment in the department. Of these, over half (54%) thought a remote discussion was a ‘little’ or ‘much’ worse than their previous in‐person consultation, with only 46% considering a remote consultation being ‘the same’ or ‘better’ in comparison.

The majority of respondents (102; 73%) reported that their remote appointment ‘fully addressed their concerns and skin problem’ and overall, 60 (43%) were ‘very satisfied’ with their remote consultation. However, if given the choice, 98 (70%) would prefer future appointments in person, with only 10 (7%) happy to receive a telephone consultation and 3 (2%) a video consultation. A sizable minority (28; 20%) had no preference for type of future consultation.

In total, 134 (96%) respondents were asked to email images prior to their appointment; 4 (3%) denied having been asked to do this and 1 (< 1%) had a video consultation so emailed images were not required. Many (n = 112; 85%) found the process of emailing photographs easy to do, but nearly half (n = 66; 47%) of patients required help from family or friends. Interestingly, none of the respondents commented on whether they perceived this to be a problem, although one patient did remark that uploading photos with the help of a family member took several hours.

The utility of photographs being relied upon was questioned by some respondents, and simple issues such as difficulties in talking on the phone if a patient was hard of hearing, plus difficulties of explaining problems without visual aids to communication, were raised. A lack of personal contact was highlighted as a negative area.

Savings were mentioned as beneficial, with regards to both National Health Service (NHS) and patient costs (e.g. time, travel expenses). The extraordinary circumstances of the global pandemic were recognized as extenuating, with satisfaction expressed by patients that they were assessed with minimal delay during the lockdown period.

Adapting to a global crisis forced the UK NHS to implement changes more rapidly than ever before. Increased use of remote consultations will undoubtedly be a legacy of the global pandemic, and the opinions of patients who will be affected by these changes are invaluable in order to ensure effective methods of working are adopted. This assessment of patients' perceptions about remote dermatology appointments reveals some potential for their future use, but highlights some developments and improvements needed for implementation.

We urge our dermatology colleagues, both in the UK and abroad, to consider carefully every aspect of remote consultations, when implemented alongside more traditional methods of patient interactions, to ensure good quality of healthcare provision and a high level of patient satisfaction.