Presented at the RCGP Annual Conference, Glasgow 1-3 October 2015. See narrative below from Dr Peter Cairns and colleagues at Wester Hailes Medical Practice.
Printable pdf: RCGP 5769 Wester Hailes online access
Four month update report on askmyGP.
We have been collaborating now with askmyGP for 4 months. We agreed we would document our experiences and thoughts at the end of the first phase of its use.
The short version:
We really like it. It would be even better if it could help patients self manage where appropriate. Askmygp could play a very important part in engaging our population (assuming appropriate costs).
The longer version:
Setting Up was straightforward and support from the askmyGP team easy to access, with problems easily resolved.
We were pleased to have flexible options as to how the information generated at our end could be handled using our Clinical System, or Document Filing System. We did not find it particularly difficult to adapt our existing systems to ensure clerical and clinician time was available to handle the requests.
Usage – I think up to about 10% of our daily contacts were coming in via askmyGP? I know you felt that was low, but it was broadly in line with my expectation – a similar proportion to that of our population who use online prescription services. We have discussed issues about online access in deprived communities. We also have discussed improving the offering for smartphone access and will progress this. I also think it is a backhanded compliment to our telephone based system – even at busy times peak wait is 3mins, so perhaps good enough not to represent a big barrier for our population? (In this case what is the positive usage case we can sell to encourage them to put the extra effort in to use askmyGP?).
Our personal perception was that a great many patients skipped the clinical questions and just used askmyGP as a messaging system to contact us – which wasn’t necessarily a problem but did detract from the worth of the package. However I note your figures would suggest over 60% did in fact complete all the questions? We did find where patients persevered to the end in e.g. depression the information available to us was very helpful in terms of depression scores generated etc. (Where hard clinical content like this was generated it would be nice to be able to transfer it directly into a record).
From a clinical governance perspective it was great to have the list of positive and negative answers that wouldn’t usually be recorded in so much detail. Sometimes it could be overwhelming though, and often the information was superfluous – the diagnosis being obvious clinically after the first few questions. AskmyGP also seemed most ideally adapted to straightforward clinical problems especially when utilised by a health literate patient. These of course are the least difficult problems and patients to handle in any system – it’s the not the straightforward stuff that makes our systems so dysfunctional!
Clinicians found the system highly acceptable – even those who were sceptical, rapidly came around to it. We are of course already running a similar telephone based system so the mental leap was very small for our team, compared to a switch from a traditional system. I also understand from our patient feedback that it was very acceptable to the patient population. I felt patients seemed more accepting of a delayed or failed contact via askmyGP than on a normal callback request (although this was not a common occurrence!).
I think a trick is missed in that there is little opportunity to shape patient expectation when using askmyGP. For example a patient with an obvious cold without serious other factors could be partly primed to expect telephone advice and NO antibiotics, or even subtly prompted to self manage – other services do this slightly better.
We have enjoyed working with askmyGP.
We are very sold on the concept of “asynchronous contact” and anecdotally feel this could be a less stressful way for patients to engage – although the existing web options remain a bit laborious to complete. Intriguingly it could also be part of the therapeutic process if applied properly.
Finally its worth mentioning that dysfunctional access can only be partially fixed by more efficient appointment systems and workflow. It’s only when practices start to make sense of local need and the underlying factors that make them so busy, that the cycle can be broken.
Thanks again for your help and support,
Dr Peter Cairns
Clinical Lead Wester Hailes Medical Practice.