Our recent Dundee SmartCare event featured the Attend Anywhere videoconsulting system which is being introduced in Highland, Grampian, Tayside and elsewhere for outpatient clinics. Just at the end of the event, it struck me that there was only one person in the room who had actually conducted patient interviews over the Attend Anywhere videoconsulting system. It seemed like a good idea to ring him up, and ask him how well it worked. His name is Navin Mistry, and he is an Adult Psychologist.
“We were thoughtful about how best to pilot the system within the department,” he told me. “We decided to start with face to face interviews as usual, and assess whether patients were suitable for follow up consultations online. We considered areas of risk.
"If people are using Attend Anywhere and in crisis, we need to know what supports are available to them. That doesn't need to be a barrier, it just means we - together - make a clear plan about what that support is and how the person would access it.
"What excites me most is the prospect of using Attend Anywhere to reach people who just wouldn't be able to come to a conventional clinic appointment because their depression and/or anxiety means they can't leave the house by themselves or cope with public transport.Â We are opening up treatment to a number of people who really need help but find it almost impossible to get that help. "
"Take the example of someone who is agoraphobic. They could start treatment through Attend Anywhere and progress through stages to coming in for face to face consultations. This is a big change in how we currently deliver the service; for our service users and our clinicians but it's worth remembering that some places have been using this approach for a long time."Â
Navin was able to give an example of one patient he is seeing online. The patient lives in Dundee but works elsewhere for an employer who knows nothing of their mental illness. “It would be great to think there is no longer a stigma around mental health problems but, in reality, lots of people still find it challenging to tell their employer about their difficulties," says Navin. “We encourage people to get to the point where they can share that information, but employers’ attitudes vary greatly on this topic.”
So Navin sees his patient online, after conventional office hours. That works for the patient; they don’t need to ask for regular days off. It also works for Navin. Using Attend Anywhere means he can continue to consult after Reception staff have gone home.
Navin’s current patient has good IT skills and was willing to upgrade their data connection to cope with videocalls and enable the use of this delivery option. So far there have been few technical problems … as well as sharing his screen, Navin can do sketches and hold them up to the camera.
One thing he has had to change is his practice of showing patients useful materials during face to face interviews. Now he sends them out in advance, and the patients have a chance to read them before the videoconsultation.Â
Navin has some ideas of how videoconsulting can be useful for other patients. “For example, we see students during term time, and then they go home to another town or another country and their treatment is interrupted. Using Attend Anywhere, we could keep their treatment going until they return. We could do the same for people who regularly work away from home.Â
“I'm making the argument,Â that by using Attend Anywhere we can play the long game. If we can make our service more flexible, we can engage with people sooner. Working people could attend online appointments, maintain their employment, and avoid their condition getting worse and reaching crisis point before they ask for help.”
The Dundee Adult Psychological Therapy Service are among the first clinics to offer online appointments via Attend Anywhere, and have been pathfinders for the much larger Near Me Tayside initiative which is making online consultations available to many more outpatients. Detailed information is available on the Dundee SmartCare 2019 webpage at https://dva.scot/news/blood-pressure-and-videoconsulting/ÂÂ